Endo Center vs Hospital

core0 · Jan 28, 2007

We've got a new Endo Center going up in our town and some of the docs have approached nurses from our unit about going there to work. Can anyone give us input as to the advantages and disadvantages of working for a Center? Does a new Center take a lot of time to build up enough business to support a staff that needs 40 hours a week? (I know this will depend on the population of the city but in regards to insurance reimbursement.....?) Is it better to have the the buffer of hospital support between the doctors and nurses? And what about losing skills with ERCPs and Bronchs? Is it worth the trade off? We'll take any input you have!

Our practice has its own center and initially we staffed up for 2 rooms. The beauty of the endo center is that we have a variety of shifts 4-10 hours 2-5 days per week. We started with two rooms 8 hours per day and are now running three rooms.

The good - more schedule flexibility, no call.

The bad - little overtime, pay is usually a little less.

The nurse here don't really miss the bronch and ERCP's. A few of them work weekends at some of the hospitals to keep up the good work. The real problem that we have, is that there are so many experience nurses working with us that it really slows things down in the hospital. The other thing is it really depends on the doctors you work with. You are relatively insulated from this in the hospital. In the endoscopy center they are your bosses. If they are jerks it makes for some long days.

David Carpenter, PA-C

GIRN · Jan 28, 2007

edited

core0 · Jan 28, 2007

Thanks for your input. We've thought about the personalities that will be working there because you're right....that sets the tone for place. Does your Center use Anesthesia-delivered Propofol or nurse-delivered conscious sedation? We're also worried that if the docs are our bosses and they say to give more sedation when we're not comfortable that it's a safe practice....we won't have the hospital policy to back us up. What do you guys use? Does that ever become a conflict?
What do you do when the docs take vacations and a room is not needed? Are your people salaried or hourly? Do you get your hours every week?

We use sedation. There is no real market in an outpatient setting for Propofol. There are some centers in the midwest that use nurse administered propofol, but our doc's don't see any real advantage. In an endoscopy center you get a flat rate per procedure so using more expensive drugs comes out of you pocket. I have not seen there is that much difference between propofol and sedation.

As far as doing the sedation we have policies and procedures just like in the hospital. Any accredited facility has to have those. It mostly comes down to trusting the physician that you work with.

As far as scheduling I really don't get involved with that, but I think there are a core group of full time nurses and then some that work part time to fill in so everyone gets there hours. As far as vacations, if we have someone on vacation then the manager pulls someone from clinic to get it covered. Essentially filling the endoscopy center has priority and it is up to the doc on vacation to get coverage. Also on those rare days that we have free rooms the nurses can get caught up on paperwork etc. I think most of the nurses are hourly with our CNO and a few of the charge nurses salaried.

I think the best statistic is that our core group of nurses have been there since the center opened five years ago and we haven't had an opening in more than a year.

David Carpenter, PA-C

Chuckie · Jan 29, 2007

I work parttime at both.

Love the interesting stuff at the Hospital. We do fewer cases at the hospital, but they are much more interesting, ERCP's PEG's Bronch's Bonemarrows, major GI Bleeds. I did get burnt out with pulling call. I was pulling half the call because we only had 2 RN's and 2 Techs. We have an RN and a Tech on call at all times. Pay is very good. Call back pay is great.

Endo unit is busy , no call no traveling to ICU. We do only healthy walking patients. They are in the Endo unit for and hour and a half then out the door. We do 36 cases a day in two rooms and work 4 10 hour shifts a week. The pay is 15.00 /hr less than the hospital pays.

I now work 1 day a week at the endo unit and 2 at the Hospital with a small amount of call.

core0 · Jan 29, 2007

I work parttime at both.
Love the interesting stuff at the Hospital. We do fewer cases at the hospital, but they are much more interesting, ERCP's PEG's Bronch's Bonemarrows, major GI Bleeds. I did get burnt out with pulling call. I was pulling half the call because we only had 2 RN's and 2 Techs. We have an RN and a Tech on call at all times. Pay is very good. Call back pay is great.
Endo unit is busy , no call no traveling to ICU. We do only healthy walking patients. They are in the Endo unit for and hour and a half then out the door. We do 36 cases a day in two rooms and work 4 10 hour shifts a week. The pay is 15.00 /hr less than the hospital pays.
I now work 1 day a week at the endo unit and 2 at the Hospital with a small amount of call.

