CNN Money: Anesthesiologist #36 on list of "Best Jobs in America"

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pgg said:
I have a nagging suspicion that when independent midlevels (in any specialty) start getting successfully sued in meaningful numbers, about 20 minutes later Congress will pass nationwide tort reform to put the brakes on it.

Independent "low cost" midlevels are the government's solution to expensive and limited access to healthcare. The people pushing healthcare in this direction are cynical, they are opportunists, they are pragmatic; they are not stupid. They know complications will rise. They know more malpractice suits will be filed. I think they will take steps to thwart any market forces that get in the way of that vision.

Before malpractice suits put the brakes on midlevel independence, the rules will be changed.
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Congress is fantastic at passing reforms... :rolleyes:
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FFP said:
More work, less pay. Fewer solo jobs. Fewer jobs in general. Increasing supervision ratios. More and more militant CRNAs. Partnerships disappearing. More and more abuse from the bean counters.

Reality is always depressing. One doesn't really see what's going on until one becomes an attending, especially an employee. Until then, all the crap one reads on the Internet goes in the "this won't happen to me, because I have always been told I was special" box.
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Spoken like a true pessimist...
I wouldn't keep reading/posting on this forum if I weren't somewhat of a pessimist myself.
Do you mostly enjoy your job, or mostly dislike your job?
 
Sirach38 said:
Bottom line: There is ALWAYS something to bitch about in life. You're either the time of person that is grateful for what you have in life and take time to enjoy it or your the time of person who never has enough, always sees the grass greener on the other side, and spends their life bitching about their situation. Anesthesiologist have and will always have great jobs compared to many Americans not to mention people in other parts of the world. If Anesthesiology perfect? Absolutely not. Just like nothing else in life is perfect. But it's a hell of a good gig. This site is used as an outlet for many to pour out their frustrations that they may not be able to express in person. The doom and gloom is always the loudest because SDN is a good place to express frustrations. Don't let the negativity get to you. Life is beautiful and gas is a great field.
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There are people who love being teachers, too. Or primary care docs. Or taxi drivers. Or many others. That doesn't mean one should sacrifice one's best years for them.

Of course there is always worse. But then one could go become a monk, have nothing, and be happier. What we call positive thinking, others tend to call denial.
 
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U
Ezekiel2517 said:
Trust me, it's a smart move. At the absolute very least, you'll be a better physician and anesthesiologist and stronger candidate for any job, whether it be in PP or academics. It also gives you an out. Just in the past month I've gotten calls from recruiters and med directors trying to hire me for 3 fulltime CC jobs in L.A./OC/inland empire, all paying 400K+, full benefits, vacay
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PP doesn't seem to care about CCM fellowships. And even in academia it seems not so easy to land an OR+ICU job. Maybe when the bundled payments start, and anesthesia departments will scramble to take over ICUs.

Or maybe it's just my pessimism.
 
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murdoc9 said:
Spoken like a true pessimist...
I wouldn't keep reading/posting on this forum if I weren't somewhat of a pessimist myself.
Do you mostly enjoy your job, or mostly dislike your job?
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I mostly enjoy my job.

I did gas because anything else was boring. It's the only part of medicine I can read about like forever. It's just friggin interesting. It fits my brain, and part of my personality (I baby my patients). That doesn't mean that I am blind.
 
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FFP said:
There are people who love being teachers, too. Or primary care docs. Or taxi drivers. Or many others. That doesn't mean one should sacrifice one's best years for them.

Of course there is always worse. But then one could go become a monk, have nothing, and be happier. What we call positive thinking, others tend to call denial.
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There lies the problem my friend...if one sacrificed the best years of one's life for anything other than one's family or one's faith, one is a fool. I have in no way sacrificed the best years of my life for medicine. I have continued to live and enjoy my life and relationships throughout medical school. He who puts his life on hold for their career and gives up their friends/family/health/hobbies for their career will ALWAYS be unhappy with their career. No career will ever pay you enough to justify sacrficing your best years because, you cannot buy back time. Luckily, this sacrifice is a choice for most. Reality is not depressing. I love my reality, even as a med student.
 
