It took two partners’ nights and weekends to run one anesthesia group’s schedules. Now one partner does it in five minutes. From his phone.

Dear Doctor,

It’s Sunday night. Somewhere in your group, a partner is sitting at a kitchen table with a laptop open to Excel.

Next month’s call schedule is due. There are eleven emails to reconcile, two texts, and a hallway conversation from Thursday that may or may not have been a real request. Dr. K can’t take call the weekend of the 19th. Dr. M is back from vacation on the 8th — and does the Monday after count as a recovery day? It always has. Nobody wrote that down. It lives in this partner’s head, along with about forty other rules.

When the schedule goes out Tuesday, the first reply will arrive within the hour. It will be about fairness. It will be at least half right. And fixing it will cascade through three weekends of assignments, which means another evening at the kitchen table.

This partner trained for a decade to deliver anesthesia. This is not what the training was for.

Everyone in the group knows he’s drowning. Everyone is grateful. Nobody volunteers to take it over, because taking it over means inheriting the fights: who got stuck with the bad weekends, whose vacation got trimmed, why Dr. So-and-so has three Mondays in a row.

If that partner is you — or if you feel a little guilty every time the schedule arrives, because you know what it cost — keep reading. This letter is long because the problem is real, and I’m not going to hand-wave at it.

Our first customer is Trident Anesthesia, a private anesthesia group in South Carolina. For years, it took two partners to run their schedules.

One partner gave up his nights and weekends building the daily schedule — who’s in which room, at which facility, every day. Pencil, paper, and Microsoft Excel.

Another partner did the same thing, nights and weekends, for the call schedule — the rest rules, the weekend rotations, the vacation protections, the quiet politics of who gets Thursday call and who eats Friday.

Two full partners. Two sets of lost evenings. Two people who couldn’t take a real vacation, because the spreadsheet couldn’t run without them.

They’d seen scheduling software before. Here’s what actually happens when generic scheduling software meets a real anesthesia group: the software becomes a bulletin board. The partner stays the machine. The tool records and distributes a schedule that a human still constructs by hand, because the rules that make the schedule hard — the tribal ones, the ones living in one partner’s head — never fit in the settings screen.

So we did the opposite. We built this system in Trident’s conference room, sitting next to the partner who’d been doing the schedule for years, following one rule:

Today, one partner at Trident runs both schedules. It takes about five minutes. He does it from his phone.

That’s not a demo-day promise. Trident has been publishing its schedules from this system for six months, on a paid contract — and when the managing partner heard the monthly price, his exact words were “that’s cheap.” I’ll name the price later in this letter, because I don’t believe in making you book a call to find out.

What changed wasn’t one thing. It was three.

Here is how scheduling requests actually arrive at an anesthesia group. You know this, but say it out loud once:

An email. A text. A different email, to a different partner, three weeks later, contradicting the first one. A conversation in the hallway outside OR 4. A voicemail. “Oh — I told you about that at the Christmas party, remember?”

The scheduler-partner is the human database for all of it. Every request must be found, decoded, remembered, and transcribed into the spreadsheet without error. One missed email and Dr. R is on call during his daughter’s wedding, and now there’s a story people tell about the schedule for the next five years.

Here’s what we did about it.

Every doc gets a calendar on their phone. They tap a date, pick “Vacation” or “Prefer off,” and hit submit. That’s the whole workflow. Pending, approved, denied — each visible at a glance. They can withdraw a request themselves. No email required, no wondering if it landed.

But docs never fully stop emailing — someone will always send “No call Wednesday 6/10 (board meeting), no call the weekend of 6/19–21, no call Friday 6/26 — Saturday is fine.” That message is a ten-minute transcription chore, and it’s where errors are born.

So we built a reader for it. Paste the email in, and it extracts the requests into a table — clinician, dates, type, reason — with a confidence score on every row, so your admin knows exactly which lines to double-check before anything is approved. Your group can even get a forwarding address, so scheduling emails land in one shared inbox and get triaged automatically — with a hard safety rule we refuse to break: emails from facilities about coverage needs are never processed automatically. Those always wait for a human. Requests get automated; commitments get a person.

Every request — tapped, emailed, or parsed — lands in the same queue, feeds the same schedule, and leaves a paper trail back to its source. Nobody’s memory is load-bearing anymore.

In most groups, annual vacation allocation is the single most political event of the year. A spreadsheet goes around by email. Seniority is invoked. Someone sits on their turn for nine days. Someone else swears they replied-all with their picks and nobody can find the message. It takes six weeks and at least one grudge.

