confused about anesthesia

[pgg]

IR? Again the bottom line is be brilliant and be better than 90% of the other doctors out there.

The market for non- fellowship trained radiologists is awful. And it won't be getting better. Diagnostic radiology is THE field that is most vulnerable to telemedicine sweatshops. No other field's workload can be done over the internet. Yes yes they'll argue that midnight wet reads from the other side of the planet are one thing but *cough*reasons*cough* the final reads will be done in the USA, and computers will never read a CXR the way they read ECGs. Mmmm hmmm. If anyone believes that this technology won't be leveraged to the hilt to squeeze radiologists even more, they're dreaming. I don't need a cardiologist to read 90% of the ECGs that cross my path, and one day radiologists won't be needed to read 90% of the CXRs that cross anyone's path.

So every radiologist needs to do a fellowship. You grind out that radiology residency and then have to scratch and compete your way into a fellowship. If you can't get one I would argue you're likely to be substantially worse off as a general radiologist than you'd have been as a general anesthesiologist. If you're brilliant and can land that IR spot, radiology looks great, I guess.

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[Carbocation1]

http://m.anesthesiologynews.com/Art...ement&d_id=3&i=March+2011&i_id=713&a_id=16793

So anesthesiologists have to prove their worth by finding ways to save the hospital money by taking ownership of all procedure processes? Is this legit?

 

[bashwell]

IR. That's where it's at.

Not sure if this comment was meant seriously or jokingly?

If serious, I've heard IR is super competitive, but if you can get in, then it does seem awesome. Although the first few years while establishing a referral base etc can be difficult in terms of lifestyle to say the least.

 

[bashwell]

I

IR? Again the bottom line is be brilliant and be better than 90% of the other doctors out there.

The market for non- fellowship trained radiologists is awful. And it won't be getting better. Diagnostic radiology is THE field that is most vulnerable to telemedicine sweatshops. No other field's workload can be done over the internet. Yes yes they'll argue that midnight wet reads from the other side of the planet are one thing but *cough*reasons*cough* the final reads will be done in the USA, and computers will never read a CXR the way they read ECGs. Mmmm hmmm. If anyone believes that this technology won't be leveraged to the hilt to squeeze radiologists even more, they're dreaming. I don't need a cardiologist to read 90% of the ECGs that cross my path, and one day radiologists won't be needed to read 90% of the CXRs that cross anyone's path.

So every radiologist needs to do a fellowship. You grind out that radiology residency and then have to scratch and compete your way into a fellowship. If you can't get one I would argue you're likely to be substantially worse off as a general radiologist than you'd have been as a general anesthesiologist. If you're brilliant and can land that IR spot, radiology looks great, I guess.

In a sense, aren't CRNAs "automating" a lot of what anesthesiologists do?

Also, I don't see this as a real threat in the near future, but I suppose there's always the dark spectre of machines like Sedasys automating parts of anesthesiology.

My view is I don't see either anesthesiology or rads going away any time soon. At the end of the day, as everyone says, it's best to just do what you like.

 

[anbuitachi]

IR? Again the bottom line is be brilliant and be better than 90% of the other doctors out there.

The market for non- fellowship trained radiologists is awful. And it won't be getting better. Diagnostic radiology is THE field that is most vulnerable to telemedicine sweatshops. No other field's workload can be done over the internet. Yes yes they'll argue that midnight wet reads from the other side of the planet are one thing but *cough*reasons*cough* the final reads will be done in the USA, and computers will never read a CXR the way they read ECGs. Mmmm hmmm. If anyone believes that this technology won't be leveraged to the hilt to squeeze radiologists even more, they're dreaming. I don't need a cardiologist to read 90% of the ECGs that cross my path, and one day radiologists won't be needed to read 90% of the CXRs that cross anyone's path.

So every radiologist needs to do a fellowship. You grind out that radiology residency and then have to scratch and compete your way into a fellowship. If you can't get one I would argue you're likely to be substantially worse off as a general radiologist than you'd have been as a general anesthesiologist. If you're brilliant and can land that IR spot, radiology looks great, I guess.

i think thats the trend in every field. more and more are going fellowships. when i was at my Medicine residency interviews.. like 1 person out of 20 raised their hand when they asked who wants to be hospitalist. everyone else wanted fellowship. same w/ my anesthesia days...
i think Med students are entering residencies EXPECTING to do a fellowship these days, like its the norm.

