Anesthesia vs IM

[Silent Cool]

Irrelevant. This is not a free market; this is corporate capitalism.

I agree that we are seeing corporatism at its finest right now, but what Milton said is still relevant and true.

Have any of you thought of starting your own mobile anesthesia business, like this guy?

http://www.drtarg.com/

---

Members don't see this ad.

 

[deleted171991]

The question is this:

What can you do to regain control of billing? Of the cash flow?
I've said it before: you have to find a way to OWN something, whether it is an urgent care center, an ASC, or simply the person who contracts with a hospital to provide the anesthesia. If an AMC can do it, so can an enterprising group of anesthesiologists. I have full confidence that opportunities exist--physicians just have to find them.

I am afraid that any large group of solo anesthesiologists is just another ACT-based AMC waiting to happen.

There are always opportunities, if one is willing to make sacrifices, e.g. related to location/shift/fees. Of course, when the entire specialty suffers, the term "opportunity" becomes very relative.

 

[pgg]

If you match into a strong academic IM program (think name recognition here) and you EXCEL as a Resident the odds are high you will secure a nice, lucrative fellowship.

I wonder, if you polled every new medical student on day 1, how many think they'll graduate in the bottom 1/4? I bet it's right about 0.

The alternatives for med students that are "better" than anesthesia, at least in terms of pay and security and self-determination, aren't open to all med students. They're not even open to 50% of med students. Maybe the top 10-20%? Anesthesia may have become more competitive in the last 5-8 years, but our specialty still isn't that competitive.

One of the reasons I hate these threads is because the standard pessimist advice is to just be a 10%'er and rock out in orthopedic surgery. I think those same 10%'ers can still carve out a great career in anesthesia, and they won't have to lobotomize the pharmacy piece of their brain so that only Ancef remains.

The SDN view skews everything, everyone here is a top performer, 250 step 1, sociable, handsome, and could succeed at whatever they chose, be it anesthesia, ENT, ortho, i-banking, or restaurant ownership.

So the general consensus from the anesthesia attendings on here is do not go into Anesthesia?

No. Anesthesia is a great field. This forum frequently suffers from a profound lack of perspective. You don't see this kind of despondency from pediatricians, who currently and will probably always make a lot less money than us, despite the NPs who want their jobs. Somehow they get out of bed each day without getting suicidal.

All of medicine is staring down the barrel of huge financial pressures. Some specialties are a little further behind the 8-ball than others, and yeah, there are some sad and concerning things about the business side of anesthesia. There's a lot of denial out there in other specialties ... surgeons maybe won't be replaced by midlevels, but if they think their reimbursement can't or won't be cut, they're dreaming. Every week I see general surgeons doing lap choles and vas caths for peanuts. The country is broke. More money is being funneled and siphoned off by the middlemen and insurers, not less.

It's a bad time to go into medicine thinking you're going to get rich.


To answer the OP's question, I wouldn't do IM for twice what I get paid as an underpaid public servant anesthesiologist. Seeing 15 minute clinic appointments all day is my idea of hell. I'm glad there are doctors who can tolerate other human beings long enough to be their internist, but I can't see myself doing it. I'm not even sure I could've gutted out an IM residency to get to a cardiology fellowship on the other side. Of course, I'm 3/4 sure that I would've EXCELLED as a resident and had no trouble landing one.

 

[Disciple]

IM docs will end up supervising 2-3 NPs the same way we supervise CRNAs. It's just a matter of time (unless the winds change significantly in the Congress and the White House).

Funny, that's how some of big pain practices in my area operate.

High volume injections by the doctor, and high volume E&M for narcotics by his/her 3-4 midlevels.

 

[Silent Cool]

I wonder, if you polled every new medical student on day 1, how many think they'll graduate in the bottom 1/4? I bet it's right about 0.

The alternatives for med students that are "better" than anesthesia, at least in terms of pay and security and self-determination, aren't open to all med students. They're not even open to 50% of med students. Yup. Maybe the top 10-20%? Anesthesia may have become more competitive in the last 5-8 years, but our specialty still isn't that competitive.

One of the reasons I hate these threads is because the standard pessimist advice is to just be a 10%'er and rock out in orthopedic surgery. Yup. I think those same 10%'ers can still carve out a great career in anesthesia, and they won't have to lobotomize the pharmacy piece of their brain so that only Ancef remains.

The SDN view skews everything, everyone here is a top performer, 250 step 1, sociable, handsome, and could succeed at whatever they chose, be it anesthesia, ENT, ortho, i-banking, or restaurant ownership. Yup.


No. Anesthesia is a great field. This forum frequently suffers from a profound lack of perspective. You don't see this kind of despondency from pediatricians, who currently and will probably always make a lot less money than us, despite the NPs who want their jobs. Somehow they get out of bed each day without getting suicidal.

Heh, yup.

All of medicine is staring down the barrel of huge financial pressures. Some specialties are a little further behind the 8-ball than others, and yeah, there are some sad and concerning things about the business side of anesthesia. There's a lot of denial out there in other specialties ... surgeons maybe won't be replaced by midlevels, but if they think their reimbursement can't or won't be cut, they're dreaming. Every week I see general surgeons doing lap choles and vas caths for peanuts. The country is broke. More money is being funneled and siphoned off by the middlemen and insurers, not less.

It's a bad time to go into medicine thinking you're going to get rich.