Sirach38 said:
There lies the problem my friend...if one sacrificed the best years of one's life for anything other than one's family or one's faith, one is a fool. I have in no way sacrificed the best years of my life for medicine. I have continued to live and enjoy my life and relationships throughout medical school. He who puts his life on hold for their career and gives up their friends/family/health/hobbies for their career will ALWAYS be unhappy with their career. No career will ever pay you enough to justify sacrficing your best years because, you cannot buy back time. Luckily, this sacrifice is a choice for most. Reality is not depressing. I love my reality, even as a med student.
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Medical school? That's piece of cake. You ain't seen nothing yet.

I have never been a bigger doctor and ego than in med school and internship.
 
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Sirach38 said:
There lies the problem my friend...if one sacrificed the best years of one's life for anything other than one's family or one's faith, one is a fool. I have in no way sacrificed the best years of my life for medicine. I have continued to live and enjoy my life and relationships throughout medical school. He who puts his life on hold for their career and gives up their friends/family/health/hobbies for their career will ALWAYS be unhappy with their career. No career will ever pay you enough to justify sacrficing your best years because, you cannot buy back time. Luckily, this sacrifice is a choice for most. Reality is not depressing. I love my reality, even as a med student.
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Bold added
 
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FFP said:
Medical school? That's piece of cake. You ain't seen nothing yet.

I have never been a bigger doctor and ego than in med school and internship.
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I could see this being true if I was going into general surgery. I know many anesthesia residents and while anesthesia residency isn't a walk in the park, it's not exactly hell and it's very similar in terms of time commitment to most third year rotations.
 
FFP said:
Remember when these constraints did not apply to so-called professionals?
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Everyone is expendable in the workplace. Even Peyton Manning was replaced and he is the best at his job. Being a doc doesn't make you immune to competition or threats to your job/profession! CPAs, dentists, lawyers, physicians and all the other "so-called professionals" have to compete for business.... Or did you just think you were owed something? Your posts make you sound like a new college graduate who thinks they are owed a job because they finished college.
Pick up a hobby, visit match.com. If you're over 50, visit http://www.ourtime.com
I truly hope you find the fulfillment you're seeking.
 
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FFP said:
PP doesn't seem to care about CCM fellowships. And even in academia it seems not so easy to land an OR+ICU job. Maybe when the bundled payments start, and anesthesia departments will scramble to take over ICUs.

Or maybe it's just my pessimism. :D
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CC allowed me to obtain my current job. I had job offers/interviews at PP groups in every major market I was interested in. If you can't find a combined gig, there are many intensivist opportunities per diem/locums that you can do while doing ur OR gig. And like I said, you can go with a full time CC job that will beat out many anesthesia jobs out there.
 
D P356 said:
Everyone is expendable in the workplace. Even Peyton Manning was replaced and he is the best at his job. Being a doc doesn't make you immune to competition or threats to your job/profession! CPAs, dentists, lawyers, physicians and all the other "so-called professionals" have to compete for business.... Or did you just think you were owed something? Your posts make you sound like a new college graduate who thinks they are owed a job because they finished college.
Pick up a hobby, visit match.com. If you're over 50, visit http://www.ourtime.com
I truly hope you find the fulfillment you're seeking.
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Of course society owes doctors stuff after they sacrificed many years of their youth just for training. When a society breaks that covenant, crappy healthcare follows. The best doctors will go elsewhere, and the best minds will avoid medical school. There is a reason many countries have numerus clausus for medicine (including residency positions).
 
pgg said:
I also remember when the US debt wasn't $18 trillion. Our world is changing ...
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Doctors are less than 8% of healthcare costs. I would bet that hospital bureaucracy, Big Pharma and insurance middlemen are much more expensive. Also much less important for everybody's health.
 
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FFP said:
Of course, but at the price of losing OR skills.
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Not to mention the high rate of burnout rate if one practices CCM full time. That's part of the reason why most pulm/cc guys usually do clinic at least half time.
 
kazuma said:
Not to mention the high rate of burnout rate if one practices CCM full time. That's part of the reason why most pulm/cc guys usually do clinic at least half time.
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Full time is usually one week of day- plus one week of night-shift per 4 weeks, with interpolated off-service weeks. Depending on vacation, ICU size, and acuity, it's not always such a bad gig. Especially if there is an in-house trauma surgeon or hospitalist who covers the nights, so it's days only.
 
