Updated: Sep 8
🧐Why I quit my Anesthesia job at Envision Healthcare - North Florida Anesthesia Consultants (NFAC), Would never work for this group again AND why I am considering leaving the anesthesia profession all together…
Seriously though. I would work at McDonald's before returning to work for this sad group again.
👉Today was the day the proverbial "straw broke the camel’s back" and I am seriously considering not being a practicing CRNA any longer... At least in Florida anyways...
Envision Healthcare, they run a monopoly on the anesthesia system here in Florida....
My experience with Envision (NFAC) started in November 2018, when I accepted a CRNA position covering L&D for 24 hour shifts…..
The on-boarding was rough to say the least, I can honestly say that I had a better on-boarding experience when I accepted a job as a sever at Pizza Hut when I was 18.
Sure, Envision Healthcare is an enormous healthcare corporation with over 48,000 employees, so some hiccups are certainly likely in this bureaucratic beast, but I was certainly never expecting to be treated the way they treated me... Which has been with complete disregard to the fact that I am an actual human being.
From the initial orientation to my last couple of weeks here, much of their systems and processes have proven to be rigid, broken, and of complete disregard for you as a professional and as a person.
Obviously, there are many nice, caring people who work here, and I am only speaking about my own personal experiences, some of which were good.
In my opinion leadership, as a whole at Envision is completely misguided and lacks any sort of common human decency or concern for anything other than profits.
Here is the story, keeping it as brief as possible....
The On-boarding Process From Hell:
The on-boarding process at Envision is one that is conducted 100% online in the form of dozens and dozens of inefficient, carbon copied emails, with people you will never meet. Some of these email communications are sent to your personal email address and some of the emails are sent to your work email address.
…..An email address, that, if you are like me, you will not even know you have, let alone be shown how to access it
….Until, there is a “miscommunication” that is.
I didn't receive any emails from corporate email, or even know that I had one until management was aggressively texting and emailing me to tell me that I missed my computer orientation they had scheduled me for…
This was just one of dozens of times that someone at NFAC could have, but failed to, proactively solve a problem that resulted from poor communication…..
NFAC's desk jockey MBAs and lackluster clinical “leaders” should get educated on how to pick up their phone and communicate like actual professional, by informing a new hire that they scheduled them for a class at x time on x date, seems like common sense, right? …
Simply use a communication method that includes confirming the intended recipient actually received your communication. You know, that closed loop communication stuff you learned about in middle school….Yes, the leadership here at NFAC possesses zero understanding of what closed loop communication entails..
Are you considering working for NFAC?? Ahhhh…You must be a rarity that embraces the concept of countless robotic and pointless emails that flood your inboxes which provide you with “vital company news”, such as the countless broadcasts about the “exceptional” achievements of the many layers of corporate managers and physician "leaders"…None of which you have ever met, or will ever meet…
Never once did I see an email recognizing what they refer to as a “mid-levels” for their accomplishments….
Don’t even get me started on the term “mid-levels,” a derogatory term whose use is supported by the physician lobby, a term whose use is intended to be offensive towards NPs and physician assistants and implies that the care we provide, is, oh, just middle of the road and subpar……
What is that stink you ask?? …. The fishy smell of physician bais?....Yup that’s it. It is pervasive and nearly palpable.
My first day consisted of me shadowing at my non-primary hospital for 4 hours…. No problem, except when I arrive, I couldn’t park my car because they never activated my badge… So I had to park in patient parking and beg for forgiveness from the security guard. Not that big of a deal, it happens I get it. ...I go with the flow
During my shadow time I was walked around the unit, observed a c-section, and tested my computer & pyxis access. Neither login worked, even though I went to the hospital computer lab to have my accounts setup…Okay, no big deal. I can roll with the punches, things like that happen. I fixed the issues before leaving, or so I thought....
My First Shift:
A week later it is my first shift at my primary facility, and I have a scheduled c-section in the morning… Great, I’ll get some hands-on at my primary facility!
...Then the problems emerge, I cannot even enter the hospital at the employee door because my badge was not activated, as I had thought. Weird. I wait for, and follow another Nurse through the badge only employee door….