To answer the OP's question, I wouldn't do IM for twice what I get paid as an underpaid public servant anesthesiologist. Seeing 15 minute clinic appointments all day is my idea of hell. I'm glad there are doctors who can tolerate other human beings long enough to be their internist, but I can't see myself doing it. I'm not even sure I could've gutted out an IM residency to get to a cardiology fellowship on the other side. Of course, I'm 3/4 sure that I would've EXCELLED as a resident and had no trouble landing one.

pgg,

You are one of my favorite posters on the Anesthesia forum and your post above just reinforces my opinion. I couldn't have said it better myself. Thank you for bringing a dose of realism to this thread. I think most people here have never experienced the real world and don't know how difficult it really is. Everyone in the country is suffering right now, but this, too, shall pass.

Re: getting rich. NO profession guarantees getting rich, and I think that expectation is a problem and is demonstrated in threads like this. Your field won't make you rich--it doesn't matter if you are an Anesthesiologist or an Orthodontist--neither will make you wealthy. If you want that, you need to focus on two things:

1) Investing and,
2) OWNING something (or many somethings).

Rinse and repeat (to get rich).
The money that higher paid docs make is more than enough to get rich if invested wisely.

 

[BLADEMDA]

So the general consensus from the anesthesia attendings on here is do not go into Anesthesia?

Go into anesthesia with your eyes wide open to the problem and your likely job after residency. This means a lower wage than today, many more midlevels doing the cases and far fewer partnership opportunities.

 

[BLADEMDA]

pgg,

You are one of my favorite posters on the Anesthesia forum and your post above just reinforces my opinion. I couldn't have said it better myself. Thank you for bringing a dose of realism to this thread. I think most people here have never experienced the real world and don't know how difficult it really is. Everyone in the country is suffering right now, but this, too, shall pass.

Re: getting rich. NO profession guarantees getting rich, and I think that expectation is a problem and is demonstrated in threads like this. Your field won't make you rich--it doesn't matter if you are an Anesthesiologist or an Orthodontist--neither will make you wealthy. If you want that, you need to focus on two things:

1) Investing and,
2) OWNING something (or many somethings).

Rinse and repeat (to get rich).
The money that higher paid docs make is more than enough to get rich if invested wisely.

There are plenty of jobs out there working for an AMC or a hospital. Pay range is $280-$400K right now. Partnership opportunities are few but they still exist. CRNA encroachment is a REAL Issue but the majority lack the skill and education to effectively compete against a Board Certified Anesthesiologist.

As long as you are realistic about the issues this specialty faces going forward there is nothing wrong in picking Anesthesiology. However, there are far more lucrative specialties out there if you are good enough to land one.

Please understand the issues. They aren't getting any better.

A Major issue is the fact that doing your own cases is far more rewarding and less taxing than supervising 4 (or soon to be 5/6) midlevels who think they are equivalent to a Board Certified Anesthesiologist. So, it isn't just the pay cut or the loss of autonomy as a private practice Physician but the fact you will likely be stuck "supervising" midlevels for the majority of your career. In short, It's a Perfect Storm situation for anesthesiology.

 

[Consigliere]

I agree that we are seeing corporatism at its finest right now, but what Milton said is still relevant and true.

Have any of you thought of starting your own mobile anesthesia business, like this guy?

http://www.drtarg.com/

I wonder how successful this guy is. I have often thought about doing mobile anesthesia.

 

[LeverArm]

There are plenty of jobs out there working for an AMC or a hospital. Pay range is $280-$400K right now. Partnership opportunities are few but they still exist. CRNA encroachment is a REAL Issue but the majority lack the skill and education to effectively compete against a Board Certified Anesthesiologist.

As long as you are realistic about the issues this specialty faces going forward there is nothing wrong in picking Anesthesiology. However, there are far more lucrative specialties out there if you are good enough to land one.

Please understand the issues. They aren't getting any better.

A Major issue is the fact that doing your own cases is far more rewarding and less taxing than supervising 4 (or soon to be 5/6) midlevels who think they are equivalent to a Board Certified Anesthesiologist. So, it isn't just the pay cut or the loss of autonomy as a private practice Physician but the fact you will likely be stuck "supervising" midlevels for the majority of your career. In short, It's a Perfect Storm situation for anesthesiology.

Blade, I would like to hear your honest opinion of working in an academic center +/- fellowship +/- teaching residents. How much of a problem is encroachment in these positions and how much of a pay cut can one expect? Also, how realistic is it to work up the ranks in those environments? Thanks.

 

[deleted171991]

I wonder how successful this guy is. I have often thought about doing mobile anesthesia.

Me, too. If you look at his schedule, he seems to be pretty successful.

I think the big factor is that he works prepaid (and then submits the paperwork to the insurance companies for the patients), so his overhead is minimal and collection rate 100%.

 

[Silent Cool]

Me, too. If you look at his schedule, he seems to be pretty successful.

I think the big factor is that he works prepaid (and then submits the paperwork to the insurance companies for the patients), so his overhead is minimal and collection rate 100%.

Bingo. His schedule is mostly booked far in advance, so I'm guess he is doing well. I have to imagine better than what he would get working in a hospital, etc... Not to mention the fact that he is his own boss and therefore controls the money flow.

 

[pgg]

I wonder how successful this guy is. I have often thought about doing mobile anesthesia.

I wonder how much pressure there is from your clients (the procedure-performer, not the patient) to do stuff that ought to be done in a better equipped facility.

