Anesthesia Staffing Strategies That Work | Live from the Anesthesia Economics Summit

This episode of the Anesthesia Economics Podcast was recorded live at the Anesthesia Economics Summit in Charleston.

As anesthesia groups and health systems face ongoing staffing shortages, rising costs, and increasing operational complexity, traditional staffing models are no longer enough. 

In this panel discussion, industry leaders break down what’s actually working today, from flexible locum tenens strategies to hybrid employment models, and discuss how organizations are balancing cost, culture, and continuity of care.

You’ll hear practical insights on:

• Aligning providers across employed and contracted models
• Reducing turnover and improving retention
• Navigating compensation pressure and workforce shortages
• Using data to drive smarter staffing and operational decisions

Whether you're leading an anesthesia group, managing perioperative services, or navigating staffing challenges at the health system level, this conversation offers a grounded look at how to build more sustainable, high-performing teams.

Panelists:

• David Donnelly, Trinity Health Advisors (Moderator)
• Stephen Porter, Piedmont Healthcare
• Todd Horowitz, DO, Hospital Staffing Partners
• Spencer Lilly, Medaxion

Explore the full episode page: https://www.medaxion.com/successful-anesthesia-staffing-strategies

Jeff McLaren introduces the speakers and panelists whose discussions were recorded live at the 2026 Anesthesia Economics Summit.

Watch on YouTube. Learn more about Medaxion's solutions.

Transcript

Introduction

unknown 0:11

Joining us is Dr.

SPEAKER_05 0:14

Todd Orwell, who's the main director of hospital staffing partners of Certifying Speciologist with more than 20 years of experience in clinical leadership. And he's bringing today on our panel of deep expertise in advanced staffing trends and practices as well as practice management. He's joined by Steve Spencer Lilly, a strategic health care advisor with action, formal hospital leader. He advises healthcare organizations on strategic alignment, operational performance, and then physician enterprise development. So we'll pick on his experience. And then lastly, at our end is Stephen Porter, the corporate senior EP and CEO of the Piedmont of Faithville Hospital in the Atlanta market. And Stephen leads the operational excellence physician alignment and hospital growth strategy there. And so I wanted to start with uh it was brought up that a lot of the physicians and APPs are interested in flexibility.

Flexibility Driving Locums

SPEAKER_05 1:26

Uh post-COVID, many people looked at the models that are available with locomos. When you have people speaking about opportunities within your organization, what is it that appeals to them from something other than the W-2 position?

SPEAKER_03 1:43

Sure. So Dr. Hicks uh hit on it earlier this morning, you know, he called it the number two most important thing, which was the flexibility in scheduling. And I would argue it's maybe even a number one tie, you know, for number one at least. You know, what we see all the time, I get probably 20 calls a week from physicians, CRNAs, CIAs, all contemplating whether they're going to make this switch to you know locums to the 1099 lifestyle. And I'm brutally honest and I tell them it's not for everybody that we have an honest discussion about what they're looking for because I think many people feel like if they go into locums, they're going to be instant millionaires and it's going to be amazing.

unknown 2:31

Uh, and that's of course not the reality.

SPEAKER_03 2:33

But when you dig down, I find often they're dissatisfied with their sites they're at currently for many of the reasons we've already outlined, right? They don't have buy-in, they don't have support, um, maybe their pay structure isn't great, maybe their time off isn't adequate. So often people are willing to transition to the locums life, if you would, because they will have control of their of their lifestyle and of their schedule. Um, and I was speaking earlier about this 26-week job trend, which I think is super important right now. You know, it's it's catching fire, and as a locums agency, we're actually capitalizing on that because so many people are moving to work hard for 26 weeks, then they'll come and call us and work steadily every month for another week of locums each month, and then keep a week for themselves. And they're, you know, when they do that, they're making more money than they would in their W-2 job. They still have their benefits. Uh, so it's you know, it's about creative scheduling, and I think that trend is uh it's only going to get bigger and bigger. I

Rise Of The 26-Week Model

SPEAKER_03 3:42

find that you know the locums life, it's kind of taken on a life of its own. Uh, it's not for everyone, we don't tell everyone to do it. Um, I think you were, you know, table is like, oh, you know, as the locums person on the panel, you can almost be vilified because you know we're doing uh we're doing a job that some people would argue is is you know is expensive uh and and not great for the industry, but you know, we're filling this necessary void. And I can tell you at least with our company, we're doing so with transparency and honesty, uh, which is all that we can offer is you know try to be better than the rest of the thank you, Steve.

