Episode 63: Unpacking COVID’s Impact On The Anesthesia Job Market w/ Kyle Hadley

This week I’m talking to Kyle Hadley at LocumTenens.com. Kyle is connected to many health systems, hospitals, and private practices with regards to their employment needs. Today we’re doing a deep dive on some of the things impacting jobs for anesthesiologists. Covid has been a huge factor and I’ve heard of a few docs that have had job offers rescinded, many who have been furloughed, and others who haven’t been able to find jobs. I think in the long run, you should be optimistic about your employability, though we’re certainly in some short term weirdness. It’s also not a bad idea to think about doing locums for a little bit while you’re waiting, if you’re willing to work some tough shifts you can make a whole year’s worth of salary in just a few months.

Justin (01:28):
So there’s definitely options if you’re willing to think outside the box a little bit. And I think in the long run, things are definitely gonna return to normal. And I would say normal is strong demand for the services of an anesthesiologist. So thanks for tuning in hope you enjoy today’s episode.

Justin (01:45):
Hello and welcome to episode 63 of the anesthesia success podcast. I’m very pleased to be joined again by a now friend of the show. Kyle Hadley, Kyle, welcome. Thank you, Justin. Happy to be here. And Kyle is one of our resident experts on the anesthesia job market. And we’re going to be talking today about the impact of coronavirus on anesthesiology employment, specifically for physicians and, and what it means for people who are trying to either transition into an attending role or maybe switch jobs and looking at all the different ways that coronavirus has kind of turned a wrench in things some of the micro and macro trends, and just think, what does it mean for someone trying to find a job right now? So Kyle really excited to do it again to this with you, you may recognize Cal from episode 17, if you missed that one, we talked about locum tenens and what that means is just a physician who’s working in the place of another physician who is taking a long term leave of absence for some reason, or an organization that has a staffing shortage. So Kyle is an expert at getting the right position in the right place for organizations that need them. And we talked about how to use locum tenens to get yourself on the fast track to financial independence. But today we’re talking about employment more generally. So Kyle, what are you, what are you seeing out there?

Kyle Hadley (03:01):
Yeah, thank you so much, Justin. I’m I’m happy to be here. So as you said we are, we are experts in this market and get to see a lot of the the trends, you know, locum tenens.com. We are literally connecting physicians and PA to patients across the country. So we work in all 50 States and we work with private groups. We work with large management companies who work with hospitals and also surgical center. So we get to see a little bit of everything. The past year has been extremely interesting as COVID-19 impacted the, the health care market, you know, we experienced like many people challenges prior to this anesthesia for the past 24 months has been one of our top required specialties when it comes to physician requests. And when, and when Mark the elective surgeries started to decline it was very drastic and immediate, and it had a, a large impact on our market.

Justin (04:06):
When you said the top four physician requests, what does that, does that mean? It’s the most sought after one of the most sought after specialties is what you’re saying?

Kyle Hadley (04:14):
Correct. So over the past few years, anesthesiologists and CRNs have dominated the the search.

Justin (04:21):
And so what we’ve seen recently obviously is, you know, I’ve had clients who’ve been been impacted by this and a lot of just friends friends of coworkers of my wife, my wife at, at Penn and people, you know, for the first time in recent memory, like finishing residency and kind of looking for a job and not being able to find one because of the, the shock to the system that coronavirus has had. So talk a little bit about sort of the elective case volume drop off and, and how that’s impacted things.

Kyle Hadley (04:49):
Yeah, so the immediate impact was significant. What we saw was throughout the entire United States, we saw a a dramatic drop in elective cases, which meant less of a need for surgical services. And that obviously includes anesthesiologists and CRNs we, we did see quite a bit of furloughs and layoffs throughout the country. What we are seeing is an uptick in electives now mostly in areas that were not impacted heavily. So sites like New York and other sides that experience hotspots, they’re a little slower to increase the amount of elective cases they’re having. But throughout the U S we saw an immediate impact where people they’ve declined the amount of electives that they had, so they could create room for a potential increase in COVID-19 patients where they would need acute setting. So ICU, so they were turning ORs into beds. Right. And

Justin (05:58):
Have you seen it all, have there been any types of practices, whether it’s like the big private groups or academic centers that have been more impacted by this dynamic than others?