We replaced the whole ritual with something your partners already understand from their fantasy football leagues: a snake draft.

Here’s how it works, in plain terms:

1. Your admin sets up the year’s weeks and everyone’s budget — pre-filled from each doc’s vacation allotment. Then the pick order: drag names around, or hit Shuffle, or Reverse for the classic “last year’s losers go first.”
2. When it’s your turn, you get an email: “You’re on the clock.” You tap the button in it. That’s it — no account, no password, no app to download. The link is cryptographically signed, revocable, and yours alone: it is your identity.
3. You see the board on your phone: every week of the year, green for open, initials on the days that are taken. You tap a week. The button says, in actual English: “Take this week — costs 1 of your 5 weeks.” You tap it.
4. A green card confirms it’s yours — and it really is on the calendar, that instant, as approved vacation in the real scheduling system, protected by every rest rule I’m about to describe. No transcription step. No steward.

Want just Monday through Wednesday? Split the week — tap your first day, then your last. If two docs race for the same Wednesday, the loser doesn’t get a silent gray-out; they get a plain sentence — “Dr. Marsh just took Wednesday — reselect” — and a one-tap button to see what’s still open.

Your admin, meanwhile, watches from a control panel: who’s on the clock, how long they’ve been sitting on it, a Nudge button, a pick-for-them button for the partner who’s been scrubbed in all day, an undo on every single pick, and a feed narrating the draft. If someone stalls, the system reminds them automatically, then escalates. A draft that used to take six weeks of email finishes in days — and next January, one button (“Run it again”) clones the whole thing for the new year with fresh budgets.

Why does this matter beyond convenience? Because it removes the one event each year where colleagues who like each other end up quietly furious. Nobody can resent a schedule they picked themselves, in an order everyone agreed to, with every pick logged and visible.

This is the section where I have to earn your trust the hard way, because “AI makes your schedule” is exactly the kind of sentence that should make a physician suspicious. So let me show you the actual rules the system enforces, in your language.

The engine is a constraint solver — the same class of mathematics airlines use to schedule crews. For a group of about twenty docs, one month is roughly 2,000 yes-or-no decisions checked against thousands of interlocking rules, searched by eight parallel workers in about a minute. While it runs, you watch an honest readout — “within 2% of provably optimal” — not a fake progress bar.

Now the rules themselves. Tell me if these sound familiar:

Rest after call. Three full days off between calls, with exactly one sanctioned exception: Friday and Sunday of the same weekend. And — this is where spreadsheets quietly fail — the rule holds across month boundaries. A call on January 30th blocks February 1st and 2nd. Last month is never a blind spot, because the solver looks ten days backward and seven days forward on every solve.

The weekend is a package. Whoever takes Friday call takes the matching Sunday. No back-to-back weekends — also enforced across the month line, in both directions.

Vacation protection, the way a human scheduler actually does it. A week-plus vacation protects the weekend before, the weekend after, and the Monday you come back — the recovery day. A lone mid-week vacation day gets a hard no-call the day before, because nobody should walk into vacation post-call. And before a long vacation, the solver actively tries to hand you a Thursday call — get your call in, then leave clean. Trident’s scheduler had been doing that by hand for years. We asked. We wrote it down. Now the machine does it. (Internally we call this rule “Sweet Thursday.” A scheduler-partner taught it to us. It’s now math.)

Fairness measured in suffering, not just counts. Every day of the week carries a pain weight: Monday call costs 3 points. Thursday is worth minus one — Thursday is the good call, and anesthesiologists know it, and now so does the math. Friday, Saturday, and Sunday cost 7 apiece. The solver doesn’t just even out call counts — it evens out cumulative year-to-date pain across the group, so nobody quietly becomes “the Monday person” or eats a run of weekends. January’s imbalances get repaid by December, on purpose, because every fairness term starts from year-to-date actuals.

Partners and employees treated the way your partnership agreement actually works. Employed docs have contracted call numbers — hard-capped, prorated automatically if they started in July. Partners don’t get fixed quotas; they absorb the residual — whatever call the year has left after every employee’s contract is honored — split by FTE, with offsets for the partner doing admin work. Recomputed monthly. Conserved to the call.

If that last paragraph made you sit up — good. It means you’ve fought this exact fight, and now you know we have too.