SPEAKER_05 4:21

I wouldn't think go to you. Piedmont consolidated its anesthesia, took accountability in storage. When it came up with a staffing strategy, she wound up having a number of different options.

Building An Internal Locums Model

SPEAKER_05 4:35

Yes. So I want to hear about how you navigated that and also about the F and V issues. F and V hurdles are different if you're dealing with an outsourced group than if it's one-to-one with uh someone that CMS considers a referring or monitor. So that 26-week option or alternative scheduled has F and V support been a challenge, but uh that's a good question.

SPEAKER_04 5:00

So um Steve Worried with PMO Healthcare, and we are developing a 67-person anesthesia group to cover our system. Um nine of our 17 hospitals are currently covered. And when we're approaching this, we looked at definitely the traditional model of W-2 employment, that was the core, and how do we transition our current groups that are having service in our hospitals to the employment model? But in some of the hospitals, you know, the locums coverage rate was 30% of the providers, some are 15%, so we have it's all over the place. And um what I did or what we did was we decided to go ahead and create our own locums company under the Piedmont umbrella, several separate companies. So we're now able to tell providers whatever, wherever you want to work and whatever type of employment relationship you want to have with us, we can offer that. So if you want to come in, straight out your grant training and be involved in a very complex hospital doing transplants and really working with top of your license, and as you evolve through your life, you can then move to a suburban hospital where good neighborhoods to raise kids and have a normal life to move into an ASC environment or back or bounce back and forth. But then if you are looking for that flexibility, is don't feel you have to leave Piedmont to go to a company A or Company B to get that. We'll be your locals company as well. And with that, we have set up our the providers, they sign up, we broke our system into regions, so we'll have providers in our northeast region, our Atlanta region, our southern region, and they have to agree the flexibility. We'll try to keep them within their prime facility, but they also know that they have to be willing to be deployed when we need them to be deployed. So that's been very helpful. We launched this about six months ago. We have about 150 providers in now. Some of those have been our W-2s who were looking to leave, and some have been contract external. We wanted to stay because we want to use this as a way, not wanting to offend any of the outside contract companies, but you know, we wanted this to be an opportunity for us to transition from external contract into 1099, 1099, 2W-2, or W 2 to 1099, and keep that group within the system. So from an F and B perspective, we do approach things a little differently. I mean, we went through a complete F and V process both on the W 2 side and on 1099. The 1099 was a little bit easier. I mean, we're not paying more than the external contract companies, it's you know, close to what their base salaries would be, it's just we're not paying the overhead markup with an external company.

SPEAKER_05 7:46

So

Beyond W2 Vs. 1099

SPEAKER_05 7:48

it's not binary. I mean, there's not a W-2 versus uh a 1099 option expensive. It may not work for every market, but there are some alternative models out there, uh, especially with physicians uh and lease back agreements and things. What has been your experience about other solutions that health systems have employed?