Kyle Hadley (06:10):
So I think groups, private groups were, were impacted pretty significantly actually, locum tenens that come, we did a survey, roughly a 62% of CRNs and anesthesiologists were furloughed. And we also looked at like what people were concerned about the future of their practice. So for, for group settings 65% of groups said that they had either mild concerns or major concerns about the future of their practice.

Justin (06:40):
And that’s from the private groups specifically, correct? Yeah. You said 60 somewhere in the sixties was the percentage of groups that had to furlough either CRNs or anesthesiologists. That sounds like a huge

Kyle Hadley (06:53):
Number. Yeah. 62% had to the furlough or lay off their medical staff. And that’s where the regards to the anesthesiologist anesthesiology specialty. One thing to note there though, I mean, over the past few months, we’ve seen an uptick in require or requests for anesthesiologist. So we’re are at five times the amount of whenever COVID hit. So it, the jobs aren’t coming back, so the Shirley,

Justin (07:23):
Yeah. And you said they’re coming back most quickly in areas that are unaffected, so, or that were, I’ll say relatively unaffected. What can you maybe share? Like what, what are the geographic locales where you would say, this is like a hotspot for need for anesthesiologist right now?

Kyle Hadley (07:39):
Yeah, so honestly it, right now we have jobs in 36 States for anesthesiologist. So there’s not a specific site that is looking for candidates, and there’s not a specific geographic location. I can tell you that the locations that were impacted the most heavy, whether it be, I mean, there’s certain cities in certain States that maybe were impacted more than other cities, those locations are likely to, to build electives a little bit slower.

Justin (08:11):
What kind of conversations are you hearing? And are you participating in among the, you know, some of the healthcare power brokers that I know you, you have occasion to talk to or listen in with on occasion?

Kyle Hadley (08:23):
Yeah. I mean it’s, it’s obviously a fluid situation. Then the most important thing right now is for hospitals to take care of their communities. So they are still making it a priority and, and thankfully, so, but to take care of the COVID patients and make sure that they have all their risks mitigated with regards to acute care and being able to service their communities as, as you probably know, there were, there are a lot of financial implications on the system and the health system in general when COVID-19 hit. So a lot of the groups are, are taking action to bring electives back slowly but surely as stated before, but in hospitals are doing the same because without surgery, they truly don’t have a revenue stream. And some of these critical access hospitals throughout rural United States, I mean, they are being impacted significantly.

Justin (09:20):
Yeah. And obviously having the anesthesia staffing necessary for the surgeries to happen is going to be an important part of the financial sustainability and viability of, I mean, not only the, the rural areas, but even like in the Metro areas. One of the things that I’ve been seeing is on a very micro level, like one anesthesiologist, one job in sort of that dynamic is that a practices have been, you know, I I’ve seen plenty of people get hired in the last three to six months, but, but also it has impacted the negotiating dynamics or at least this is sort of how the practice has kind of played this and anybody listening out there, I’m always going to be the advocate for the independent physician, independent practice and the little guy trying to equip physicians to, you know, do the best they can get the best deal.

Justin (10:09):
They can, the most proper fit for employment and have all the, all the facts that they possibly can going into negotiations or things like that. What I’ve been seeing is you know, when a physician would try to negotiate the initial offer, they kind of just come back with up, sorry, COVID take it or leave it. And frankly, it has been a time of not a lot of leverage for the individual physician, because it is true. There’s a, we’re on like a little, you know, we’re in a unique period of time where there for a short period of time there is you could call it a glut. There, there’s more people seeking this type of employment than there are slots for employment for anesthesiology. And so the leverage has swung a little bit to the employer and I’ve seen like, Oh, signing bonuses or, you know, any of that relocation bonus that frequently would be part of the deal has been a little bit tougher to come by.

