Clinical Component

Navigating the Clinical Component

This is a production-based practice where physicians are assigned to operating rooms, work their cases, and generate units. The work is busy and the earning potential rises directly with case volume. On block days, physicians can expect five to eight cases. The pace varies day to day, with a busier day often followed by a lighter one as the schedule rotates.

Physicians handle their own cases with no CRNA supervision. The general anesthesiology positions cover the full range of surgical and procedural work across the three hospitals, excluding cardiac. Cardiac cases are completed by cardiac fellowship-trained physicians at Fresno Heart and Surgical Hospital.

Case Environment

• Five to eight cases on a typical block day
• Full surgical and procedural range across the three hospitals for general roles
• Obstetric coverage at Clovis Community and the downtown site
• Trauma coverage at the downtown trauma center
• Bariatric and neurosurgical cases at Fresno Heart and Surgical Hospital
• Endoscopy and high-volume procedural rooms available to first-call physicians

Operating Room Schedule

• OR start time is 7:00 AM
• Between 3 and 15 OR start times per day depending on the site being covered
• Daily room assignments released the afternoon before, beginning around 2:00 PM
• Physicians select rooms in call-position order; remaining rooms are assigned by startup unit value

Room Selection

The group uses a call-number list to keep room assignments fair. The first-call physician picks first and can choose the highest-value room, often a high-volume endoscopy room, and each subsequent physician selects in order. Some physicians choose the most productive room, others select the surgeon or service line they prefer to work with.

Call Structure

• Roughly one weekend of call every five to six weeks
• About two calls per week, most structured as home call rather than overnight in-house
• Approximately three to four in-house calls per month, split between OB and trauma, plus one or two home calls

Call Experience

The downtown trauma shift is a backup role. An independent CRNA group covers the operating rooms overnight, and the physician steps in only to start a case when an emergency arrives, then hands off to the incoming call physician. Most trauma shifts stay light. Clovis call is not trauma-based; overnight call-ins are limited to cases such as an ectopic pregnancy or an urgent bowel case. Physicians on Clovis call are typically finished by early evening and sleep at home.

Post-call time off is protected. More than 95 percent of the time, physicians are off following OB or trauma call, with only an occasional add-on during busier stretches. Physicians who want additional work can trade for more rooms and calls.

Scheduling

• Monthly call schedule published about two months in advance through Amion
• Vacation set a year in advance, with the ability to trade weeks
• Flexible enough that some physicians build 24-hour-heavy schedules while others work primarily weekdays