benefits

OC_An Khe · May 10, 2002

One benefit you left out is a retirement package. is it a defined benefit or defined contribution? Is it completely employer paid or do you have to contribute part of your salary? How portable is the program? If its partially funded by salary reduction do you have control over investment choice?

kmchugh · May 11, 2002

There are quite a few things to consider when thinking about accepting a position:

-Salary: Of course, if the salary is less than about $85,000 (and that's on the VERY low end of the scale), I'd look elsewhere, even if that meant moving to a different location. Other than that, look at how that salary, combined with other benefits, compares with salaries offered by other groups. If the salary is not comparable, go elsewhere.

-Hours: I'd never accept a straight salary position, unless there was a cast iron guarantee that no overtime hours or call was expected. Currently, I work some overtime, and am paid time and a half for any hours over 40 hours a week.

-Paid time off: I'd expect a minimum of four to five weeks paid time off annually, including sick time, vacation, and time for educational conferences. I don't think I'd settle for less than four, depending on other benefits.

-Malpractice insurance: Covered by the anesthesia group, or hospital, fully. No compromise on this one, malpractice for anesthesia providers is too expensive.

-Health care and dental insurance: I have full coverage for myself and family, with no contribution from me. If I had to contribute to my health care insurance policy, the other benefits and salary better make up for this.

-Pay for education: I get $2000 annually for CEU or CME use. I can use this to pay for and travel to conferences. I'd expect it to be in any contract offered to a CRNA.

-Retirement: Look at the 401K offered by the employer. Look at how much it accumulates annually, and how long it takes you to become vested. I have probably the best retirement package I've seen or heard of. There is a somewhat complicated calculation required, but when all is said and done, I get almost $20,000 per year in retirement, without any contribution on my part. These funds are deposited in Jorifice accounts, over which I have some investment control. I also have the option of contributing to a 401K plan.

Ok, those are the minimums. Some other benefits may be offered, and you must consider those individually.

-Loan repayment programs: Not everyone offers to repay, or help repay, student loans. It is a nice perk if you can get it (I did). If it is done by the group, a nice side benefit can be that the group's accounting office handles the repayment, so you never even have to deal with it at all, really.

-Other benefits: Given the shortage of CRNA's, many things can be negotiated. What do you want? Is it a reasonable request? Negotiate it.

A bit on non-tangible benefits:

There are some other things I'd look at when considering a position, that you really can't call benefits, but can make a difference in your overall satisfaction.

Who do you work for? In some areas, you work for an anesthesia group that provides services to a hospital (or hospitals), while in other areas you work for the hospital, but are under the supervision of the anesthesiology staff. I work for an anesthesia group, and frankly, it would take A LOT for me to work for a hospital again. I find that I am in a great position. I can ignore the hospital politics and politicians. Generally, those folks are real nice to me, even those who would not give me the time of day when I was a staff nurse at the same hospital. I also have greater control over equipment and supplies, because I am outside of the hospital chain of command. I can (and have) said "I won't use this or that equipment or supplies, because they are inferior." In the case of some IV catheters the hospital bought, we (anesthesia providers) all said, "Buy what you want. Those are inferior, and we won't use them. If a patient needs an IV start in surgery, we will call for a hospital employee to come start the IV, and if that delays the case and puts the surgery schedule behind, tough. We won't accept the liability of using inferior IV catheters." They bought their IV's for hospital use, but keep the older, better IV's available for our use. I can also ignore SOME of the more foolish hospital regulations with impunity. I don't work for them.

Another benefit I'd think about is breaks and lunches. The group I work for falls down a bit on this one. There is a shortage of anesthesia providers, and surgery schedules are getting bigger, not smaller. There will always, for everyone, be busy days where you may get no breaks, even for lunch. But if this is a frequent occurance, I'd factor that into my decision making process. I can tell you from experience that it really sucks doing a six or eight hour case from start to finish with no breaks.

