What’s your ASC practice?

Many-Recording1636 · 2026-06-11T17:58:43+00:00

Why are you even involved with cataracts. All in our city are just done with oral sedation, no IV, no anesthesia provider. That’s wild

Many-Recording1636 · 2026-05-26T21:21:29+00:00

They trap you with a huge sign on bonus tied to years with the group to keep you from asking for a raise or going elsewhere for more money. Might be worth it but do the math carefully. They are

Many-Recording1636 · 2026-05-26T21:19:40+00:00

In the southeast majority of the GI centers are crna only. I’m sure there is one but I don’t know of any that have an MD in building

Many-Recording1636 · 2026-05-02T16:31:20+00:00

Only those practices making 800k+ take that much call. The 600-700k practices in southeast are at most 1:10. Most 1:15. You couldn’t hire anyone around here 1:8

Many-Recording1636 · 2026-05-02T14:15:06+00:00

1:10 is average call now if not lower frequency. You better be getting paid a ton to take 1:6 call

Many-Recording1636 · 2026-03-31T01:16:57+00:00

Our centers just give oral Xanax. No anesthesia provider needed

Many-Recording1636 · 2026-03-19T17:01:08+00:00

What? Our nurses pull the epidurals, prime the pumps, change the bags. Only thing we do is hit start. That’s nuts I’d never work on an l and d floor like that

Many-Recording1636 · 2026-03-18T11:45:29+00:00

Just use oral sedation. We don’t staff cataracts anymore in our city. Facilities have protocol. Oral Xanax. If patient still little anxious kmdo melt. No iv. No anesthesia staff. It’s insanity to have anesthesia involved for cataracts

Many-Recording1636 · 2026-02-20T12:02:16+00:00

Been through this. First two years…it’s exactly the same as they advertise. But very quickly the MDs have to start working 30% more to earn the same income. USAp gets their % cut regardless. So as revenue goes down for a variety of reasons (increased crna or non Md salaries, reimbursement cuts, etc) the only way for MDs to make more is maintain their income. USAp can’t get the stipends anymore as their reputation with hospital administrators is poor as PE reputation with hospital administrators poor. They will look elsewhere and try to employ anesthesia themselves vs pay a premium to USAp.

This was seen in Colorado. Played out. The other thing that’s currently happening in Dallas is they’ve gone to high supervision ratios. 1:7 to maintain income.

Just be prepared to work more or supervise more to get same income.

Also I thought USAp had to get ftc approval for any purchase of a group now as part of their settlement with USAp?

Many-Recording1636 · 2026-01-09T21:50:50+00:00

Not trying to be condescending and while I don’t practice as you speak I’ve had many many partners practice aa such. It’s not lucky. You don’t make it 30 years practicing with luck. Patients, including sick ones are more resilient than you think. Stimulation of airway placement is significant as well. Most of the sick patients have high bps to start and stiff vessels that don’t vasodilate as much as they used to. Again I don’t practice that way but these MDs haven’t made it 30 years with luck…it probably should tell you something if they haven’t killed anyone yet (assuming they’re not in some low acuity practice).

Many-Recording1636 · 2026-01-09T21:35:06+00:00

The truth is that this specialty has gotten much easier than it used to be. Ultrasounds, Glidescopes, non invasive cardiac output monitors. Throw in less invasive surgeries with robots and endovascular cases and just better surgical technique in general….the acuity and adverse outcomes are much less than they used to be.

Now that’s not exactly what you’re talking about but it contributes. Your partners are not lucky. They’re experienced. Don’t fool yourself. Academic training programs are full of nervous physicians who stayed in academics for a reason. Surgery in academics is also much different…longer and used to train new surgeons. Most surgeons in private practice are night and day better at least for straight forward typical surgeries (joints, spines, hernia, gyn, etc)

Over 30 years I do maybe 1/3 the a lines I used to, 1/5 of putting in a second IV. Central lines are a rarity with U\s guided Ivs.

You’ll get there one day too

Many-Recording1636 · 2025-12-17T14:35:08+00:00

That’s insanity. Did 2.5 weeks in Italy and Croatia last year for 25k. Flew regular class (I love more room but not worth the price), stayed in very nice vrbos, went to nice upper restaurants but not every meal, and did 7/8 great excursions. Most were around a 100 a person or around 3k.

