Excellent advice for young and old anesthesiologists (link to article)

[Euripides]

Pat Everett captures what I have seen over my career in this recent article. If only more folks would take it to heart.

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[BuzzPhreed]

It's a long article, let me summarize it for you:

Intro: Times have changed, the field is training too many practitioners, your job is no longer secure. The administrators now call all the shots now, not you.

1) Respond to concerns in a definitive and timely fashion... or you'll be replaced.
2) If anyone in your group can't play nice, get rid of them... or you'll be replaced.
3) Work when the surgeons tell you they want to work, and don't expect more money... or you'll be replaced.
4) Start providing cookie-cutter anesthesia... or you'll be replaced.
5) Talk nice about the hospital and people there, even if it's a lie... or you'll be replaced.

About the kind of article I'd expect from a non-physician business "consultant". I'm sure when he needs some emergency surgery, he'd be happy to go to one of those places he's consulted for where he'll get some meek thoughtless cookie-cutter anesthetic.

This article is a bellwether of the death of our specialty.

 

[NICMAN]

People who have learned to work in teams and who contribute to building a cohesive corporate culture will be more successful. Those who are responsive and even act preemptively in the best interests of those around them will be far more successful than those who are concerned about their own interests only. Let's face it, clinical excellence is going to be far more influenced on the organizational level than on an individual level with the new health care environment. In med school everybody's solution to improving healthcare is "we need more primary care". This when the average baby boomer has over 7 different doctors (cardiologist, pulmonologist, radiologist, orthopedists, etc.). Anesthesia is no different. The technical skills are not terribly difficult, and if I'm a surgeon who is working hard through a case while looking over at the anesthesiologist reading on his iPad even a part of the case, then I'm not going to have much respect for that anesthesiologist either. It's the implementation of clinical standards and organizational ethos. A good chunk of Anesthesiology is the management and leadership of other people. The specialty has to integrate or die. The good news is no other field is as well positioned to integrate and lead the organizational innovation than anesthesiology.

 

[deleted171991]

if I'm a surgeon who is working hard through a case while looking over at the anesthesiologist reading on his iPad even a part of the case, then I'm not going to have much respect for that anesthesiologist either.

That just shows how shallow (and uninformed) people are. For any surgery that's longer than 1-2 hours, as a patient, I want my anesthesiologist to occasionally read from his smartphone or iPad. I want him alert, not almost napping from the surgeon's stupid chit-chat with his OR court, and from watching the grass grow. It's like judging a pilot for having a coffee while the plain is on autopilot, or a driver for listening to the radio. A truly good professional should know her own limits, including the limits of reading.

We are trained to pick up auditive cues from the monitors despite the OR noise; reading (without replying) is no different, as long as one does not sink its entire attention and concentration into it (that's why it should be done in short bursts, of a few minutes only, intermingled with patient/monitor/surgeon checks, and only during "autopilot" "tramtrack" periods). I find exchanging text messages way more dangerous; the number of car accidents they cause is not a coincidence.

Too much vigilance will wear off even the best professional. There are tons of studies demonstrating a drop in audience attention during presentations, after more than 35-50 minutes, and that was before the current young generations with their extra-short attention spans. Why would the OR be any different?

I have seen at least one study that shows that the occasional reading does not diminish anesthesiologists' attention. Here's a brief overview of the literature: http://theanesthesiaconsultant.com/...laptops-or-smartphones-in-the-operating-room/

The specialty has to integrate or die.

I cannot agree enough. The writing is on the wall, and that's why I advise all talented medical students to keep away.

 

[Sirach38]

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[BuzzPhreed]

People who have learned to work in teams and who contribute to building a cohesive corporate culture will be more successful.

This mentality is the breeding ground for group think and it is not necessarily in the patient's best interest. I know. I've worked as a consultant anesthesiologist in three different practices. The worst of those three was a practice that aspired to the exact situation that the author of the original article describes.

You don't want business people influencing medical decisions. That's the bottom line and an ultimate conflict of interest.

 

[deleted171991]

I am so disappointed when I hear things like this. Why would you advise talented medical students to stay away if, anesthesiology is what they love? Sure, we are not going to get rich from this career anymore but, it is still a great field if you love it and don't go into it thinking you'll become rich and make a million dollars per year. Instead of discouraging students why not encourage them to find what they love and do that, regardless of what their potential income will be. The doom and gloom mentality is present in every single field of medicine. Most every field is facing problems from midlevels. At the end of the day, the happiest people, regardless of specialty, are the ones that went into it for the right reasons. Anesthesiology offers the flexibility of doing pain, critical care, and even sleep if you wish to have a break from the OR. Even with it's current problems, it is still a great field and will always be much better than MANY other medical specialties.