Lease Model Explained

SPEAKER_06 8:10

Yeah, um, so I'll describe an experience I had at A trip and welcome to our Patriot colleagues here. Thank you guys for participating. Um yeah, so before I jump into kind of the model we landed on, which is an in-between, it's we affectionately called it the lease model, um, where we we used FMV, which we're just talking about for uh FTE and at least the providers we did. Um before I jump into that, a couple quick thoughts. Uh, FMV should roll around in your minds if you're on the hospital side. Um if your subsidy is gotten large, which most happened. So a lot of times, you know, you do you required to do F and V for a variety of reasons. But many times possibly specialties that the administrative team is clean. So if you're paying $6, $7, $14 million, whatever it is for subsidy, you need to start. The other thing about employment or just contracting in general from a timeline perspective, and there's a dual prediction process that has to the timeline. So you guys have this all too well on the top of the system as well. You just don't have to account for everything through it is, and there's the prediction on the medical side side, but there's also the pay permission as well. So uh I think Patty mentioned in the first six months, first year was angry financially. A lot of that relates to cash flow because of the lack of potential or the delay in potential. So anyway, those are just kind of added problems. But we found ourselves in a situation um where we uh we employ the large health system is a large health system, so we have a lot of employee positions. Um but employment doesn't equate to the line number necessarily, unless you have all the things we've worked about, that leadership, data, transparency, et cetera. So we we weren't necessarily jumping straight to employment. Um, but we were in a contractual relationship with our MDs. We employed our CRNAs with had a contractual relationship with the position department. So for us, it started with strategy, um, which to me is key. You know, we wanted to understand, you know, if you want to make that kind of a change, it's a massive change. And those who have been through it understand that, and I see some bad as not. Um so why are you doing this? And in our case, it was a matter of um understanding what was going on in the hair environment. We had some abundant payment opportunities, some high-based hair, some things that kind of um raised red flags around our cost. So um hospitals as well as professional costs, but that's easy to really jump up as a red flag for some certain procedures entertaining other things with our attention. So we understood first understood just the economics of what we had, and that sounds very basic. But um again, on an experience, I had no idea what we had the employee CRNAs, the building intellections associated with that, the contractual relationship with the MDAs and professional side, what that you put those two things together is and we just really didn't look at it as a

Strategy Before Staffing

SPEAKER_06 11:21

result. So I think strategically understand it first and foremost.

SPEAKER_04 11:24

No, I have to agree with you 100%. We're not employing because contracting failed. I mean, everybody's faced with the same challenges, whether you're proud of your community practice or hospital-based employee. It was mentioned earlier. We're that was a it was a very um specific strategy to manage the risk that hospitals were now carrying. We could not risk the disruption to our perioperative services and our NOR services, everything we talked about earlier today. The value of that service line is too tremendous to be disrupted by something we could not have more leverage or control over. And we do, we did think, I understand, I do feel it's different when I did this 15 years ago, um, where you couldn't really define the alignment to be quiet. I think the providers feel more aligned to something now because of the comment earlier. They felt like they were pawns every two or three years. And now they're part of something, you have to build the leadership structures and everything we talked about. But I think there is a better for us, not for everybody, it has driven a better alignment model for our market. We had nine different anesthesia companies within our system, and it was just they just we were competing against one another, we're competing with the same providers, and we could not use the scale of our system like I can include providers from this hospital, group A to this hospital were needed because it's an exclusive arrangement. Now I'm able to scale providers across the system, that also helps with the problem.

SPEAKER_06 12:57

Yeah, we didn't have as many providers, we had two provider groups, but the model itself, the lease model as I referred to it as was kind of a um an agreement where first strategy and then understanding what your staffing requirements are, including the notes and CRNAs. We had a desire also to improve the uh ability of our CRNAs or the practice at the top of their license, which understanding your staff, and then we basically went tomorrow and said we need a next number of doctors at this location, except for this location, and here's what fair market value is what we're paying for that service. Um and we traveled at one hospital first and it worked uh basically at a year's experience, uh, and then spread to the rest of the hospitals, um which ultimately our contract group didn't want to they participated in the model in some of our hospitals, but not all of them. So that kind of precipitated the change. But at least model uh is still in place, and we have in the room after where notably, if you were interested in the details of it, um, we could talk about it. We started that in 2014, I think was the first trial period first facility, and it's still in place now. So you kind of get the best of both worlds, you get control and transparency on the revenue cycle side. You understand you communicate with one voice through the paper, so which employment does the same thing, but you're not committing to the employment part. Um but uh you know, Dr. Wary, his team's credit, you we also negotiated in um to get the ability to become employed if either party desired that. So you know it may make sense for a trainer to do that one day down the road or not, but that flexibility was in there, so non-competes are not an issue. So for us, it was a happy medium between the fully outsourced and fully employed. Um, it was kind of a middle one. So we yeah, it's still in place. I'm uh since retired, but it's still in place, so uh presumably still still working for such the panelists.