We do about 36-40 cases per day. We see a big fatigue factor past that. Also its hard to get people to schedule after noon. We try to do more EGD's in the afternoon. I don't think that our pay is that different but probably $5-7 less than the hospital. The big problem with the hospital is that there are so few cases done there anymore they don't have the staff to support the call. We usually have one RN and then the nursing supervisor or recovery room nurse to help. Most of the hospitals only have 3-4 nurses on staff so that means at least one night per week.

David Carpenter, PA-C

GIRN · Jan 31, 2007

edited

Clem52 · Mar 12, 2007

A couple of things kind of concern me in this thread:

Cost determines the drugs used (propofol vs. sedation). The poster stated that there is not much difference between the two--but did anyone ask the patient? I don't like to think that the patient gets the short end of the "stick" for a few dollars worth of drug.

It sounds like a lot of cases per day in the endo facility. Can you really pay enough attention to each patient and their needs if you are doing 36 per day in 2 rooms? Sounds like a factory. Shove them out the door in 30 minutes. And you wonder why you can't get patients to sign up for the afternoon? They don't want to have fatigued nurses and docs doing them at the end of the day when they are tired, behind schedule, and hurrying to get done at the cost of patient comfort.

I try to be first of the day, even if it means a long wait. It's worth it to get fresh people sticking that thing up my bum.

core0 · Mar 12, 2007

A couple of things kind of concern me in this thread:
Cost determines the drugs used (propofol vs. sedation). The poster stated that there is not much difference between the two--but did anyone ask the patient? I don't like to think that the patient gets the short end of the "stick" for a few dollars worth of drug.
It sounds like a lot of cases per day in the endo facility. Can you really pay enough attention to each patient and their needs if you are doing 36 per day in 2 rooms? Sounds like a factory. Shove them out the door in 30 minutes. And you wonder why you can't get patients to sign up for the afternoon? They don't want to have fatigued nurses and docs doing them at the end of the day when they are tired, behind schedule, and hurrying to get done at the cost of patient comfort.
I try to be first of the day, even if it means a long wait. It's worth it to get fresh people sticking that thing up my bum.

I think that the propofol vs. sedation is more than just a few dollars worth of drug. There are some places that absolutely believe that it is safe for nurses to administer and others where the state BON is stating it is outside of the scope of practice. If you are talking about MAC then you are doubling the cost of the procedure (more or less).

As far as case load thats spread across 3 rooms. Our doctors limit this because they think that fatigue becomes an issue. There are other practices in our market that routinely do 18-20 per day per room. If you are used to hospital based endoscopy center then yes this seems like a lot. Hoewever in endo centers this is the norm. We rely on good nursing and a great charge nurse.

David Carpenter, PA-C

GIRN · Mar 12, 2007

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core0 · Mar 12, 2007

When your Centers opened, did they use a Management Company or did the Doctors do all the legwork on their own? Or maybe I shouldn't assume the Centers are doctor-owned. Who owns your Centers and who was in charge of the start-up work? Were any RN's hired to help set things up?

It is owned by the physicians. There are some around here that are owned by the management companies. We have a very bright CEO who did the legwork. They looked a lot at other centers to see what worked and what didn't. Our CNO was involved early on. We built the endo center as part of the clinic so it went up at the same time. They left one of the rooms unfinished since they had less doctors than they do now. They ended up finishing it 9 months after they opened and were making money after 6 months. The only bid mistake was not enough parking. Don't underestimate how much parking you need.

David Carpenter, PA-C

boriquarn · Jun 14, 2007

The major issue for me was working FOR the physicians...

In the hospital, I didn't have to tolerate the bad attitudes or issues and basically told them so.

But if you work for them, you have to deal with it and smile....

The physicians look at it like a business and will treat you as such.

The benefits will be just enough to be tolerable and the pay will be a little less than the hospital- unless they are desperate.

Remember, they are looking for profit, not your wellbeing or happiness and that it is a money making opportunity for them.