A "don't do this" or two: Some anesthesia groups and hospitals include a "no compete" clause in their contract. Essentially, this says that if and when you quit, you cannot go to work for any group or hospital within a given radius that competes with the group offering you the contract for a specified period of time (usually two years). The upshot of this clause is that if you decide to quit, you may be forced to move to continue to work in anesthesia. I'd NEVER sign a contract with such a clause, and I get a little angry with CRNA's who do sign such contracts. Also, look at the length of the contract. Some contracts are open ended, with no minimum time to work for the group required on your part. Some have a penalty if you leave the group before a specified time period. Personally, I don't think I'd sign a contract with more than a two year committment on my part.

The bottom line is that you will have to consider all of these factors when weighing a contract. Some things may not be included, but those are outweighed by other factors that beat everyone else. I think looking JUST at the salary is a mistake. My own contract is a great example. The group I work for appears to pay slightly less than the top paid group in town (and we are about to get a raise to match them). But, when you factor in the benefits and retirement we get, we come out WAY ahead. And, we get more paid time off than anyone in town.

Did I take the hint well enough? Seriously, if there are other questions, let me know.

Kevin McHugh

alansmith52 · May 11, 2002

hint most beautifuly taken. thankyou sir.

I hear of a group here in town that have a houseboat they share.

matt

ma kettle · May 12, 2002

What are the opinions about agencies verses contrating on your own? As in the nursing is it genrally paid more on the dollar? I see alot of agency advertisement. BUt I always wonder about this factor.

Kevin what types of anesthesia is your group responsible for. IE: OB ,trauma, open hearts.

Also do you start A lines and Tripple lumens? I understand some groups or states just simply like MDs here.

What kind of oppossions have you encountered?

Sandy

kmchugh · May 12, 2002

Sandy

I haven't really encountered any opposition. Around here, the CRNA's generally seem well liked and respected by the MDA's. In my group, we do everything except OB. This includes general surgery, vascular, open hearts, and neuro. Our group is used by most of the surgeons who do the bigger cases, so on average, our patients are sicker than many, and, on average, our cases are bigger. There are no cases reserved strictly for MD's. CRNA's do them all. Also, in our group, CRNA's do art lines, central lines, and swan ganz catheters, if we want to. I do most of my own lines, but if the patient looks particularly difficult, or if there is some problem with the line, I readily turn it over to an MD. There doesn't seem to be a feeling that this makes the MD's better, just an acknowledgement that they have more experience than I do. We also do our own spinals, epidurals, and regional blocks, as desired.

Sometimes, though, its nice to have a doc do those things. For example, while I am finishing up a case, the doc will put the regional block into the next case, minimizing the lag time between cases. It works out well.

I think that occasionally, the friction between CRNA's and MD's is overblown. Sure, there is a fight between the AANA and the ASA over the supervision issue, and I have my disagreements with my own docs about that issue. But these differences do not really affect the work environment where I am at. We all respect each other, and get along pretty well. I like where I am at, and the folks I work with. I have heard that may not be the case everywhere.

Kevin McHugh

FritoPie · May 12, 2002

Wow, that is great information kmchugh, thanks! It made me think about a posting I saw on the net for a CRNA position, I think it was in Dallas or some metro area here in Texas. Anyway, the pay was $180,000 but the ad stated that the position offered no benefits. I assumed that meant no paid time off, no medical insurance, no retirement, and so on. But now I'm guessing that it means absolutley NONE - but I believe it should be the employer's responsibility to provide malpractice insurance, no matter what. I mean come on - you work for them and not yourself. I would have thought that if you work for them they would want to provide the malpractice insurance to protect their own interests as well, they could get sued and get a bad reputation just as easily as you for possible mistakes. If I owned an Anesthesia group I would not allow my employees to provide for their own malpractice insurance needs, a insurance professional needs to be hired to ensure every employee in the company is properly covered and not taken advantage of. But I am assuming from your posts that malpractice insurance is truly a benefit and the responsibility really lays with the CRNA, I just find it really hard to believe that any company could be that stupid. Am I totally off the mark here, or what?