SPEAKER_05 14:54

Uh we've heard earlier today the culture matters, in my experience, for CRNAs that might be more interested in uh different practice settings, that it's probably worth at least $25,000 if you like where you work, even though someone might be offering more money at a competing facility that they could not have to uproot their family and join. Uh, maybe to the panelists, when you speak churn in the market, it usually resets the compensation because people now are offering someone bonuses and other incentives. Just your experience about uh whether or not you've been able to create culture and have a dividend there that has kept people even though there's a reset in the market that either you're gonna try to match or not have to match because you have a culture dividend.

Culture Vs. Compensation

SPEAKER_03 15:46

So I will tell you, you know, and it's it's very important, but when someone, when hospital A increases their package, uh I give it six months, regardless of how great their culture is. But you know, hospital B down the road, they're going to be asking. And it's not that they're not loyal, um, but they it's just that's the nature of the market. Um so this you know, tit for tat and constantly you know matching your competitors has become a death spiral for the financial people in the hospitals. I don't know how you break it because even when you have good culture, they're still willing, you know, and it's all of the letters, it's not just the docs or the ADP, uh, they're still willing often to change if your market has enough facilities in it. I think you know, feedback on say your comments, I think it's pretty incredible what you've done. You really solved for a problem. You know, you had so many vendors in different companies managing your sites, and now you know you can handle all of it, which is great. And we actually uh we we created another similar situation or solution to a problem that some of our hospitals are running into. They couldn't, many of our providers wanted to work as 1099s for whatever reason, uh, and their tax structure or their you know their legal departments wouldn't allow that. So we created a program within our company. We never have non-competes, so it wasn't an issue anyways, but uh, where we will actually be the payroll company for them. So they'll run their people through us as a 1099. There's no non-competees, there's no buyouts if they ever want to go back and forth between W2, but it was a unique solution to the situation. If that's what the market wanted, we were willing to get to that.

SPEAKER_04 17:36

And it's interesting, your your your question is multifaceted. Um Atlanta, you've got Emory, you've got Wells Scholar, you've got us, you've got North Side, and it just became more insurance. And so we cross the systems drove up the market rate, the providers and it drove up the market rate competing against one another. So we have now have a very intentional effort to do as much as our of our recruiters from outside of the state just to try to break that pattern. In terms of the culture case, I think there is a return based on the facility. Take a P Mine, an amazing culture, amazing leadership structure. We had people who left and said, hey, I'll go for this $50 more than an hour, and six months later get back and go, I want to be back part of this culture. I have facilities where people definitely are leaving because of the culture, and that's one of the areas we have to focus on our big focus on leadership development structure. We're going in where we've had seasoned leaders and ASD, great leaders, and as they're going to retirement, we're approaching them and say, I'd rather pay you $100,000 and come in and be a coach and mentor in our sites for a year or two to help develop the things and help you drive the culture before you actually move out completely. So we're seeing that as a success uh mature.

SPEAKER_05 19:06

Chick-fil-A is huge in Georgia. And uh, I think about what they've done about theory of constraint. They figured out that you know what was blowing them up, wasn't about taking the food and getting it through the drive-thru windows and what you're taking. So this is about significant, but I'm curious about uh I typically different health systems, you might have a happy limit, and that is a choke point in Ant-Speech throughput, or you might have terrible processing issues. And so I'm just curious to maybe see just your experience about the happy Anstitut, but are they rate limited because of other Anastasia teams work but other uh solutions and being able to let them maximize what they

Operational Bottlenecks

SPEAKER_05 19:49

can do?