There's a dental office near here that some of our CRNAs used to moonlight at. Not truly a traveling gig since they didn't take their own equipment, but it may as well have been one given the sparse equipment at the site. They quit working there because they couldn't stomach the risk, substandard recovery staff, crappy equipment, etc. If you're doing mobile anesthesia, you've got to be 5x the service-oriented businessperson and I bet there's some envelope pushing going on. Of course $cash and autonomy go a long way to make risk tolerable ...

 

[Silent Cool]

I wonder how much pressure there is from your clients (the procedure-performer, not the patient) to do stuff that ought to be done in a better equipped facility.

There's a dental office near here that some of our CRNAs used to moonlight at. Not truly a traveling gig since they didn't take their own equipment, but it may as well have been one given the sparse equipment at the site. They quit working there because they couldn't stomach the risk, substandard recovery staff, crappy equipment, etc. If you're doing mobile anesthesia, you've got to be 5x the service-oriented businessperson and I bet there's some envelope pushing going on. Of course $cash and autonomy go a long way to make risk tolerable ...

Yup. Targ has a custom anesthesia unit that he brings with him, with all the appropriate monitors, etc.. I believe he also brings a paramedic with him to the sites. I think a big part of risk reduction is case selection--ie, only ASA 1 and perhaps ASA 2 in the outpatient setting. As long as the patients are healthy and you have the right equipment, I imagine that risk is greatly reduced. I read somewhere that the overhead for mobile anesthesia is low--on the order of 8%. It's definitely something I would look into, as I believe there will be more demand in the future for office-based anesthesia. All you have to do is invest in the equipment (drugs, monitors, crash cart, etc..), and market yourself at a reasonable rate.

 

[wolverine09]

so the consensus is anesthesia is not a "lifestyle" field? and the likely AMC/hospital employee future is more detrimental to lifestyle than not?

 

[pgg]

so the consensus is anesthesia is not a "lifestyle" field?

No, it's not.

Days start early. There's no escaping call ... surgery happens at 1 AM, and moms want epidurals on the baby's schedule, not ours. Sick patients can demand great focus for hours on end ... this can be exhausting.

I was an intern 11 years ago, and a busy night of call was pretty easy to bounce back from. I'm not that old, but it's harder now. I don't plan on taking this much call when I'm past 50. I dread the notion of taking call like this in my 60s. (I plan on going part-time around 55, give or take.)

But ... when you're off, you're off. Given a job with enough vacation time, or a sparse enough call schedule, it can be pretty nice.

 

[msmith83]

Ok, so I assumed most docs would take a pretty substantial pay cut due to the unaffordable care act.... but is it really expected to be that much?

CIM has the median pay for ALL Anesthesiologist at 427k and some of the practicing attendings on here are expecting to make no more than roughly 200-220k in the future? 50% drop?

 

[Bostonredsox]

I should have gone gas. If I could do it over it would be 4 years gas 1 year CC instead of IM CC. A gas residency would have been infinitely more enjoyable to me then medicine was.

 

[LeverArm]

I should have gone gas. If I could do it over it would be 4 years gas 1 year CC instead of IM CC. A gas residency would have been infinitely more enjoyable to me then medicine was.

That's an interesting post. Do you do pulm as well? How marketable are gas/cc to ICUs compared to im/cc?

 

[secants]

That's an interesting post. Do you do pulm as well? How marketable are gas/cc to ICUs compared to im/cc?

Gas/CC seems to be predominately in academic settings with them running the SICU usually. In PP, you usually have the IM/Pul guys running the hospital's ICU unit and then your gas group doing anesthesia; money ends up complicating cross covering from what I hear. I do think in the future all types of CC trained MDs will be in demand so IMO doing a CC fellowship might be a good investment, granted you actually like critical care.

 

[Silent Cool]

Ok, so I assumed most docs would take a pretty substantial pay cut due to the unaffordable care act.... but is it really expected to be that much?

CIM has the median pay for ALL Anesthesiologist at 427k and some of the practicing attendings on here are expecting to make no more than roughly 200-220k in the future? 50% drop?

What can I say....

 

[Critical Mass REACHED]

One thing that is clearly evident from this thread is the number of trolls in here from allnurses.com scaring people into doom and gloom. At the end of the day if a patient had to chose between a FP, vs a NP guess who wins? It won't be the one who trained as a nurse changing bed pans and diapers the first couple of years (they count that as experience) before becoming an NP. Same applies to the NURSE anesthetist. The MD wins every time.

If you think Obama Care had people all wound up in the streets screaming in rage, imagine when the secret gets out that the one in the cute white coat is a NURSE parading around as an MD. Good luck getting reelected Mr. Congressman, good luck Mr. Senator. You can parade the studies all you want, patient's care about the brand and quality of the MD.

It's like comparing Nike shoes to Payless brand shoes. It's insulting. If you want the Payless shoes because that's all you can afford, then by all means GET THEM. But what if Nikes and Payless shoes cost the same? People would flock towards the NIKES. And right now Nurses get same reimbursement rates as physicians (cost you the same) so guess who patients will prefer.

Last time I checked former Clinton had heart surgery, and the one performing the Anesthesia had those fancy 2 letters of MD, despite them trying to push for independence for nurse anesthesia providers. The public will demand the same.