I arrive at the CRNA call room to obtain the report from the off-going CRNA and I am handed a device called the Volte, it is a heavy smart phone type of device that works via wifi… I try to login to the system… Big surprise; It doesn’t work either, I was never set up with a login for the inconvenient 2 pound "smart" device….
….Interestingly enough, I learned that only the CRNAs and AAs are required to carry this oversized, unreliable device, aptly nicknamed he “brick” due to its unwieldly size and weight.
The almighty and powerful physicians at NFAC complained about the extraordinary inconvenience they suffered as a result of carrying this device and so they became exempt from using it….Instead they get to use an app on their cell phones, that’s convenient….
....CRNAs and AAs start to use the app on their phones, NO! it is strictly forbidden for "mid-levels" to do such a things, only the physicians are allowed to do so, and the order comes down via an email from the higher ups through the Chief CRNAs…
At NFAC, this double standards for physicians exist everywhere you turn… Take the 24 hour call shifts for example, CRNAs, yup they stay in-house 24 hours a day. The physicians, you guessed it, they will sometimes take call from the comfort of their own home while you do all the work and they earn their $350-$400k+ a year..
Back to my first day, I proceed to my c-section and fumble though my first case without access to anything, except that which was in my OR anesthesia cart (my access was never set up)…..
Thank god the case went smoothly because the physician who was “supervising” me didn’t know where anything was, and I mean anything.
.........Nor did he have access to any medications in the locked medication system, but why would they, they don't actually do cases...Scary……The case ends, Back to the security office to fix my non-working badge... Followed by a bunch of wasted time on telephone hold to correct my computer access problems….
A very similar series of events also played out the first time I worked at each and every facility…. Again not terribly uncommon, there is certainly room for a ton of improvement…
Clearly, NFAC has no clue how to properly on-board new staff members. After all, how difficult would it be for them to have an in-person orientation; One where they get all of these potential access issues addressed from the start… The same series of issues that the practice manager acknowledged to me happens repeatedly with each and every new hire... Yet no solution sought out or attempted by the top performers here at NFAC.
A little secret, it is not hard to fix these problems, they just don’t have any competent problems solvers in leadership roles..
So that was just the beginning of this cluster F%$@$ of an anesthesia group…. A group that is rapidly replacing Certified Registered Nurse Anesthetists (CRNAs) with minimally trained Anesthesiology Assistants (AAs) at lightning speed!!
A group that is staffed by over 50% AAs, A group were the doctor must “supervise” your every move…..
Yes, you must even be “supervised” for a healthy labor epidural at 3 am… The CRNA preops and prepares and waits for their physician “supervisor” to arrive so the they (CRNA) can place the epidural....
...The “supervisor” finally arrives, walks up to the patient and states something to the effect of “Hi, I am your Anesthesiologist. He/She (referring to you) is your NURSE anesthetist”
…Some of them seem to enjoy making the word nurse sounds so lowly and incapable…. Some of the physicians even enjoy referring to you as “my nurse.” …Soo condescending and unprofessional
For the record, I am proud to be Certified Registered Nurse Anesthetist. This credential is the most rigorous credential one could earn as an Nurse or even Nurse Practitioner for that matter... Nurses are caring and compassionate, that is why I chose to become one...
But, apparently here at NFAC, my 8+ years of studying nursing and several years of advanced practice anesthesia training, and tens of thousands of clinic experience mean nothing here.... Neither dose my 8 years of experience in the Navy Reserve Nurse Corps, 5 of which I have served as an INDEPENDENT anesthesia provider....
You have an OR case that needs to start, but your “supervising” doctor is busy observing an induction in another room.... Everyone waits… and waits….. and waits… including the patient, the nurses, the surgeon, everyone.. You grow increasingly frustrated this inefficacy and massive waste of time and hospital resources.
…The funny thing is that you have done thousands of cases without a “supervising” physician watching over your shoulder…In fact, you just returned from 3 years of practicing in an independent practice state, yet, because your family is in Florida, you subject yourself to this nonsense that takes place here…
This is all too common of an experience here in Florida. I know, I trained and worked in Orlando. Which, although the physician bravado was still deeply pervasive, at least that group was run like a well-oiled machine and it felt much more like a family. Leadership there went out of their way to make your day great and everyone was respectful and friendly…
The working experience with NFAC has been bad. Bad, even for Florida standards. So bad you start to question your decision to practice in Florida again….You even question why you got into this profession in the first place.