FFP said:
Guess what? He'll have no choice, as patients don't nowadays either. So he'll learn to put up with it, sooner or later. Wanna bet?
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Surgeons do have a lot of say in this matter.

There is a big difference between having an MD covering 3-4 crnas vs having CRNA only practices.

Surgeons do have a say during credendialing meetings.

Surgeons do have a say with hospital administrators cause they bring the patients.

While we have seen MD only groups replaced with team models. We have yet to see md only groups replaced with crnas only group.
 
Except if the independent CRNAs work for the hospital/ASC, doing the easy well-paying cases. The MD group can pick up the rest. Or they can become employees, too. ;)

If the bean counters get greedy, surgeons can say whatever they want, it still usually happens. Slower, later, but it does.

Btw, there isn't much difference between 1:4 coverage and independent CRNAs. There is nobody really watching there, just a small safety net. That's exactly why the AANA is winning.

Just playing the Devil's advocate...
 
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Sirach38 said:
Su in the current system it works. That's why the AANA should be working to keep the current system instead of pushing for further independence if they were truly working in the interest of CRNAs. Total independence will destroy the job market for CRNAs and greatly reduce our salaries. It's a lose lose situation that they are pushing for.
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YOu fail to understand that Physician oversite/direction is grotesque to crnas. They truly believe that not only are they equivalent but they are superior.
 
criticalelement said:
YOu fail to understand that Physician oversite/direction is grotesque to crnas. They truly believe that not only are they equivalent but they are superior.
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What I fail to understand is how a group of nurses can be so stupid as to desire independent practice where they can be held completely responsible for the patient when in the current system they are having their cake and eating it too by making good money while having very little responsibility when sh*% hits the fan. That is what I fail to understand.
 
Sirach38 said:
What I fail to understand is how a group of nurses can be so stupid as to desire independent practice where they can be held completely responsible for the patient when in the current system they are having their cake and eating it too by making good money while having very little responsibility when sh*% hits the fan. That is what I fail to understand.
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My guess is that they think independence will make them more money.
 
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Sirach38 said:
What I fail to understand is how a group of nurses can be so stupid as to desire independent practice where they can be held completely responsible for the patient when in the current system they are having their cake and eating it too by making good money while having very little responsibility when sh*% hits the fan. That is what I fail to understand.
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Food for thought:

Out of the 20 or so CRNAs I've spoken to about the subject, exactly 0 are interested in not having anesthesiologists supervise them. They range from late twenties to fifties. Without exception when I ask them they say something to the effect of "hell no, I know I don't know everything. I like having someone above me who knows more, it's like a safety net."

Now the SRNA's.....
 
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Wolverines83 said:
Food for thought:

Out of the 20 or so CRNAs I've spoken to about the subject, exactly 0 are interested in not having anesthesiologists supervise them. They range from late twenties to fifties. Without exception when I ask them they say something to the effect of "hell no, I know I don't know everything. I like having someone above me who knows more, it's like a safety net."

Now the SRNA's.....
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Yes, these would be the intelligent ones. I hope that these feelings are shared by the majority. From what I hear, militant CRNAs are the minority.
 
Wolverines83 said:
Food for thought:

Out of the 20 or so CRNAs I've spoken to about the subject, exactly 0 are interested in not having anesthesiologists supervise them. They range from late twenties to fifties. Without exception when I ask them they say something to the effect of "hell no, I know I don't know everything. I like having someone above me who knows more, it's like a safety net."

Now the SRNA's.....
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Food for thought: you won't know the truth until it happens. They would be crazy to tell you something different than what their employers want to hear. Smart people don't advertise their planned revolution; they just do their work behind the scenes.

I never had a CRNA tell me to my face that she would prefer to be independent. But they don't have to. They basically suggest it, starting from how they (don't) follow your instructions and ending with how they piss on your education (if it comes up in a discussion). The way they behave, with no respect and no fear, like they are your equals. If a resident did what get away with on a daily basis, the resident would end up being fired. And there should be no difference, since both types of employees are working under supervision; but there is.

You should rather talk to already independent CRNAs.
 
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Wolverines83 said:
Maybe. On the other hand, when has a nurse of any kind ever bitten her/his tongue to med student?! lol
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The average CRNA IQ is higher than the average nurse IQ. They look down on nurses. Don't expect them to behave the same way.