 

[Dwindlin]

Sorry if this topic has been done before but I was wanting some general advice on choosing IM vs Anesthesia. I have a strong interest in both but there are a couple of things in Anesthesia that concern me. First I was wondering about concentrating for long periods of time, which isn't my best quality.... I've been known to space out in lectures quite a bit. Then there's the whole emergent aspect of it, I generally am not good at making decisions very rapidly and am worried this would also cause issues in Anesthesia as well.

I'm planning on trying to do an away elective in Anesthesia this upcoming year so I know that will help, but I just wanted any kind of incite that any of you had that could possibly help.

Any advice is greatly appreciated, thanks

I realize this thread has taken quite the detour, however if you are still checking out this thread, there actually is a couple combined 5 year Anesthesia/IM programs. I wish I had known about these when I was applying. I knew late third year I want to do critical care, I enjoy Anesthesia by orders of magnitude more than IM (honestly straight IM was never even an option, I would have went EM if not Anesthesia). The combined program would have opened up the opportunity for Pulm/CCM, while providing me a specialty I thoroughly enjoy if fellowship didn't work out.

 

[Critical Mass REACHED]

I realize this thread has taken quite the detour, however if you are still checking out this thread, there actually is a couple combined 5 year Anesthesia/IM programs. I wish I had known about these when I was applying. I knew late third year I want to do critical care, I enjoy Anesthesia by orders of magnitude more than IM (honestly straight IM was never even an option, I would have went EM if not Anesthesia). The combined program would have opened up the opportunity for Pulm/CCM, while providing me a specialty I thoroughly enjoy if fellowship didn't work out.

Sounds like an awesome triple threat to be specialized and triple boarded in IM/anesthesiology/ CCM. But, why not just go the Anesthesiology route and fellowship in CCM if you love CCM that much?

 

[Dwindlin]

Sounds like an awesome triple threat to be specialized and triple boarded in IM/anesthesiology/ CCM. But, why not just go the Anesthesiology route and fellowship in CCM if you love CCM that much?

I am, currently on the downhill slide of my CBY, starting CA1 in July. Though admittedly I am nervous about being completely relegated to the surgical based ICUs, I actually do enjoy the medical train wrecks as well. Also, I like the IM based CCM training a little better in the sense that there is more "stuff" worked into the curriculum so to speak (e.g. months dedicated to bronchs, imaging, etc). Where as I've seen no Anesthesia/CCM programs with that kind of dedicated time. Maybe it just isn't advertised but something I have noticed.

 

[BLADEMDA]

Show me the money Pathway:

1. Combined IM/Anesthesia of 5 years
2. Gi fellowship 3 years

Post Training hire a CRNA for $100 per hour while you "supervise" and bill $600 an hour for the anesthestic plus another $1200 an hour for the procedures plus the facility fee. Total per hour pay at YOUR Gi clinic is over $2200 an hour! Even if Obama cuts you by half the bucks keep rolling.

Gi docs average $900K per year in my area with top producers clearing $1.2 million.

SHOW ME THE MONEY$$$

Gas= $350-$400
Critical Care= $350-$400

Gi with your own center: $900K plus

Are you sure you can't 'tolerate' Gi for that kind of money? Instead, you will be delegated as someone's bitch in the O.R. equal to a CRNA instead of EMPLOYING said CRNA. Any back talk by the CRNA and he/she is fired on the spot.

 

[BLADEMDA]

One thing that is clearly evident from this thread is the number of trolls in here from allnurses.com scaring people into doom and gloom. At the end of the day if a patient had to chose between a FP, vs a NP guess who wins? It won't be the one who trained as a nurse changing bed pans and diapers the first couple of years (they count that as experience) before becoming an NP. Same applies to the NURSE anesthetist. The MD wins every time.

If you think Obama Care had people all wound up in the streets screaming in rage, imagine when the secret gets out that the one in the cute white coat is a NURSE parading around as an MD. Good luck getting reelected Mr. Congressman, good luck Mr. Senator. You can parade the studies all you want, patient's care about the brand and quality of the MD.

It's like comparing Nike shoes to Payless brand shoes. It's insulting. If you want the Payless shoes because that's all you can afford, then by all means GET THEM. But what if Nikes and Payless shoes cost the same? People would flock towards the NIKES. And right now Nurses get same reimbursement rates as physicians (cost you the same) so guess who patients will prefer.

Last time I checked former Clinton had heart surgery, and the one performing the Anesthesia had those fancy 2 letters of MD, despite them trying to push for independence for nurse anesthesia providers. The public will demand the same.

You don't control the market place or the O.R. The patient has NO SAY in their anesthesia provider and rarely picks the surgeon/facility based on who is giving the anesthetic. This is vastly different than Family practice or Psych where patients CHOOSE their doctor/noctor upfront.

The trends is AWAY from MD anesthesia and towards midlevel providers. Hospitals/AMCs want safety as cheap as possible. Do you understand what that means for your job prospects? Do you really need to be an electrical engineer to flip a light switch?

 

[BLADEMDA]

Nurse Anesthesia • Safe Anesthesia

Which ones are the
anesthesiologists and
which are the nurse
anesthetists?

CAN'T TELL?
It's just as hard to tell the difference between their anesthesia education, the way they administer anesthesia, and their safety records.

Recreation of an advertisement placed in the Congressional Newspaper Roll Call by the AANA.

The nursing lobby has repeatedly made these claims.

“As a patient, you get the medical knowledge of a physician, with added skills of a nursing professional.” Mary O’ Neil Mundinger, Dr.P.H., then Dean of the Columbia University School of Nursing, which was the first to pioneer the DNP concept.