Back to waiting in the OR.... The “supervising” anesthesia physician arrives…. Now, and only now, is it “safe” for the CRNA to start a case… Or so everyone is trained to believe anyways.
Oh, and some of the surgeons…. Good luck if they even acknowledge your existence… They are in cahoots with your "supervising" physician and the entire physician lobby
Why? Your “supervising” physician has often and subtly led everyone in the room to believe that CRNAs (and AAs) are incompetent and are therefore offer little in the way of conversational value….
To that, I say follow the money trail....Specifically how billing works in anesthesia...If you do, you will learn why the physician anesthesiologists created the AA profession while simultaneously they demean and belittle the CRNAs... A little hint....They make A LOT of money from the services we provide...
That was just the start of my mentally exhausting experience with this huge, cold, corporate anesthesia conglomerate, where you are treated like you are oh so dispensable and simply an insignificant cog in the wheel of a heartless corporate machine…
Changing The Schedule:
....Less than 3 months into the position, I get a call at home from an Anesthesiologist.
"Jason, we are changing the schedule. We have ran the numbers, and we are getting rid of the after-hours and weekend call team. The L&D CRNA (you) will now be responsible to cover all add-ons and emergency cases from 4pm to 7am and all weekend. It's just not cost effective to have 24 hour CRNA coverage" they say....
....Meanwhile they are paying for 2 providers (1 CRNA and 1 Physician ) to be on 24 hour call, but only one of these to people are required to stay in-house for the entire 24 hours....
Yes....You are correct to assume that the CRNA stays, and the physicians leaves at their leisure to go shopping, meet their family for dinner, and even sleep at home during a slow night.
You, meanwhile, are allowed to handle minor patient issues, process their paperwork and neatly stack it in their office...
The Shift I Offer To Cover:
My real issue with NFAC started on the back of yet another “miscommunication.” I volunteered to cover a shift at my primary facility to be a team-player and help out….
....Boy was this a mistake!
I arrived for this shift at my scheduled location and was told that I was at the wrong facility….. Hmm that’s strange, I have emails in my personal account from “leadership” stating that I was covering the shift here…
Later, I discover that “leadership” decided to change my schedule and send me to the busiest of all the facilities…
...How did they attempt to notify me you ask..??? They sent an email to my corporate email account and scolded me for not checking this email on my days off... I attempt to login to view the email.. And guess what? My email account was disabled by corporate incompetence several weeks prior, so even if I tried to login I couldn't have.
Being switch for a shift a the busy hospital is okay though, I like being busy, it makes the shift fly by....
And hell, I already put my 60 day notice in, I only have a handful of shifts left with NFAC… What do they care if they inconvenience me… After all, I am disposable and leaving anyways, so lets just take advantage of his even keel, go with the flow attitude….
I drive 40 minutes to the other hospital, a drive that was interrupted by phone calls and text messages from various individuals at NFAC, including one from the CRNA that was required to stay late until I arrived… I felt bad for her and was sorry she got stuck there…
The physician could have started the case and sent her home… but here at NFAC, anesthesia physicians exist to “supervise” and walk around standing tall with their chest out, after all, they are very important and indispensable leaders of the Anesthesia Care Team, and no CRNA or AA can function without them, or so they seem to erroneously think…..
How delusional can they really be??? Tens of Thousands of CRNAs, including myself, have performed anesthesia independently and safely for years….. without an anesthesia physician in sight… Hell, often times without one in hundreds of miles…
So now is where these cold-hearted “leaders” at NFAC really got my sympathetic nervous system fired up….
...And ultimately threw me over the edge into writing this post.
March 8th my wife delivered our first baby, Aria. She was born 3.5 weeks early and has had trouble with jaundice, improper feeding and flipped sleep cycle… She had to go to multiple appointments for medical evaluations and lab draws since she was born….
March 22, I was starting a stretch of heavy work. ....In fact, I was schedule 96 hours over eight days, normally not a problem, I have worked 120 hours in eight days as a solo anesthesia provider in the past..