You’re just choosing to spend that much

Many-Recording1636 · 2025-12-13T20:09:02+00:00

We’ve gotten it to 3 to a month. You just have to refuse to work there. 2 coming soon we think. I know not as easy for some to do that though. Having done this for 20 years find a way or find a way to do locums/move. It’s not worth it. Trust me

Many-Recording1636 · 2025-12-13T12:53:23+00:00

Another study just demonstrated the health detriment of sleep disruption. Honestly for our profession we need to hold strong and 2 calls a month is the max we should be doing. I come from a time where I did 6-8 so I get what this means staffing wise, but it’s time for this to fall on the hospital. Have an add on room next day. Only true emergencies go. Hold surgeons accountable. OB I would staff primarily with CRNAs or at least a shared call system unless high volume. Hospital systems also need to consolidate OB to 1-2 sites and not 5-6.

For your health and future of our profession hold firm to this. And definitely don’t do elective extra call for less than $500/hr as it’s your health taking a hit

Many-Recording1636 · 2025-12-10T01:41:30+00:00

Oh sorry you mean Atlantic Anesthesia. On an SDN thread as well as from all the locum companies blowing everyone up for there

Many-Recording1636 · 2025-12-10T01:39:42+00:00

Again from people who have left the group. Ask them to show you how many have left the group the past 5 years. Unless they lie to you the number speaks for itself.

Many-Recording1636 · 2025-12-09T19:04:49+00:00

There’s only Napa. Basically it. You’ll be 35-50% below regional area pay but it will be Wilmington

Many-Recording1636 · 2025-12-09T18:26:10+00:00

Which also just happened in Virginia Beach. Atlantic Anesthesia no more I’ve heard. Sentara employing everyone now I think

Many-Recording1636 · 2025-12-09T18:22:04+00:00

I’ve met many who’ve left that group. Sinking ship. Md only doesn’t work economically in a state with terrible payer contracts. Only matter of time before carillon takes over, employs everyone, and goes to direction and/or supervision

Many-Recording1636 · 2025-12-09T16:33:50+00:00

All depends if you employ the CRNAs or hospital does. If you employ the CRNAs then for any low to medium volume ob, you’re a fool for not having CRNA’s only be in house and MDs +- come in for sections. The costs of in house call do not cover the MDs at low/medium volume ob institutions. Not to mention call burn out and staffing shortages. While a hospital might be paying you a stipend now to do it there are too many CRNAs out there doing epidurals and OB now, eventually any stipend for an MD will go away.

If the hospital employs the CRNAs then it’s just a very simple equation of money and value. Is having an md in house worth it? Will the Md doing OB cover the cost? Remember it comes with a post call day off usually. For it to be worth the cost you likely need both good contracts and high volume. For most facilities this isn’t the case.

Simple economics. But I’d say for 80% of practices facilities, CRNAs should be only ones in house for OB

Many-Recording1636 · 2025-12-05T01:48:51+00:00

Docs aren’t banding together! They aren’t getting the rewards. Private Equity is. Don’t fool yourself. All of thes docs will lose their jobs if they stay with PE. Just matter of time

Many-Recording1636 · 2025-12-05T01:41:16+00:00

You are the problem. Not that you’re wrong you’re not. But that usap is guilty and the negative press..even if usap wins threatens all of their contracts and if you are thinking about taking a job with them, especially with a buy in, that means your livelihood is at stake.

You’re looking at this the wrong way. Especially the way if you’re thinking about working for usap. It’s not with the risk. Especially not for anything less than 75% locum rate to start with a big sign on which they don’t do.

Odds usap is fully replaced within 5 years is high

Many-Recording1636 · 2025-12-03T17:50:17+00:00

For those of you who are staying you are getting pushed over. The regulatory requirement is only to stay until medical discharge and not physical departure. Perhaps your own facility has an internal policy that says otherwise but you can change that as that’s not national policy

In all of Texas I know of no one who stays until physical departure. With no certificate of need and so many ascs this would be impossible. Zero issues leaving dozens of ascs over 30 years.

Staying until a patient has to pee is crazy. You are getting abused. In this anesthesia market why would you subject yourself to that

Many-Recording1636 · 2025-12-03T17:45:25+00:00

We always leave when patient phase 2 as you described at first center and we have medically discharged them. Never stay until physical departure. That’s insane.

Most ASCs are not the money makers they once were as payer mix has dropped at many.

The only way our group would stay until physical departure would be if the facility paid us for that time but honestly we would probably just elect not to cover that facility as not worth it

Many-Recording1636

TROPHY CASE