And when the rules genuinely conflict, it tells you which ones. When a month is impossible — too much vacation, too many must-work pins, not enough bodies — a spreadsheet fails silently and the human eats the weekend figuring out why. This system diagnoses its own infeasibility: it names the exact rule family, and if two specific requests are fighting each other, it names those requests, with the rest-window math printed out. Before it even solves, a one-second health check reads your data and says things like: “Dr. X’s remaining 14 calls cannot physically fit around her vacation and the rest rule. Fix the quota or the vacation — the schedule cannot.”

The solver produces a preview. Your scheduler looks at it, hand-fixes anything they want — hand-edits lock in place, and the solver never overwrites a human decision — and publishes when it’s right. Publishing is a deliberate act.

The monthly schedule that took a partner a full weekend now takes about a minute of machine time and a few minutes of review. That’s the whole trick. There is no other trick.

Everything above is for the scheduler. But your group has one scheduler and twenty other physicians, and for them the entire product is one question — “Where am I working tomorrow?” — asked from a phone, between cases, in the eleven seconds before the next patient rolls back.

So the doc side is built for a phone, first and only. Open it and today’s assignment is the first thing on screen — facility, shift, who else is on. Two taps to any day. A clean month call calendar that’s readable on a phone and prints to a single page — because someone’s spouse still wants it on the refrigerator, and we respect that. Requests, as described: tap a date, done.

And you stay logged in. Add it to your home screen once and it just opens, like a real app. I mention this because we did our homework: the single most common complaint physicians make about the biggest scheduling platform in this market is being forced to re-log-in on mobile, over and over, at 6 a.m., with gloves in one hand. We treated that as a bug in the whole category and refused to ship it.

Day-of chaos is handled too. Room closes early, a doc goes home sick? A designated coordinator — your board-runner, your night person — can swap assignments from the day sheet in four taps. Ineligible swaps are explained in plain English (“Dr. Chen is post-call”), overrides require a written reason, and every change lands in a feed with who, when, and why. At 7 a.m., nobody has to reconstruct what happened at 6.

“Is this a HIPAA problem? We can’t be casual about data.”
Good instinct — and here’s the clean answer: a staff schedule is not patient data. Who’s on call Tuesday contains no PHI, and our standard agreement commits to storing none — in writing: not a HIPAA Business Associate, no PHI stored. You own your data, and you can have a full export within five business days, any time you ask. The magic pick links I described grant identity only and can be revoked per-person with one click.

“Our group is weird. Our rules won’t fit your software.”
Every group says this, and every group is right. Trident’s rules include a standing arrangement where one doc physically works another doc’s weekend calls — his quota and his fairness math, her body in the hospital — and the solver runs the rest rules on her physical schedule while the call counts stay on his paper one. That is not a setting you’d find in a dropdown menu. It exists because they told us about it and we built it. That’s the model: your rules get encoded per-group, by us, as part of setup. You configure nothing. You don’t learn a tool. Your weirdness isn’t an obstacle to this product. It is the product. And if one of your rules turns out to be something we can’t handle, we’ll tell you that in writing before you’ve spent a dollar.

“We already have QGenda.”
Then you already know what it costs — typically $25 to $29 per provider per month, which for a 25-doc group is on the order of $10,000–$15,000 a year. Two questions to ask about it. First: is it building your schedule, or recording and distributing one a partner still builds by hand? (We know of a group paying thousands a year for scheduling software who still construct the actual schedule in Excel first, then type it in.) Second: does it produce your daily OR assignments — who’s in which room at which facility, every day — the schedule that took Trident’s second partner’s evenings? That daily schedule is half of your problem, and we treat it as half of the product: a day-by-day staffing board, a one-tap fill that proposes assignments for every open slot in under a second, and a nightly finalize ritual with a named sign-off stamp.

“What if the schedule it makes is wrong?”
Then you change it, and the system defers to you. Every hand edit locks; the solver builds around locks and never undoes a human. We even track how often admins override the solver’s output more than two days ahead — because that number is the real report card, and we want to see it as much as you do.

“Who are you?”
A small company with one obsession, built literally in an anesthesia group’s conference room, sitting next to the partner who’d been doing the schedule for years. Not a platform with forty modules. Either way you reach out, you’ll be talking to the person who wrote the code, not a sales team. There isn’t one.

And one more, in fairness: if your current system is genuinely constructing both schedules and your scheduler-partner is home for dinner, close this letter — you don’t need us.

Either way, the worst case is that your group gets its vacation year allocated in days instead of weeks, free, and you learn exactly where your rules stand. The best case is what happened at Trident: two partners got their nights and weekends back, and the schedule became a five-minute job done from a phone.

I don’t want a group held by a contract. I want a group held by their Sunday nights coming back.