In response to a legislator’s query whether an anesthesiologist was ever needed. Dr. Zwerling, DNP, CRNA, then President Elect of the Pennsylvania Society of Nurse Anesthetists replied, “Absolutely not...except maybe to teach residents.”

And now here in Florida, in response to the same question, is there a need for an anesthesiologist, FANA’s President, Dr. Valdes, DNP, CRNA, replied “No, we are interchangeable”.

When a story is repeated often enough, it tends to become fact. Your voice needs to be heard now more than ever.

Respond to the Calls to Action by the FSA. It takes very little time to email or call these legislators. Simply telling them or their Aides that you are opposed to independent practice of nurse anesthetists is noticed

 

[Dwindlin]

Are you sure you can't 'tolerate' Gi for that kind of money?

Not even a little. Honestly if I hadn't done well in medical school and didn't have my pick of specialties I would have went right on back to the fire service in a heartbeat.

 

[msmith83]

I realize this thread has taken quite the detour, however if you are still checking out this thread, there actually is a couple combined 5 year Anesthesia/IM programs. I wish I had known about these when I was applying. I knew late third year I want to do critical care, I enjoy Anesthesia by orders of magnitude more than IM (honestly straight IM was never even an option, I would have went EM if not Anesthesia). The combined program would have opened up the opportunity for Pulm/CCM, while providing me a specialty I thoroughly enjoy if fellowship didn't work out.

Thanks for the reply! I had no idea that kind of residency existed. Is it pretty competitive to get into? I would think that type of program would be pretty rare. Honestly the thing holding me back most from Anesthesia right now may be the fact that I've always seen myself eventually being my own boss or at least a partner in a PP, though it seems like that is dwindling for IM as well

 

[Dwindlin]

Thanks for the reply! I had no idea that kind of residency existed. Is it pretty competitive to get into? I would think that type of program would be pretty rare. Honestly the thing holding me back most from Anesthesia right now may be the fact that I've always seen myself eventually being my own boss or at least a partner in a PP, though it seems like that is dwindling for IM as well

I don't know. My guess is yes simply because I think there are only like two in the country.

 

[Critical Mass REACHED]

Nurse Anesthesia • Safe Anesthesia

Which ones are the
anesthesiologists and
which are the nurse
anesthetists?

CAN'T TELL?
It's just as hard to tell the difference between their anesthesia education, the way they administer anesthesia, and their safety records.

Recreation of an advertisement placed in the Congressional Newspaper Roll Call by the AANA.

The nursing lobby has repeatedly made these claims.

“As a patient, you get the medical knowledge of a physician, with added skills of a nursing professional.” Mary O’ Neil Mundinger, Dr.P.H., then Dean of the Columbia University School of Nursing, which was the first to pioneer the DNP concept.

In response to a legislator’s query whether an anesthesiologist was ever needed. Dr. Zwerling, DNP, CRNA, then President Elect of the Pennsylvania Society of Nurse Anesthetists replied, “Absolutely not...except maybe to teach residents.”

And now here in Florida, in response to the same question, is there a need for an anesthesiologist, FANA’s President, Dr. Valdes, DNP, CRNA, replied “No, we are interchangeable”.

When a story is repeated often enough, it tends to become fact. Your voice needs to be heard now more than ever.

Respond to the Calls to Action by the FSA. It takes very little time to email or call these legislators. Simply telling them or their Aides that you are opposed to independent practice of nurse anesthetists is noticed

I have followed a lot of your postings dating back for a while. The sky seems to be falling at your house for the longest time, yet you seem to be employed. I've spoken to other Anesthesiologists, and you seem to have your own issues. Your opinion is not the consensus. Yes, things are changing, but healthcare is changing all around. I'd almost say you're a troll. But, can't be certain, or just some old guy sour guy about his decision to go into the field.

Funny you'd post some poop propaganda by the ANA. It's laughable. You're a disgrace if that is what you go by. Or some troll.

Folks, anyone interested in Anesthesiology or Primary care, please seek second opinions other than SDN about the job markets, and prospects.

 

[Critical Mass REACHED]

Nurse Anesthesia • Safe Anesthesia

Which ones are the
anesthesiologists and
which are the nurse
anesthetists?

CAN'T TELL?
It's just as hard to tell the difference between their anesthesia education, the way they administer anesthesia, and their safety records.

Recreation of an advertisement placed in the Congressional Newspaper Roll Call by the AANA.

The nursing lobby has repeatedly made these claims.

“As a patient, you get the medical knowledge of a physician, with added skills of a nursing professional.” Mary O’ Neil Mundinger, Dr.P.H., then Dean of the Columbia University School of Nursing, which was the first to pioneer the DNP concept.

In response to a legislator’s query whether an anesthesiologist was ever needed. Dr. Zwerling, DNP, CRNA, then President Elect of the Pennsylvania Society of Nurse Anesthetists replied, “Absolutely not...except maybe to teach residents.”

And now here in Florida, in response to the same question, is there a need for an anesthesiologist, FANA’s President, Dr. Valdes, DNP, CRNA, replied “No, we are interchangeable”.

When a story is repeated often enough, it tends to become fact. Your voice needs to be heard now more than ever.

Respond to the Calls to Action by the FSA. It takes very little time to email or call these legislators. Simply telling them or their Aides that you are opposed to independent practice of nurse anesthetists is noticed

http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=49514

Fellow SDN members please click the link and see what happened to Mr. Jack Nicholson's Florida Bill.

