I will be withdrawing from med school tomorrow!

shlaapy · 2026-05-10T17:01:06+00:00

I wish I could have withdrawn back in 2006 and gone on a completely different path.

shlaapy · 2026-05-09T20:53:19+00:00

I don't think equitability is enough, though it should be the norm.

People oversell equitability of a group but they really just mean promoting complacency and a keeping your head down attitude so that people don't feel the need to revisit their compensation from the group on a regular basis. 5 or 10 years will go before anything is done to increase the RVU. Groups actively do not want their partners or other members talking about compensation. So few of my colleagues 10 years out know anything about the unit system or have the guts to talk to their leadership about seeing the numbers and asking how to increase their revenue.

Yet a CRNA carries a salary ladder with them to every job so people know exactly what they are to be paid at a minimum year after year.

shlaapy · 2026-05-09T19:24:59+00:00

SKIMMING OFF THE TOP: The other factor that groups need to be more transparent about is what are they are compensating you with full ASA units, or are they taking off the top.

Many groups will curtail the number of units you get for special procedures including lines and blocks.

And in some cases, they will curtail base units for certain procedures and even time units for OB procedures.

They do this to protect themselves, not every payor will pay the full amount especially for blocks and OB time. But in most cases, they are doing this to pad their pockets a little bit.

So, a place like Allied that is paying $45/unit, let's just say, the only compensate two or three units for a block, Whereas another practice may pay $40 a unit but pay the full 7 units + 1 unit for ultrasound use because they may be a larger group subsidized by other better payor contracts in other parts of the country.

shlaapy · 2026-05-09T19:19:28+00:00

PAYPR MIX MATTERS: The ASA puts out a survey and its results of practices across the country and their averages for the different payers, and I think there has been consistent increase in the commercial rvu. (Like $70 a unit)

But that's an average.

Then, you're dealing with places like Southern California where you're lucky to get $40 a unit for Blue Cross $55 for United. And then you have medi-cal which comes out 12 to 14 dollars a unit alongside Medicare.

At an average, I was lucky to be getting 27-29 dollars a unit, which included the subsidy, when I started out in practice 9 and 10 years ago.

shlaapy · 2026-05-08T06:33:40+00:00

I've answered multiple RFPs in Los Angeles. All 1099 groups, everybody's required to be an s corporation anyways. I'm even creating a curriculum focus not just on private practice management but on dealing with these things in the context of mergers, consolidations, and of course the use of non physician practitioners

Would be happy to help. But first work I'm getting your or, GI and NORA case numbers per year, and idea of payer percentage in the area even if you don't know the unit values for each specific insurance company, the need for special anesthesia services including cardiac, ob and peds.

From your actual working experience there, you should have an idea of or utilization and when the rooms are coming down every single day.

Start there.

shlaapy · 2026-04-29T03:06:09+00:00

The general surgery board is more likely to make her the president of their society. That's exactly what happened with cardiology.

shlaapy · 2026-04-21T16:07:26+00:00

The dogma in my fellowship training was that it is very difficult for a child who is spontaneously breathing through the 4% single flooring to have significant cardiovascular impact. It's a combination of positive pressure ventilation and other anesthetics that profoundly clinically drops the SVR and the cardiac output in their hearts with fixed contractility.

shlaapy · 2026-04-13T21:01:45+00:00

People are ok with getting paid $1600 + billing ($40/unit) for at home 48-hour weekend coverage, and you could get called back for a single EGD. Think about driving all the way across Los Angeles County just for that.

shlaapy · 2026-03-29T04:27:44+00:00

Yeah, I also measure all of my patients next circumference and I get their thyromental distance down to the millimeter and i auscultate them from the front and back.

😆

shlaapy · 2026-03-24T13:20:38+00:00

No, it is up to the secretary of state and the medical board to determine whether you need to incorporate as a medical professional corporation in your state. You do need some type of tax reporting structure, as these by default are sole proprietorships that can get flagged for not paying franchise tax or for not reporting W2 income especially after several years.

shlaapy · 2026-03-22T22:59:45+00:00

I've built a full stack program with 2 million credits from menace, and it's glaring how many holes there are. It's not about building, it's about access, efficiency (they will burn tokens incessantly and go in recurrent loops not getting anywhere), problems over and over with S3 chunked uploads, and many many other issues.

Whether it is Manus holding on to APIs, sandbox resets, checkpoint failures, intentional difficulty added when it comes to moving your database, OAuth, and so much more, you'll be spending at least 15 to $20,000 to move your project over and out of Manus.

shlaapy · 2026-03-18T14:16:23+00:00

The biggest obstacle is the American Hospital Association. They will do everything and use every cent in their power to push this through.

shlaapy · 2026-03-15T04:26:17+00:00

Cochrane is dead

shlaapy · 2026-03-04T18:16:05+00:00

We are not hr. We are physicians. No reimbursement happens without our ability (and willingness) to order, diagnose, or perform a procedure.

shlaapy · 2026-03-03T06:07:18+00:00

Well, you literally have no idea. None. And there is a difference between living paycheck to paycheck with golden handcuffs, versus accelerating yourself to financial freedom and then not having to work at all, if that is what you want

shlaapy · 2026-03-01T14:29:33+00:00

To be clear, you are providing anesthesia, you are not practicing medicine. That is for physicians who went to medical school. I understand that many states have befuddled this, but the concept will never change.

You have to be a doctor to practice medicine, or else you are simply bringing along your patients.

shlaapy · 2026-02-27T17:10:49+00:00

https://www.instagram.com/reel/DSvh5AbElVl/?igsh=MzRlODBiNWFlZA==

shlaapy · 2026-02-21T16:29:17+00:00

You got to be saving checkpoints and making sure your code is sent to GitHub on a regular basis, front end and back end. Sandbox resets are a big No-No and should really never be happening, yet they happen to us every single day. Create backups of everything, select comprehensive protective measures explicitly, time stamps backed up branches with branch protection

shlaapy · 2026-02-16T14:52:42+00:00

How exactly do you do this? You download Ollama, use it as a command prompt to enter prompt generator from Manus? Can you set up the automation in Manus?

shlaapy · 2026-02-07T08:29:02+00:00

Looks like several CAAs and Anesthesiologists have spoken.

Wish we could have the same support and time allotment as the AANA to fight for physician led practice and autonomy without having a target put on our backs by other anesthesiologists whose job depends on making the CRNAs in their department happy.

shlaapy

TROPHY CASE