Justin (11:00):
One of the things that I’ve been encouraging people to do is to discuss a retention bonus for anybody who is looking for a job, if you’re able to find something in the near future, and the practice comes back and says, you know, here’s the initial offer. And you say, you know, maybe you can give me like a five to 10% signing bonus on top of that. And they come back and say, well, coronavirus, it’s terrible. Like you’re lucky to be getting the job offer. One of the things you can do in that context is to say, how about a retention bonus, which is, you know, if I’m still here in 12 months, things are going well, cashflows support it with the practice and maybe put another couple quantifiable metrics around it. That’s a way that you can acknowledge the crazy situation that the practice that’s hiring you was in and still want to be a team player and defer some economic benefit, but still looking for that economic benefit, knowing that you’re rightfully do it.

Justin (11:54):
So one strategy for anybody out there right now, looking for a job think about the, if you get an offer, think about the retention bonus as sort of a counter counter to the signing bonus. If they say, sorry, COVID blow us up. And there was no chance that you’re gonna get that. What other, what other kinds of things are worth keeping in mind, Kyle, as far as, you know, anesthesiologists out there, especially just finishing training, maybe even just finishing fellowship, looking for a job, what kinds of things do you think they should be aware of as far as different types of practices, different geographic, locales, different things that you’ve seen that might be helpful.

Kyle Hadley (12:28):
Yeah. First I want to touch on, on kind of what you just, you outlined. So I think you, you hit the nail on the head with the market and the glut. It’s very interesting because right now, more than ever, you have private practices that were impacted by know, elective surgeries right now there’s some uncertainty around their future. And with regards to just unemployment in the U S understanding, are there going to be more uninsured patients? The assumption is probably yes. So they’re making decisions right now to keep the their physician groups going forward and trying to stay solvent. So one thing I would say is just consider that, and I really liked the idea of the retention bonus. Consider that though, and being a team player, if, if you are trying to get into a group that you’ve always wanted to be a part of look at the long term of it, not so shortsighted because you know, people will remember the way you handle situations like this whenever they need you with regards to your other question.

Kyle Hadley (13:37):
I mean, I, I think now more than ever would be a perfect time to try locum tenens work. So if you’re a physician like your wife out of Pennsylvania and you wanted to go to a spot that wasn’t hiring because they’ve been heavily impacted by COVID-19 and it was your dream job, it’d be a great opportunity to potentially take a locum assignment for maybe where you were born to go be near family. You’re going to have flexibility with regards to a schedule. Your commitment level will be lower from an administrative standpoint and leadership standpoint. You can even consider things like trying an opportunity before going permanent. So there may be a job out there that you have considered before, but you weren’t sure if you would like it, you could go try it out and see what it’s like. Also, I mean, it’s a perk, but compensation is, is typically higher. When you work a locum assignment than a W2, you’ll be covered with your malpractice.

Justin (14:36):
Let’s talk about that. Cause we like to talk about money on this show. So if somebody is like, I want to do locums, cause I heard I can make money and I’m looking for a job and maybe I should call Kyle let’s, let’s talk Turkey. You know, you can send me to some interesting city and you know, I can work there and make some money and there’s like a daily rate of pay and you’re going to pay for my hotel and pay for my malpractice. Let’s give me some numbers around that.

Kyle Hadley (15:00):
So on average, I mean, so it’s always going to depend on the, the type of setting, right? So your compensation’s determined by a lot of factors and some of those are geographic location. So if you go work in LA, you may want to go there cause it’s a nice place. You’re likely gonna make less money than if you were to go to Muskogee, Oklahoma. But if you were, if you were trying to make as much money as possible, my suggestion would be to contact a recruiter or, or, or if you took a job on your own, but identify opportunities that had call in house call preferably that’s a typically a 24 hour rate pay hourly. And then work as many weekends as you can and also as many hours as you can.

Justin (15:50):
Yeah. That sounds like something you don’t want to do for too long, but perhaps for a period of time, you can stack a little paper. That’s where the flexibility

Kyle Hadley (15:57):
The schedule comes in. So you do that for a few months. I mean, a lot of people can make five to $600,000 and you know, three to four month period, what if you’re doing an in house call? It is.