I would expect SRNAs to be more truthful if prompted. Their words might reflect more what they had been taught by senior CRNAs. ;)
 
FFP said:
The average CRNA IQ is higher than the average nurse IQ. They look down on nurses. Don't expect them to behave the same way.

I would expect SRNAs to be more truthful if prompted. Their words might reflect more what they had been taught by senior CRNAs. ;)
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This sort of attitude runs deeply within nursing. When I was in undergrad, I was a phlebotomist in a county teaching hospital ED. Talk about being looked at down the long end the nurses noses; and the way they spoke to me, almost unthinkable now.
 
Sirach38 said:
This is anyone's guess but it's unlikely the extra money will go to CRNAs. Much more likely this money will go to bean counters.
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I agree but CRNAs probably don't think so. Hence the militant mindset.
 
Carbocation1 said:
Are you still thinking about doing Gas or are you too frightened by the noctors?
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Still deciding... Have a few more months to contemplate.

I've realized that healthcare is like most things in America. It's all about the money and a race to the bottom for bean counters.
 
Baller MD said:
Still deciding... Have a few more months to contemplate.

I've realized that healthcare is like most things in America. It's all about the money and a race to the bottom for bean counters.
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Nice.

If you can't beat 'em, join 'em. The PSH model is all about benefiting the bean counters. If you do well enough you may become a bean counter yourself one day.
 
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big_data_starts_with_recording_and_counting.jpg
 
Carbocation1 said:
Nice.

If you can't beat 'em, join 'em. The PSH model is all about benefiting the bean counters. If you do well enough you may become a bean counter yourself one day.
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The problem is that I hate hospitalist-type work. PSH would be a disaster for me if it comes to fruition. You thinking about gas?
 
Baller MD said:
The problem is that I hate hospitalist-type work. PSH would be a disaster for me if it comes to fruition. You thinking about gas?
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Yeah, gas or IM subspecialty. I'm hoping that the next generation of anesthesiologists will learn from the mistakes of our elders and do a better job of protecting the specialty/lobbying better. As Sirach38 says, the crna problem should select strongly for people who really love the specialty, which would be a good thing in the long run.

I don't think it would be as bad as a hospitalist, since this is a more acute setting. The follow up shouldn't be as bad. Plus. patient interactions should be much more positive since they are scared of surgery.

 
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doing an anesthesia rotation right now as a 4th year and work with SRNA's half the time in the OR. had lunch with one finishing up his program in the next month. he said he accepted a job offer in LA to work for a hospital, 150k, full autonomy to practice without MD/DO oversight. Also said if he wants to work for a private group, pay is 200k
 
Carbocation1 said:
Yeah, gas or IM subspecialty. I'm hoping that the next generation of anesthesiologists will learn from the mistakes of our elders and do a better job of protecting the specialty/lobbying better. As Sirach38 says, the crna problem should select strongly for people who really love the specialty, which would be a good thing in the long run.

I don't think it would be as bad as a hospitalist, since this is a more acute setting. The follow up shouldn't be as bad. Plus. patient interactions should be much more positive since they are scared of surgery.

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Lol! Who is this he? I like him a lot.
 
sloh said:
doing an anesthesia rotation right now as a 4th year and work with SRNA's half the time in the OR. had lunch with one finishing up his program in the next month. he said he accepted a job offer in LA to work for a hospital, 150k, full autonomy to practice without MD/DO oversight. Also said if he wants to work for a private group, pay is 200k
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I love anesthesia. I would have no problem doing it for 200k or even 150k. Of course, I'm going to fight tooth and nail through lobbying and education to try to prevent it from ever coming to that. But if it comes to that, so be it.
 
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Baller MD said:
Still deciding... Have a few more months to contemplate.

I've realized that healthcare is like most things in America. It's all about the money and a race to the bottom for bean counters.
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What other specialties are on the table for you at this point?
 
Why are anesthesiologists among the highest paid docs in Canada, which is a single payer system? Is HillaryCare modeled after Canada? From what I understand HillaryCare should be very similar to ObamaCare, but note sure.

Also, interesting article: http://www.theglobeandmail.com/news...sts-need-to-wake-up-to-reality/article536108/

I wonder if US Anesthesiologists have the guts to withdraw their services for elective surgeries...
 
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