You see, I am not happy being an employee for life (which anesthesia is rapidly moving towards), and I don't see why any good professional would settle for it. People will seldom pay extra for a good private anesthesiologist (and they don't have time/wisdom to choose a good private intensivist), but they will for a good private surgeon or internist. Hence, even if my choice of specialty means that I will stay an employee, I don't advise it to my student friends.

I am a big believer in capitalism, just not the corporate version, where the top 1% of employees make 100 times what the worst-paid employee makes, and 10+ times what most employees do. I am OK with making much less than an owner who made significant effort and took a risk to start a business, I just won't be a slick executive's personal moneymaking slave, which is exactly what we are as employed physicians, even of "non-profit" organizations.

In a truly free market, with open competition and no protectionism, all these AMCs would wither and die, because an employed professional will never be as motivated as an equal partner, and there is absolutely nothing an AMC does that a private group couldn't do better (except bull****ting hospital bean counters).

 

[gasdoc77]

I agree with the above. After working hard to get to this point I plan to make hay while the sun shines and ride this cockroach til it dies. I can't in good conscience imply that the future looks bright though.

 

[Noyac]

Times have changed and will continue to change. Hospital administration will continue to look for ways to save money and anesthesia services will constantly be in the crosshairs. They want you to continue the high quality service but will constantly approach you with pay cuts, stipend reductions, more administrative duties and on and on. A unified group that Appears to be on the same page at all times is very important. If you disagree with the group members on something, address it in private. If you are an obstruction to cases and a person that is seen as exerting more effort to cancel or not do a case then you exert in finding a way to do the case you will find things difficult for you.

There is a major issue for anesthesiologist when they are employees. Today's medical landscape is one of protocols, meetings, team building and cost cutting. The days of pt care are behind us. As employees you will be thrust into a business and not a practice. You will be challenged to provide the pt care that you were trained to provide all while being expected to make less and less. Your administrators will get richer and richer in the meantime. The environment will then become hostile to a point. The ones that let the environment affect them negatively will be miserable.

My approach has changed over the years. I treat anesthesia as my means to support my interests outside of medicine. I look at it as a job that I still enjoy. Unfortunately my job has downsides. I take them in stride and continue to take care of pts as well as I can. It seems like every week something new is thrust upon us with regards to new agendas and more cost cutting. I now expect it, and then I go back to my OR and continue my excellent care. They can't affect me.

 

[GA8314]

There is a lot of work out there. Be good at what you do. Be skilled in anesthesia with a customer service attitude (not mutually exclusive to safety) and you should ALWAYS be able to earn a good living. How good is up for discussion. But I think that if things get really bad for earnings then there will be a comparable decrease in hours and call etc etc.

Granted they work their asses off but I know CRNAs whom are making hay in ACT models working multiple jobs and taking extra call. There is no gravy train and we are no exceptions.

I love this field and have fun more days than not.

 

[Sirach38]

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[deleted171991]

The future has never looked bright in any time period or in any specialty. The sky is always falling, going to fall, or has been falling for everyone. First it was medicare now obamacare. The more times change, the more they stay the same. Happiness is a personal thing influenced much more by internal as opposed to external situations.

Yeah, sure. That's exactly what the manufacturing people said when their jobs went abroad, or the Jews when the nazis started talking nasty. It's called wishful thinking.

Smart people act before most others, before it's too late.

 

[Sirach38]

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[deleted171991]

Not necessarily derm (which I see open to takeover big time), but a specialty where you can be the primary provider and can dictate terms if you are good (e.g. surgery, especially certain subspecialties). To put it in a different way: if your current patients would not drive an extra hour just to be treated specifically by you, you are as replaceable as your car's spare tire.

Many young grads choose so-called lifestyle specialties, only to find out later that, when you are an employee, you either work your butt off or you won't have much of a lifestyle (financially). As a private physician, you might work more or less than the average employee, but it's mostly your choice. Nobody gets pissed that they are not making more money on your back. Plus nothing beats being your own boss.

Please give me one example of a patient who chose a certain hospital just because a certain anesthesiologist works there. (Now replace "anesthesiologist" with "surgeon" in the previous sentence.)