Justin (16:08):
So tell me about that 24 hour call pay rate, like how you said paid hourly. How does, what does that mean? How does that work?

Kyle Hadley (16:15):
So typically we would just if you were on an assignment and you wanted to take in house call I’ll give you an example. We had a physician who had incurred quite a bit of student loans and just like many people do and he needed to pay them off quickly. So he negotiated with us to go to job in Oregon. And he did in house call OB shift. He did it for six months and paid off his student loans and one year,

Justin (16:48):
Wow. I’m surprised that these numbers have never come up in this conversation conversation before. I’m like, man, I’m going to tell Sarah, we need to fix him in house, calling Muskogee for a little while. Okay, cool. And so talk a little bit about, you know, one of the things to consider here, obviously. Okay. You’re throwing these big numbers at me. That all sounds great. But what does it mean in terms of, you know, I’m afraid of coronavirus or I don’t want to be intubated COVID positives all day. If I can avoid it, what if I get sick on the job and you know, w w what are the allowances that you’re making around those types of situations?

Kyle Hadley (17:21):
So that’s, it’s been a very fluid situation. And just the decision making around that has been very challenging because we found new information every day, right? So we still servicing clients throughout the entire United States. And our number one goal is to take care of the physician that’s on assignment through our agency. So what we did was we made our contracts. We made it where if a physician is uncomfortable due to limited PPE or if they have concerns about their health, we will work with them on that situation. We wouldn’t hold anyone accountable in. We, we typically ask those questions. What amount of PPD you have, what amount of COVID patients do you have, and if they’re able to tell us they do, and we share that information with a physician that we’re sending, unfortunately, it’s a bit unpredictable on where the next hotspot may be. So if a physician gets to an assignment and they’re overwhelmed, or they feel uncomfortable our number one goal will be to take care of them. I will say that we’ve had just as many, if not more calls asking if we have COVID needs, where we could send people to work in ICU, which we, we did deploy we’ve deployed about a hundred physicians and CRNs up to the Northeast to services patients. And in March and April,

Justin (18:50):
It sounds like a macro trend for the need for anesthesia is still really, really strong. Another thing that’s happening is that, you know, surgery centers are becoming more and more an important part of the healthcare ecosystem, more and more procedures. I think total hip arthroplasty is just got approved for surgery center on the surgery center, approved procedure list. So it’s like same day in and out hip replacement, which is crazy. And as more and more surgeries get pushed to those many different sites of service, you know, the number of sites of operation is increasing. And so the anesthesia is still very necessary and it has an increasing need. So, you know, at a high level, I’m always telling people like, there’s, there’s no, I, and I’m curious in your thoughts in this car, like, there’s no signs of this slowing down.

Justin (19:38):
And furthermore, there are certainly macro headwinds right now by that. I mean, like coronavirus has dislocated the job market, and it’s hard to get the right job in the right place right now, just because of these factors. But if you’re one person who only needs one job, then macro factors can be overcome. So I’d also encourage people like network reach out to your, you know, your mentors, other people in your community, and the, the system that you’re trying to get into in the department, like, you know, work the phones, send the emails, get the coffee, the virtual coffee, if you need to set up the whatever informational zoom interview, have those types of conversations as frequently as possible because persistence is going to pay off a uniquely in these types of situations where everything is challenging, the people who land on the top of the pile of the HR manager’s desk most frequently are going to be probably statistically the ones that get the attention. So don’t be discouraged if it has been tough for you, just keep at it. And the macro headwinds can be overcome by the micro persistence and effort on the part of the job seeker. I would say. What, what do you think about that co?

Kyle Hadley (20:49):
Yeah, I absolutely agree. I mean, and it’s funny that you pointed out the different practice settings and location. I mean, that’s, that’s certainly a driver in the growth of Anastasia demand. I mean, it’ll be attributed to the practice settings and location such as there’s going to be hospitals micro-hospitals AFCs office based practices. Those places is as they expand it’ll amplify the need of, of anesthesiologist also. I mean, you, you touched on it briefly, but COVID-19 is here now and it had a significant impact and it’s having a significant, significant impact. But I mean, I believe that eventually this will be under control and then the demand will still be there because you still have an aging population. And you know, the anesthesiologists that 31% of ASA members are gen X or millennials. So that means everybody else is older than that.