SPEAKER_04 19:50

I mean, every hospital is going to run into rate limiting stuff. One of the things we're our next level of that allusion is to, I mean, someone made a comment earlier about what the hospital, we actually don't allow the hospitals to have a lot of say at the end. We want their influence. If you want to add a new site on, you have to put a business case proposal, you have to come in, you have to present to me and my executive uh anesthesia team, and we decide whether or not we're gonna stack for it. So it has to make sense from that perspective. Um, but we have found, I'm sure a lot of people shake their heads in this uh in agreement, you can't optimize anesthesia without optimizing operations. So we're pulling anesthesia service line into a perioperative service line where there'll be basic three leaders, my chief of anesthesia, my DP of anesthesia, and my DP of perioperative services. So we can standardize operations as much as we can across the system and vice versa.

SPEAKER_06 20:45

Yeah, but uh piggyback on that, that's where my monument is around how you set up a governance structure. I heard a lot this morning about um outside the OR activity, so that should be folded into the governance structure, absolutely. Um that's huge. Um, the second piece would be you can't govern, you can't fix problems without identifying and measuring what the problem is to be. So so many times that we've been all of them have been involved in this are emotional arguments that result in a change being made just based on emotion. It needs to be data. And you know, providers are great. Given the data, they'll help you solve the problem. So, back to the governance. We, in essence, our theme was turn the keys over to the operators, give them to the people who are driving the car, the operators. And anesthesia is a huge driver in your prayer operative service. Uh they're there, they're saying the throughput, they understand it, but give them data, give them ways that they can they can manage uh the responsibility.

SPEAKER_05 21:48

Anesthesia is, you know, in these carity models and 60, 70 percent APDs. I'm curious about what your experience has been in uh Patty brought up diet on. Physician-led, professionally managed involvement in APP leadership since they represent so much of a majority of the workforce and these care team models and how you've incorporated APP leadership into employee models.

SPEAKER_03 22:18

Yeah, I mean we do load and staffing, so we don't, you know, it really isn't our question, but I mean I as a you know leader for 13 years in the old group, uh, which was actually the same group as PMO guys, so I know how wonderful your group is. You know, I think in our group we never had an us versus them philosophy, it never was like that. It was completely erroneous, and and uh you know, we worked hard together, we you know, we played hard together. Uh you know, I think it's more and more the SRNAs and the CIAs you know finish their education, um, they're you know they're very young how they become future leaders. So if you don't create those pathways and in the interviews uh up front explain that there are opportunities for advancement, you're gonna have difficulty recruiting these people and retaining them.

SPEAKER_04 23:11

Yeah, I agree. Um we do have uh inescus leadership uh at the table with position leadership and with administrative leadership, so there's a definite place within it. We also have created additional leadership roles within physicians and the inestus in terms of recruitment and development leaders. Um so they're responsible for really leading the charge on recruitment and development uh our providers and our provider bases across uh this the country. Um so we do believe that they're active, they're part of the team, they're equally part of the team. Um that's been a little tough in certain hospitals to get everybody on the same page with that, but um it it's gotten so there's such a big footprint, big part of your your presence now that you can't ignore and not allow them to have a seat.

SPEAKER_03 24:01

Do you find in the Atlanta market, because of the high penetrance of CAAs, do you find the rift between the two ATP levels more significant in your market than it might be in others?

SPEAKER_04 24:14

Uh it depends on the there's some where to do it, I will tell you. And some, it's it's still there uh in all facilities, but the level of the rift is like in Piedmont Atlanta Hospital specific, it's not as popular. I go down to a Vaya or Macan or something else. There seems to be a little bit more thread within those facilities from the same.

SPEAKER_03 24:46

We deal with it on the staff in that market, so uh they can tell you it's there.

