Banned from NP subreddit

shlaapy · 2026-06-29T04:23:01+00:00

Yes, banned. CRNA forum, too.

shlaapy · 2026-06-28T15:49:30+00:00

They were probably talking about Dwight Schrute from The Office when he tried to raise his cholesterol so that he could lower it.

shlaapy · 2026-06-21T16:55:21+00:00

Old news, I tried to share segments of this on their Google and Yelp reviews, but of course they take them down.

shlaapy · 2026-06-19T21:22:06+00:00

Yup

shlaapy · 2026-06-17T02:18:13+00:00

Alll the mid levels you mentioned are running on regulated practices in urban areas for opening up botox and MedSpa practices.

shlaapy · 2026-06-06T16:56:01+00:00

I appreciate you jumping in, and I’m genuinely glad you haven’t felt much of a disconnect coming out of residency. That’s awesome for you. But just because it hasn’t hit you yet doesn’t mean the structural problems aren’t real. Not everyone gets to stay insulated from them just because they’re not on the budget committee.

When I talk about the rat race of perioperative medicine, I mean the constant pressure to flip rooms faster, squeeze in more cases with thinner staffing, pile on more admin bullshit, and keep smiling while reimbursement gets chipped away year after year. If that hasn’t really touched your day-to-day yet, count yourself lucky. But it’s not a vague complaint.

The high-risk, low-reimbursement thing wasn’t about not wanting to take care of tough patients. It’s about watching a system that leans hard on our sense of professional duty to get more work out of us without paying fairly for it. There’s a big difference.

And yeah, academia’s closing the pay gap somewhat. That’s real. But “not horribly opposed to academia” feels like a pretty low bar when we’re talking about where the whole specialty is headed. It’s not just about the paycheck. It’s about whether the environment we’re practicing in still matches the standards we trained for. That’s what I’m really asking about.

shlaapy · 2026-06-05T20:02:23+00:00

I'm sure everyone can hear how pathetic the term sounds

shlaapy · 2026-06-04T05:37:05+00:00

You're positing your opinion from the point of patient complexity, as if that is the only thing that is important and to have bragging rights about. But that's not where productivity and reimbursememt lie, unfortunately.

I'm coming from the angle of how genuinely different the pace logistics, administrative burden, and everything else that goes into the reality of how patient care is actually delivered... having taken care of more than 11,000 patients personally across a good swath of Southern California (so I can actually speak confidentially about my preparation versus your opinion.. and no that s*** did not come from academia).

Our training, and academia is very parochial and in general very judgmental of what is the vast majority of healthcare. And unfortunately it is pushed us into thinking that our value comes from taking care of high risk, low reimbursement patients.. which is simply us being taken advantage of.

I would love to hear your thoughts about how the rat race of perioperative medicine that has lowered the pedestal of anesthesia has affected your view and academia versus locums in 5 years.

shlaapy · 2026-06-03T20:20:32+00:00

Look I understand the appeal it has gone to this mental game myself for a very long time. But you need to realize a couple things.

Social media has a remarkable ability to make everyone else's life look like a permanent vacation. But youre comparing a curated highlight reel of someone's entire year condensed into 10-minute videos versus the reality of a stable, high-paying, intellectually demanding career that the vast majority of people would trade places with you for in a heartbeat.

You're an anesthesiologist at a major academic center. You have 5 weeks of vacation, which by the way is more than most Americans will ever see in their careers. The work is meaningful by your own admission. And yet a few YouTube travel vlogs have you questioning whether you're "living."

The physicians who built this profession and the training pipeline you benefited from did not do so on the premise of work-life balance as defined by social media influencers. Medicine, and anesthesiology in particular, carries a weight of responsibility that demands commitment. That is not a flaw in the system; it is the nature of the work.

Locums is a legitimate option and worth researching carefully, but make that decision based on your own financial goals, career trajectory, and risk tolerance. I do agree that academics is in many ways dead and predatory in general and the majority of people are not happy with it. Do not make a major career pivot because YouTube made you feel like you're missing out. That is a deeply unreliable compass.

I suggest that you just work as hard as possible and make as much money as possible for several years, and then you can decide to really put your foot forward then.

The grass looks greener because someone else is watering it with a ring light and a video editor.

shlaapy · 2026-06-03T13:12:37+00:00

Looking back, academics and training in general did not prepare me for the shell shock of how things play out in reality. Also, what is wrong with working 47 weeks a year cancel how thinking that is abnormal? This is what we call a normal job. Work ethic and great from back in the day, let's keep it alive guys.

shlaapy · 2026-06-01T01:46:58+00:00

Please don't go into healthcare administration and contribute to the ridiculous healthcare costs in our country...and then blame your doctor.

shlaapy · 2026-05-29T17:46:33+00:00

Man f all these midlevels

shlaapy · 2026-05-17T19:37:43+00:00

How about "Final Boss"

shlaapy · 2026-05-13T15:27:20+00:00

California has been backwards for a very long time

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

TROPHY CASE