Kyle Hadley (21:50):
And there, I think I saw that dr. Peterson from the ASA said that 1800 physicians a year are coming out, coming out and those are going into critical care and pain. So the market doesn’t have enough physicians, and that’s just a fact but temporarily it’s been impacted by COVID-19, but as that passes, whereas it gets under control. The demand will still be there and there are, there are a lot of jobs out there for anesthesiologist. So I want your listeners to know that they are in a good profession and a good line of medicine that has plenty of ’em.

Justin (22:26):
Yeah. You’re saying these numbers and I, I hadn’t heard that one before you said 1500 anesthesiologists a year or boarded, is that what like finished residency and,

Kyle Hadley (22:35):
Yeah, so I think I read that 1800 according to dr. Peterson. Yes.

Justin (22:41):
100. Okay. Yeah. I mean, and this is a, a number that’s set by law through CMS, the amount of seats funded for residencies. And, and this is kind of a hard cap that requires, I don’t know if it’s a legislation or how the CMS sort of answers this question about funding for these residency seats, but it’s going to, it’s essentially, like we could say artificially artificially capping the number of doctors we can create each academic year. And so, you know, in a market where you’re an anesthesiologist, that means there’s just never going to be many more of them, which puts you in the power seat as an anesthesiologist to say, like, I’m in demand, I have a specialty that’s in demand and it’s going to continue to be in demand for a long time. And if the, if CMS waved a magic wand tomorrow and said, we’re going to double the amount of you know, CMS funded residency programs that exist, which by the way, would be a massive logistical challenge.

Justin (23:36):
Even if that happened, you’d still be looking at four to six years before even the first batch of those anesthesiologists were minted. And I think I heard some it’s like since 1992 or something, the number of many of these specialties hasn’t been increased. I’ll, I’ll look that up and throw in the show notes because it’s an interesting data point, but the fact is our demographics have shifted massively in the last 20, 30 years. And, you know, the baby boomers are starting to need all these surgeries and it is a time of desperate need for anesthesia illogical surfaces. I just made a word up there. So Kyle, any other sort of parting wisdom or things that you want to share for people who might be curious in either the marketplace and employment dynamics or wondering about the locums opportunities that exist? I mean, one thing I just want to point out that, you know, based on the, a lot of the things I’ve been reading if, if COVID-19 continues to be, be under control and we don’t see as many hotspots, I believe that a lot of the groups like the private groups will be there past kind of the most significant impact.

Justin (24:47):
So it takes 60 to 90 days for them to truly collect typically. So they were really impacted in March and April. So by June and July, they, they should be doing much better. And as long as elective surgeries are coming back jobs will be coming back. So just your listeners are in a very good and strong specialty. And there are going to be plenty of jobs out there. And temporarily they may have to choose a different geographic location. But, but things are trending up. So it’s, it’s good news. Yeah. Awesome. Well Kyle Hadley really appreciate you speaking with us today. We’ll throw some extra resources in the show notes. So if anybody else wants to see what we’ve referenced here today, anesthesia success.com/ 63. You’ll be able to see CA cow’s contact information. Kyle, what’s your email address in case anybody wants to reach you? It’s K Hadley, K H a D L E y@locumtenensdotcomlocumtnens.com. Awesome. And as always, everybody, thanks for listening. And for the job seekers out there, good luck. Feel free to drop me a line. Let me know kind of what you’re looking for, how it goes. That would love to be a resource if I can and wish everybody out there all the best. Thanks so much, Justin.

Justin (26:07):
If you liked what you heard this week, head on over to anesthesia success.com, where you can find more content and free resources to help you build a successful career in anesthesiology and pain management. If you want to leave a review in iTunes, I would also really appreciate it. Thanks for using some of your valuable time to join me today on the anesthesia success podcast.