SPEAKER_05 24:51

Very easy to what are the feedback loops? I mean, med action and I had the report, I called it the Swish G's report, it showed a provider in the building in the light space where they weren't billing. And that was a helpful part to get the C-suite to say, like, why are they sitting idle? And is it flip rooms or other controllable things that we can influence or impact to unlock them and turn availability into productivity? Are there feedback loops that you've seen that work that uh guide whether or not you're tailored to you know recurring demand for pays growth and uh and that margin for growth that you always want in case something opportunistic

Data And Utilization Gaps

SPEAKER_05 25:30

happens?

SPEAKER_04 25:30

I mean for us, uh yes, but it's maturing to be honest. So we have monthly operational reviews with each of the hospitals, and you know, they owe our staff cath lab leadership, IR leadership, anywhere where MC is provided. And we do bring as comprehensive data analysis as we can, but that's one of our challenges right now is getting the right data. Someone mentioned AI. We have brought in a company that's uh Qventus, and we deployed that across the system, and that has been helpful in terms of the OR utilization aspect of data, and it's really opened up our eyes to where we truly have uh daily insight now in terms of hey, why is this hospital opening six rooms just a shutdown for them at 11 o'clock and you know whatever? Um, and and then quickly calculate the cost of that under utilization and non-utilization. So it's evolving for us. I mean, we've really been down this uh anesthesia employment model to the extent that we're currently involved in. We had three sites that were employed throughout the last three years, but so we're about six, nine months into it now, so it's it's evolving and it's maturing, but data analytics is one of the areas that we still need to SMF to I think it's important, once again, always going back to satisfaction in your providers.

SPEAKER_03 26:53

If you look at raw data and take that as you know the only thing that matters, you're missing a very important part. So if you have you know 10 CRNAs and you know you have utilization that's you know 100% repaid of them, throughout the day, if there are downtime, the things that lead to satisfaction in the job is having someone available to give you that morning break, to get the lunch break, to make sure that all the pre-ops are done, and make sure that the pay rounds are done, the post ops are done. So just because you're not earning on that particular APP's hour, I think it's important to understand all these other things that go into the day and you're not getting billing, you're not getting reimbursement for me, but you are winning because that's what makes our happening.

SPEAKER_05 27:42

Everyone talks about AI. I think a lot of health systems try to look at predictive scheduling if they know a surgeon or procedure look specifically out to observe all day screen or eight weeks and timeout. Um I haven't seen AI and anesthesia used uh dramatically. Uh, either AI or other technology that uh you've seen used to try to optimize or uh take better advantage or tell a story in reporting. Uh, I'd be curious what you all have seen in the different uh settings that you're involved with.

SPEAKER_04 28:15

In anesthesia specific space, not a lot. I mean I've seen a lot in on the OR side, the procedural side, and introducing some into the uh pre-admission testing area that will help overall anesthesia performance utilization consistently by taking same gig cancellations down from 14 or 15 percent down to 7% or things along that line. But I don't I'm seeing a lot in anesthesia specific.

SPEAKER_05 28:46

Uh I think we want to open it up to you all to ask questions of uh the thought capital that we have up here, and so uh why don't we pause uh the panel's questions and open it to you all?

SPEAKER_00 28:59

I

Leadership And Culture

SPEAKER_00 29:00

this coming up very quick out of Mr. Karen Hawk. We just went through one of these major transitions and um looking at culture being a big driver, um, having contingent labor, having peering pools, having W-2s, how do you see the culture being better over the um existence of that transition and very first year?

SPEAKER_06 29:21

You know, just a general comment would be it begins with leadership. Um so to the extent you have the leader in place who is effective, he or she, I mean that it starts with that in my opinion. But they set the tone, they set the expectations, the accountability, the communication. Uh so it begins with leadership first before. So that then begins ability. Uh so you're gonna have if you just transition recently, you're gonna have to ramp up or ramp down or stability. And talking about leadership.

SPEAKER_04 30:12

So I agree with leadership, and also it was a discussion well in advance of doing what we did, we were talking and aligning leadership without costing too tortuous interference or anything, you know, well in advance in the transition, looking to them in terms of what needs to change about the culture, what are your biggest frustrations? We couldn't fix everything, but you said it's it's constant contact, constant communication. Don't be mad at me when I started your anesthesia, we've been sincerely.