And just in case anyone is to lazy to click the link I posted the screen shot.

Please don't listen to trolls, Google is smartphone away.

The purposes bill died, deceased, kicked the bucket, allowing pseudo doctors to practice Anesthesia without supervision in Florida.

 

[Yo GabbaPentin]

I have followed a lot of your postings dating back for a while. The sky seems to be falling at your house for the longest time, yet you seem to be employed. I've spoken to other Anesthesiologists, and you seem to have your own issues. Your opinion is not the consensus. Yes, things are changing, but healthcare is changing all around. I'd almost say you're a troll. But, can't be certain, or just some old guy sour guy about his decision to go into the field.

Funny you'd post some poop propaganda by the ANA. It's laughable. You're a disgrace if that is what you go by. Or some troll.

Folks, anyone interested in Anesthesiology or Primary care, please seek second opinions other than SDN about the job markets, and prospects.

It's funny how people who know the least and have the least experience in something will speak the loudest. Don't feel bad... That fact is not limited to med students.

 

[Critical Mass REACHED]

I'm going to pull out my magic 8 ball and ask some questions.

Is Blade a pessimist? "Yes"

Is Blade a troll? "Don't count on it"

Are you some naive know it all med student douche? "It is decidedly so"

Sorry sport. The 8 ball don't lie.

Call me what you like, but speaking with negativity towards future physicians who look to SDN for advice or suggestions does not help anything. Clearly the ones with the loudest negative voices flock toward these forums, and people actually stock these forums and read them. They take these forum debates as the consensus of what the medical field future outlook is. Which it is clearly NOT the case. Discouraging the brightest from going into fields like Anesthesiology, primary care, or any MEDICAL field is a mistake!

Once again folks, talk to real Physicians who are not hiding behind a desk pixelated, posting nothing but "the sky is falling outlook."

 

[Critical Mass REACHED]

It's funny how people who know the least and have the least experience in something will speak the loudest. Don't feel bad... That fact is not limited to med students.

And just by skimming your post Mr. Gabba, you don't seem unemployed or desperate for work. If you think a CRNa can do your job, retire now.

 

[Yo GabbaPentin]

No, they do not speak for everyone. However, they do speak their opinions. Opinions which you do not want to hear so you go on the attack and then listen to the opinions which you DO want to hear. FWIW my views are not all doom and gloom. But to refuse to see the immense potential for doom and gloom is just burying your head in the sand.

Here is the absolute truth regarding to future of medicine.... We just don't know $hit. No one does. People make educated guesses but in the end, they still don't know $hit. Anyone who claims to know the future is in fact full of $hit. Hence the magic 8 ball reference.

You calling blade a troll is analogous to a middle school student trying to tell YOU how to get into med school.

 

[countingdays]

The question is this:

What can you do to regain control of billing? Of the cash flow?
I've said it before: you have to find a way to OWN something, whether it is an urgent care center, an ASC, or simply the person who contracts with a hospital to provide the anesthesia. If an AMC can do it, so can an enterprising group of anesthesiologists. I have full confidence that opportunities exist--physicians just have to find them.

Opportunities don't exist. Exclusive contracts and non-competes prevent competition. Even if you could provide better service at a better price, you aren't allowed to compete.

 

[AnesDiva]

No, they do not speak for everyone. However, they do speak their opinions. Opinions which you do not want to hear so you go on the attack and then listen to the opinions which you DO want to hear. FWIW my views are not all doom and gloom. But to refuse to see the immense potential for doom and gloom is just burying your head in the sand.

Here is the absolute truth regarding to future of medicine.... We just don't know $hit. No one does. People make educated guesses but in the end, they still don't know $hit. Anyone who claims to know the future is in fact full of $hit. Hence the magic 8 ball reference.

You calling blade a troll is analogous to a middle school student trying to tell YOU how to get into med school.

Perhaps, then, we should act like you and mock that middle school student you described, a student aspiring to college or whatever their next step may be, and we should be all like "all colleges suck and are going to be replaced by preschools hahaha have fun in college."

Even if there are changes coming-- obviously there are-- the language exhibited on this forum toward people expressing a genuine desire to pursue anesthesia with the flaws understood is frequently bombastic, childish, and shrill.

It's hard to take your "experience" seriously, thusly, when it runs so counter to the tone and content more commonly heard in everyday life.

 

[Critical Mass REACHED]

Perhaps it's like us cynically mocking a middle school student who was being forced to pick a college and we were all like "all colleges suck and are going to be replaced by preschools hahaha have fun in college."

Even if there are changes coming-- obviously there are-- the language exhibited on this forum toward people expressing a genuine desire to pursue anesthesia with the flaws understood is frequently bombastic, childish, and shrill.

It's hard to take your "experience" seriously, thusly, when it runs so counter to the tone and content more commonly heard in everyday life.

Thank you, great comparison! I fully support and respect Anesthesiologist as a vital component of healthcare. I wish you could be as loud as Jack Nicholson, and Gabba who probably should of went into another field where they could be happier. But, then again neither of them is UNEMPLOYED!

I went into medicine to ADVANCE the field, not to let it be taken over by mid levels. This is not a job, this is a career.