 

[sloh]

i think thats the trend in every field. more and more are going fellowships. when i was at my Medicine residency interviews.. like 1 person out of 20 raised their hand when they asked who wants to be hospitalist. everyone else wanted fellowship. same w/ my anesthesia days...
i think Med students are entering residencies EXPECTING to do a fellowship these days, like its the norm.

I'm a 4th year going into Pmr and have gone on about 13 interviews. One stark difference between the top tier programs and the rest is that half if not most of the residents enter fellowships after residency training. It certainly is the trend

 

[BLADEMDA]

Great Z blog:

We recently had some traveling nurses come work at our hospital. Their most recent assignments had been at some East Coast medical center. They remarked with astonishment that we have actual anesthesiologists working inside the operating rooms.

"Why do you sound so surprised?" I asked them. They informed me that at the prior hospital back east that they've worked in, CRNA's were the ONLY ones in the operating rooms administering anesthesia. What were the anesthesiologists doing outside while the operations were going on? Seemed like they were in charge of getting the next patient ready for the case, having the anesthesia consents signed, and writing post op notes on the floor. "Didn't they ever come into the OR to do cases?" I further inquired. No, they said. And the surgeons preferred to have the nurses giving the anesthesia at their institution.

I was dumbfounded. And depressed. Something has gone terribly wrong with the way that anesthesiology group has decided to practice at that hospital. This was coming from a state that had not yet opted out of physician supervision of CRNA's. But for all intents and purposes the CRNA's were running the show in their operating rooms. Imagine that you've spent hundreds of thousands of dollars getting your medical education. Spent years out of your life that you will never get back studying to become an anesthesiologist. Then at the end, you are nothing more than a paper pusher and face greeter. That appears to be the functions of their anesthesiologists.

The longer this situation continues, the worse it will be for those doctors. As the nurses pointed out, the surgeons actually start preferring to work with the CRNA's. The less exposure the surgeons have to the expertise of their anesthesiologists, the less they can trust them or respect their hard earned anesthesia experience. They won't have gone through the difficult cases together, fought the same battles, or share the same war stories. Instead the anesthesiologists over there are on the outside looking in.

Now maybe the anesthesiologists at that hospital prefer to work in this fashion. Perhaps they like not stressing in the operating rooms. It could be that they like to go get their coffee and bathroom breaks anytime they wanted instead of rushing between cases. Maybe their accountants told them that they can make more money hiring CRNA's to work than to bring in more anesthesiologists. But if anesthesiologists start taking this attitude, then it becomes easier for hospitals, and states, to say they want their CRNA's to work without the oversight of anesthesiologists protecting the patients. If anesthesiologists are reduced to little more than legal secretaries and nurse practitioners, then anesthesiology as a relevant clinical field of medicine will be irretrievably lost.

 

[kingjames15]

I'm convinced that there's this big conspiracy where anesthesiologists are paying people to come to this forum to convince people that it's a terrible decision to choose gas. Just another way to protect the field haha


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[deleted171991]

I'm convinced that there's this big conspiracy where anesthesiologists are paying people to come to this forum to convince people that it's a terrible decision to choose gas. Just another way to protect the field haha

You're mistaken. We are too cheap to pay anybody; we just do it ourselves.

 

[Planktonmd]

I'm convinced that there's this big conspiracy where anesthesiologists are paying people to come to this forum to convince people that it's a terrible decision to choose gas. Just another way to protect the field haha


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Oh man you just ruined it... no one is going to believe us now!

 

[Baller MD]

I'm convinced that there's this big conspiracy where anesthesiologists are paying people to come to this forum to convince people that it's a terrible decision to choose gas. Just another way to protect the field haha


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How is that protecting the field? It just means that students with lower scores will enter the field. Spots will get filled up regardless because there are desperate people out there and many people outside the US are willing to do it as long as they can have a future here. The talent pool will just be lower, that's all. There is no such thing as protectionism going on here.

 

[kingjames15]

Hmm.. I know lots of other med students ruling out the field based on what they read out here.


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[Carbocation1]

I think the conspiracy theory is that greedy older docs are trying to lower the expectations of the young so they can screw them with lower salaries.

 

[BLADEMDA]

I think the conspiracy theory is that greedy older docs are trying to lower the expectations of the young so they can screw them with lower salaries.