SPEAKER_02 31:02

Um it's uh a while from uh standpoint of the private group for about 20 years and Florida for the last 12 years and tier for uh sometimes. So uh back to the common conversation of really competing hospitals competing against each other for scar and comp sometimes, MD comp. We uh you know we move our comp to readdress comp again just did about a year and a half ago. Uh now we're back at the table again looking at CRNA comp because competing hospitals have increased silent balances, uh, recreated tiers to top compensation quicker than you know so many years to make it much shorter, um, incentives on students and just continued pressure in the market to be able to recruit and retain uh CRDs, CAAs, and it just becomes tiresome. Um my director is here somewhere at India, he's new to Anne C for about a year, and he's come to me many times and says, When does this stop? I hate to say I'm not sure. It doesn't stop. It's a continual uh competition and a constant um uh drain on the system from finances and resources to support anesthesia. If we don't get it right, uh then we we damage period because we touch everything that gets done in and out of the OR. If we fail and fall down, it has such a negative impact on finances for the for the system in the hospital that it's devastating. So we have to be responsive, and the struggle is that we end up kind of competing against ourselves to a certain degree from hospital to hospital. And um, you know, on the side of the FMP, you know, there's certain hospitals I have to recruit to, they're very difficult to recruit to for physicians, and so I have to make compensation attractive to work uh life balance attractive, and then it gets thrown out on the table. Um, we're gonna have to check the FMP. And I'm like, I don't really, I hate to be rude, but I don't really care what the FMP says because I have to operationally make this happen. I have to be able to recruit, and I know we can't get in trouble for FMP, but don't go on. If you come back and tell me that won't work, what's the option? Just close the Rs. And so it's a really tough, a tough we're in a tough spot because it continues to just the impact the finances to the bottom line of the hospital for anesthesia is just uh it seems to be a constant drain, at least in my world.

SPEAKER_05 33:41

We have time for just one more brief question.

SPEAKER_01 33:47

It seems like we're talking a lot about CRA models or CAA models. One thing we've seen is also when we're talking about recruiting physicians. So does anybody have experience with doing hybrid models? Meaning, when I'm recruiting a physician, what if he wants to work this in his own cases? And being flexible enough as an employer to say, yes, we have opportunities. Maybe you don't want to do your own cases and be only every day, but a few times a month we can put to a site where you can do your own cases. So is anybody offering really hybrid models? And the reason we're doing that is because sometimes that's what's best for the structure of that facility. Meaning sometimes we might need a one room only. Like let's say we have one room at an ASC that's going late. Well, do you need an anesthesiologist covering one room? Or is that person going to be doing their own case attack to three? Um, so anybody want to comment on kind of hybrid companies?

SPEAKER_03 34:56

I mean, I think the the numbers dictate whether that model works or not, right? So if you have an ASC or a small rural hospital that only runs one or two rooms a day, you know, we know the cost doesn't make sense to have one dot covering two CRAs consistently. So sometimes that if you have multiple sites under your umbrella, you can put the dots that are interested in doing their cases by themselves at those locations where it makes financial sense. But if you're you know, like my old facility with 72% Medicare, then there was never a day where it was ever going to make sense for a doc to be in a room ever, you know, at $83 an hour, $84 an hour, or whatever it does. So I think you know you have to have the bandwidth within your system to be able to do that. I mean, you know, these big hospitals, you know, you can compartmentalize based on you know where the parts of the hospital do the MOUNIT's over here, and OB's over here, and you know, Nora's over here. It really is hard to do that and make the finances work unless you have sites that you know go along with that.

SPEAKER_05 36:06

Yeah, just briefly, I I've modeled some to where you're upgrading a CRA position and making it a doc position just from the recruiting dividend that might occur about attracting docs that would still want a hands-on attending experience. I feel like we have to leave it here. I wanted to thank the action for hosting this.