But my wife is struggling, severely sleep deprived, and needs help caring for our first premature new born, who is failing to thrive…
So, I do what any responsible professional would do, I email my colleagues and ask if someone would be willing to work a shift for me…. My family needs me at home...
Not So Fast!
My email is intercepted by the Chief OB CRNA who CC’s all the superior “leaders” and she tells me that I need to fulfill the remainder of my contract, and that having someone cover my shift is not authorized, I have no PTO left ….
I reply to all: “I do not intend to use PTO, this is a shift coverage request. I won’t get paid, the person covering will get my pay”
I receive a reply from the Chief Physician: “For a variety of reasons ranging from differences in compensation to budgetary constraints on per diem utilization, we cannot just have someone pick up your shifts and call it even….”
I further explain: “I will gladly settle-up any differences in pay that result with the HR/payroll department”
The unempathetic physician “leader” replied back: “We expect you to work all of your assigned shifts. They cannot be traded or reassigned.
.....What a wonderful, caring human being this physician is 😡
Yes, this was the exact word-for-word, and heartless response from management at NFAC….
They do not care about you or your family… NOT ONE IOTA!
Get used to it though, at NFAC you are just a revenue generator... A revenue generator who ultimately gets paid less, so that you can fund the bean counters and thick layers of unskilled managers... Oh yes, AND your "supervising" physician's exorbitant salary.
Become a cost center for this company, even for one shift, and they will chew you up and spit you out.
Lets recap, A new dad with a failure to thrive premature infant, offers to find his own replacement for an UNPAID day off, and even offers to reimburse the company any expense caused as a result.....
And the icy cold, lack luster, poor performing “leadership” at NFAC responded with what equates to a giant “F#$% You, We could care less about you or your family. You will work when we say you will work”
For these reasons, I have zero intention of ever working for such a horrific debacle of a company also known ever again.
I caution anyone considering doing such..
…The mass exodus of CRNAs and the mandatory bonus with a 2 year commitment should have been a red flag, but these guys are smooth talkers and they suckered me in.
How Do You Spot A Company Like This Before It Is Too Late?
Misguided organizations such as this, are the ones forcing people to take sign-on bonuses that are falsely marketed as "start date" bonuses….The reason you ask? They want you to spend the bonus money so that you are beholden to them, their ever-changing terms and unreasonable demands..
Lucky, I didn't fall for all their tricks... I stowed the bonus money just in case things turned for the worse... Turns out they did.
I'll escape their prison sentence in five long, painful shifts...
Words of Caution:
🛑THEY WANT YOU LOCKED IN THE GOLDEN HAND CUFFS, ENSLAVED, INDEBTED, AND FORCED INTO MISERY IN THEIR DEMEANING PRACTICE MODEL
My salvation has been my entrepreneurial drive. I have businesses and several streams of income and therefore do not have to take the incompetence and mistreatment that NFAC delivers exceptionally well, oddly enough, it is the one thing they appear to be exceptionally good at...
👉Some of you probably think, I may be the “problem child” or the “difficult employee”.... To set the record straight, I can tell you, just ask anyone I have worked with if that is the case. I am friendly, polite, a team player, and somewhat quiet. I never miss a shift, if I need a day off (which is rare) I get my shifts covered myself. I stay late when asked and pick up extra when needed.
*As I mentioned, before, there are some very nice people that for some god-forsaken reason succumb to, the mistreatment of the management here and they are okay with that. I have nothing against them at all, even though they are unwittingly contributing to the growth of this nasty group and the destruction of the CRNA profession… There are also many very polite and friendly physicians at this group who respect the care we deliver.
However the overall culture of NFAC reeks of a massive physician power-trip and overarching corporate ineptitude.
P.S. ......Oh, and I forgot to mention the fact that I did not get paid until nearly 2 months into working at this position... That alone was a battle, I could go on and on, but I will spare you.... I think you get the idea....
My Advice To You:
#1. Beware of large mismanaged groups like this.
#2. Always have multiple streams of income. Do not be 100% reliant on your J.O.B, otherwise you could be forced to subject yourself to mistreatment and corporate incompetence.
#3. Work Hard & Stay Humble.
#4. Live on purpose.