Sure, the Anesthesia management companies are setting their salaries based upon what we post on SDN. Better yet, all the mergers/sales by private groups in the past 5 years are an illusion made up by me.

 

[Carbocation1]

Sure, the Anesthesia management companies are setting their salaries based upon what we post on SDN. Better yet, all the mergers/sales by private groups in the past 5 years are an illusion made up by me.

That comment was in tongue in cheek. I'm very grateful for all your comments about the future of the specialty, thanks for taking the time to educate us, Blade.

 

[Baller MD]

Hmm.. I know lots of other med students ruling out the field based on what they read out here.


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Again how does lower qualified medical students taking the place of those with higher qualifications considered protecting the field?

 

[deleted171991]

Again how does lower qualified medical students taking the place of those with higher qualifications considered protecting the field?

Because, this way, all the geniuses from the old generations won't be threatened by (CRNA-level graduates from) the future generations. So, despite the number of anesthesia residency graduates having increased by 30%, the number of competent anesthesiologists in the market will actually go down. I can already see the effects of our hard work on SDN: this year I will finally make more than a CRNA.

 

[GA8314]

Great Z blog:

We recently had some traveling nurses come work at our hospital. Their most recent assignments had been at some East Coast medical center. They remarked with astonishment that we have actual anesthesiologists working inside the operating rooms.

"Why do you sound so surprised?" I asked them. They informed me that at the prior hospital back east that they've worked in, CRNA's were the ONLY ones in the operating rooms administering anesthesia. What were the anesthesiologists doing outside while the operations were going on? Seemed like they were in charge of getting the next patient ready for the case, having the anesthesia consents signed, and writing post op notes on the floor. "Didn't they ever come into the OR to do cases?" I further inquired. No, they said. And the surgeons preferred to have the nurses giving the anesthesia at their institution.

I was dumbfounded. And depressed. Something has gone terribly wrong with the way that anesthesiology group has decided to practice at that hospital. This was coming from a state that had not yet opted out of physician supervision of CRNA's. But for all intents and purposes the CRNA's were running the show in their operating rooms. Imagine that you've spent hundreds of thousands of dollars getting your medical education. Spent years out of your life that you will never get back studying to become an anesthesiologist. Then at the end, you are nothing more than a paper pusher and face greeter. That appears to be the functions of their anesthesiologists.

The longer this situation continues, the worse it will be for those doctors. As the nurses pointed out, the surgeons actually start preferring to work with the CRNA's. The less exposure the surgeons have to the expertise of their anesthesiologists, the less they can trust them or respect their hard earned anesthesia experience. They won't have gone through the difficult cases together, fought the same battles, or share the same war stories. Instead the anesthesiologists over there are on the outside looking in.

Now maybe the anesthesiologists at that hospital prefer to work in this fashion. Perhaps they like not stressing in the operating rooms. It could be that they like to go get their coffee and bathroom breaks anytime they wanted instead of rushing between cases. Maybe their accountants told them that they can make more money hiring CRNA's to work than to bring in more anesthesiologists. But if anesthesiologists start taking this attitude, then it becomes easier for hospitals, and states, to say they want their CRNA's to work without the oversight of anesthesiologists protecting the patients. If anesthesiologists are reduced to little more than legal secretaries and nurse practitioners, then anesthesiology as a relevant clinical field of medicine will be irretrievably lost.

These joker groups are the problem in our field. And they aren't all that uncommon I'm afraid.

The worst part about the groups described above is that very often the senior partners are very well off. F.cking chumps and jokers for anesthesiologists, yet they are, again, often very very well off. Is it a wonder we have a CRNA disrespect problem?

But therein lies the opportunity. Don't be a chump change group. Take ownership and leadership, and NEVER let your skills diminish. When anesthesiologists in ACT models actually hold up to their end of the bargain, it works. And it CAN work very well. Some of us are in such practices.

And you can still make $$ being a GOOD anesthesiologist. One that does his/her f.cking job. Sees the patient on time. Does a complete history. Blocks the patients on time. Meets the damn medical direction criteria which they actually BILL FOR...... (again, is it a wonder the CRNA's have such deep seated resentment of us??.....). Guys that actually get into the OR. Who's opinions are respected, because they actually know what they are talking about and stay up on the literature and medicine in general.