 

[BLADEMDA]

Call me what you like, but speaking with negativity towards future physicians who look to SDN for advice or suggestions does not help anything. Clearly the ones with the loudest negative voices flock toward these forums, and people actually stock these forums and read them. They take these forum debates as the consensus of what the medical field future outlook is. Which it is clearly NOT the case. Discouraging the brightest from going into fields like Anesthesiology, primary care, or any MEDICAL field is a mistake!

Once again folks, talk to real Physicians who are not hiding behind a desk pixelated, posting nothing but "the sky is falling outlook."

Do you know how foolish you sound? I have over 10,000 posts on this forum. 10,830 posts. But, I'm a troll? You have 90.

The sky isn't falling because it has fallen. You are just too ignorant to notice. AMCs have taken a larger share of the business and will continue to take share. Find the 10 largest anesthesia groups in the country; now count how many have sold or are selling to an AMC. Have you researched this fact? How many independent Groups are actually left standing right now and will be standing by the time you complete Residency?

My "opinion" is based on fact. I have never posted that Anesthesiologists are being phased out. We aren't being eliminated just marginalized and commoditized like a cheap PC computer. The safer and easier things get the less we are needed over CRNAs. Two recent examples of technology making us less needed are U/S and the Glidescope. There will be many more inventions to follow.

The outlook for Anesthesiology is BLEAK which is why the best groups in the USA have sold or will sell before you finish training. Ask yourself why hundreds of Anesthesiologist have sold out this year alone.

You live in a fantasy world not based on the reality of anesthesia in the USA. A Chairman of a top ten program in anesthesia discussed these very issues with me 2 years ago. He was quite discouraged about the future job prospects for his CA-1 residents. He fully understood the job market was changing for anesthesia in the USA and the great opportunities of the past would NOT be available for future Residents.

There will be a need for Anesthesiologists in the USA. But, these future Anesthesiologist will be employed by AMCs or hospitals for a set salary. That salary will be determined by market forces. The trend of those forces is PUSHING salaries DOWN not up.

Stop with all the rhetoric and B.S. Please discuss the situation as it exists today and will likely exist in 5 years. The trend isn't hard to follow.

 

[BLADEMDA]

Thank you, great comparison! I fully support and respect Anesthesiologist as a vital component of healthcare. I wish you could be as loud as Jack Nicholson, and Gabba who probably should of went into another field where they could be happier. But, then again neither of them is UNEMPLOYED!

I went into medicine to ADVANCE the field, not to let it be taken over by mid levels. This is not a job, this is a career.

It starts out as a career. After about 10 years it becomes a job. This isn't to say there aren't good days or even great days but for most of us it ends up being a job at some point.

 

[Critical Mass REACHED]

It starts out as a career. After about 10 years it becomes a job. This isn't to say there aren't good days or even great days but for most of us it ends up being a job at some point.

I didn't go into medicine for the "good days" I went into because I love medicine. I don't plan on being unemployed or rich, but I will be content with my decision I medicine. What I won't be content with is fellow physicians who are content with saying things along the lines of "let NPs take over primary care, let CRNAs take over anesthesiology, like the sacrifices we made meant nothing to you.

Thank you, but I plan on making sure my patients are safe, and well served.

 

[BLADEMDA]

http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=49514

Fellow SDN members please click the link and see what happened to Mr. Jack Nicholson's Florida Bill.

View attachment 178926

And just in case anyone is to lazy to click the link I posted the screen shot.

Please don't listen to trolls, Google is smartphone away.

The purposes bill died, deceased, kicked the bucket, allowing pseudo doctors to practice Anesthesia without supervision in Florida.

Ignorance. It truly is Bliss:

http://health.wusf.usf.edu/post/senate-president-says-no-nurses

The FANA bill hasn't died yet. The Florida Senate will likely kill the bill. Still, the AANA/FANA is a formidable opponent and I expect they will win eventually on all counts.
The question isn't whether the AANA will win but WHEN they will win. I donate to my PACs (ASA, FSA) every year. Even though defeat is inevitable I will fight to the bitter end.

 

[Yo GabbaPentin]

And just by skimming your post Mr. Gabba, you don't seem unemployed or desperate for work. If you think a CRNa can do your job, retire now.

Perhaps, then, we should act like you and mock that middle school student you described, a student aspiring to college or whatever their next aspiration is, and we should be all like "all colleges suck and are going to be replaced by preschools hahaha have fun in college."

Even if there are changes coming-- obviously there are-- the language exhibited on this forum toward people expressing a genuine desire to pursue anesthesia with the flaws understood is frequently bombastic, childish, and shrill.

It's hard to take your "experience" seriously, thusly, when it runs so counter to the tone and content more commonly heard in everyday life.

When a couple of "middle schoolers" turn into know it alls despite the fact that they have ZERO experience, then said middle schoolers should DEFINITELY be told that they are out of line. Blade is a very experienced anesthesiologist and doesn't need some med student to mock him. He has contributed a TON to this forum. Yes, some of it is a little negative for my taste.

And for the record, I love my job and never stated otherwise. I wish you both the best of luck but please take a step back and try to realize that you don't know how much you don't know.

 

[Critical Mass REACHED]

When a couple of "middle schoolers" turn into know it alls despite the fact that they have ZERO experience, then said middle schoolers should DEFINITELY be told that they are out of line. Blade is a very experienced anesthesiologist and doesn't need some med student to mock him. He has contributed a TON to this forum. Yes, some of it is a little negative for my taste.

And for the record, I love my job and never stated otherwise. I wish you both the best of luck but please take a step back and try to realize that you don't know how much you don't know.

Speak for yourself. I talk to physicians all the time, and for the most part they are to content with their careers to post negativity on these thread. Seems like the only ones that post on here are students, residents, and sad physicians who thought they would be millionaire.

I don't know what I don't know, you stand correct. But what I do know is that you 2 are full of negativity and need to be on some serious SSRIs. Sprinkle a little bit of positive insight for ones who seek advice on threads "which I would highly advise against."

 

[BLADEMDA]

I didn't go into medicine for the "good days" I went into because I love medicine. I don't plan on being unemployed or rich, but I will be content with my decision I medicine. What I won't be content with is fellow physicians who are content with saying things along the lines of "let NPs take over primary care, let CRNAs take over anesthesiology, like the sacrifices we made meant nothing to you.

Thank you, but I plan on making sure my patients are safe, and well served.

CRNAs made sacrifices to get where they are as well. Most try hard to provide safe, quality anesthesia every day. We Anesthesiologists add a lot of value to the care of their patients in my opinion. WE avoid disasters, put out fires and quite bluntly bail out CRNAs regularly. Unfortunately, do the administrators care? Does Medicare value our services like they do Gi , Ortho or Neurosurgery (hint: look at CMS reimbursement rates vs private payers)?


I wish you well in your career decision. But, in the end the facts speak for themselves.

 

[AnesDiva]

When a couple of "middle schoolers" turn into know it alls despite the fact that they have ZERO experience, then said middle schoolers should DEFINITELY be told that they are out of line. Blade is a very experienced anesthesiologist and doesn't need some med student to mock him. He has contributed a TON to this forum. Yes, some of it is a little negative for my taste.

And for the record, I love my job and never stated otherwise. I wish you both the best of luck but please take a step back and try to realize that you don't know how much you don't know.

Honestly all I know is what I've experienced. I have not experienced anesthesia yet as a practicing expert (obviously). But I've talked to a bunch of practicing anesthesiologists and the tone and opinion on this forum, broadly speaking, is frequently more radical and shrill compared to my other data points.

 

[BLADEMDA]

Speak for yourself. I talk to physicians all the time, and for the most part they are to content with their careers to post negativity on these thread. Seems like the only ones that post on here are students, residents, and sad physicians who thought they would be millionaire.

I don't know what I don't know, you stand correct. But what I do know is that you 2 are full of negativity and need to be on some serious SSRIs. Sprinkle a little bit of positive insight for ones who seek advice on threads "which I would highly advise against."

FYI, I am a multi-millionaire. I'm trying to help you become one as well so read more, investigate the facts and stop with stupid posts.

 

[244913]

Thank you, great comparison! I fully support and respect Anesthesiologist as a vital component of healthcare. I wish you could be as loud as Jack Nicholson, and Gabba who probably should of went into another field where they could be happier. But, then again neither of them is UNEMPLOYED!

I went into medicine to ADVANCE the field, not to let it be taken over by mid levels. This is not a job, this is a career.

Are you in high school or college?

I'm an Anesthesia resident, at a good program, who came to Gas after a few years of unique medical adventures in the service of the regime. I had a chance to experience and assess many different fields of medicine along the way, besides what I had been exposed to as a medical student and intern. I still chose Anesthesiology, but I chose it with a discerning mind and exit strategies already in place.

You are a fool to discount the opinions of BladeMDA, and the other experienced members on this forum. What reason on earth would they have to deceive you? They are not your program director, or an academic attending or a VA anesthesiologist supervising 1:1 and doing crossword puzzles in the lounge. They are PP veterans who have already made their mark and their money in this field. Do you think that (Consigliere excepted) they come here simply to vent their spleen? Did it ever occur to you that they might be trying to mentor you and offer advice about the realities of this field? Open your eyes, wake up, stop being so naïve and foolish.

This field is changing rapidly. You'll see when you're a resident. Anesthesia has become so safe that CRNA's CAN do the majority of ASA 1-2 cases without supervision. Some even do 3-4's. The model for PP Anesthesia is rapidly devolving from partnership/ownership ---> AMC/hospital employment with ever increasing supervisory ratios. The golden days are gone. Will you still make good money? Yes. Will the 300-400K ceiling be enough to compensate for the vicissitudes of OR anesthesia ie. militant midlevels, being a chart monkey, being a surgeon's bitch, "table up, table down" nights/weekends, stress...I could go on. I guess that's for you to decide- when you actually graduate medical school.

I'm not worrying, I'm planning. I've already decided that OR anesthesia in the future is not a place I want to be. I'll work my butt off and excel in this residency, taking the opportunities it affords to become a master of procedures and critical care management as these are incredibly useful skills and set us apart. But you bet your *** I'm going to do a fellowship- chronic pain to start and if the sky falls there then transition to critical care. Maybe eventually I'll go back to academics, who knows.

Take your blinders off, be proactive about your future. Do a lot more listening than talking, both to potential mentors (with no vested interest) in your community and on this forum.

ex- 61N

 

[BLADEMDA]

Honestly all I know is what I've experienced. I have not experienced anesthesia yet as a practicing expert (obviously). But I've talked to a bunch of practicing anesthesiologists and the tone and opinion on this forum, broadly speaking, is frequently more radical and shrill compared to my other data points.

Just look at the where the money is going. Talk is cheap. Are they selling out because they KNOW things look bleak or are they holding the course and keeping the Group intact? For every Group holding the line at least 3 have sold or are selling out. I love your posts.