 

[Sirach38]

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[deleted171991]

Pain is also dying, because of decreasing reimbursements. One has to be very good to have patients pay out of pocket for him/her. And that's exactly why I recommend people to go into the (sub)specialty they expect to be the best at, not the one they like the most in theory. The exception to the rule is if their natural talent is in a specialty with no future (and/or present).

For example, I knew I can easily get a small tremor in my hands when tired or after even one coffee, so I did not pursue a surgical specialty. A few months ago, I had the immense displeasure of watching a senior plastic surgery resident ***** with my kind of tremor working his way through a case in double the time a steady hand would do it. It was painful to watch, and I was shocked nobody had advised him to switch to a non-surgical specialty during his internship or later. When we reach the point where patients will get videos of their surgeries, in a decade or less, he'll be unemployable.

The theory about doing what you love most is beautiful... in theory; tell it to all the unemployed artists, or overworked PCPs.

Sleep medicine? Sounds good in theory. In practice, spare tire subspecialty, great future for NPs (like derm). That goes for pain, too.

The less knowledge and brain one needs to practice a (sub)specialty, the more likely it will be taken over by midlevels. If a specialty is easy to learn and practice, then the specialist is also easy to replace. Lowest common denominator.

 

[Sirach38]

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[deleted171991]

However, having a strong passion for something is a pretty good predictor of being good at it in the future.

Having natural talents is a much stronger predictor: steady hands for a surgeon, brain power for an internist, 3D vision and pattern recognition for a radiologist etc.

Passion is good; far from me to advise doing something one hates. But passion is less important than inborn talent.

 

[Sirach38]

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[deleted171991]

With this logic any specialty can be taken over by midlevels. It doesn't take a genius to do cystoscopies, lap chole, hernia, tonsillectomies, appendectomies, or many other procedures. ANY of these can be taught to midlevels and done by them under supervision. Nobody is for the bread and butter of their specialty. Any midlevel can do most bread and butter aspects of a specialty. However, there will always be a need for MDs to cover the more complex cases, regardless of specialties.

That's exactly how the people who spewed the ACA out envision healthcare. The nurse specialist model, practicing "at the top of their license".

No, there won't always be a need for doctors, the same way cars are not driven by engineers anymore, like they had been 100 years ago, and soon they'll just drive themselves without any human help. Nobody is irreplaceable, but one can do one's best to become, at least, hard to replace.

 

[Sirach38]

That's exactly how the people who spewed the ACA out envision healthcare. The nurse specialist model, practicing "at the top of their license".

No, there won't always be a need for doctors, the same way cars are not driven by engineers anymore, like they had been 100 years ago, and soon they'll just drive themselves without any human help.

Yeah, soon the entire world will be taken over by machines. There will be no need for humans and robots will rule the world.

 

[deleted171991]

Yeah, soon the entire world will be taken over by machines. There will be no need for humans and robots will rule the world.

As a CS major, I couldn't agree more.

 

[Sirach38]

As a CS major, I couldn't agree more.

Until then, all that we can do is enjoy the time we've got

 

[Noyac]

Blah blah blah.

 

[BuzzPhreed]

Today's medical landscape is one of protocols, meetings, team building and cost cutting. The days of pt care are behind us. As employees you will be thrust into a business and not a practice.

I have specific language in my contract that says the corporation I work for will not interfere with my medical decisions. This protects both of us. And I'm free to do what I feel is the right thing to do for my patients. No one has tried to interfere with that. A far cry from my last job.

The only real problem I have is procuring new equipment. That is a painful, painful process.

Make sound decisions and keep things moving. That's the bottom line.

 

[epidural man]

I didn't read the article because at the end, the douche had a bunch of initials that somehow I am suppose to interpret and know what they mean.

If I had a list of pet-peeves, that would be the top of the list - people who put initials behind their name other than a degree. Ugh. it is SOOOO ANNOYING.

I'm sure many of you reading this do it also. Ask yourself this..."WHY!!!!? WHY?!!!! WHY?!!!!"

No one knows what most of those are. Seriously, no one does. It makes you look as pompous as pompous can be. Is that what you really want to show?

I can bet that if I feel this way, MANY others do - so be aware of that before you place those pointless letters.

Thanks for listening

Epidural Man, MD, MS, BS, AA, High School Diploma, Eagle Scout, Winner communitee talent show singing "feebootin'" 4th grade, Pythias in second grade play.

 

[Sirach38]

Epidural Man, MD, MS, BS, AA, High School Diploma, Eagle Scout, Winner communitee talent show singing "feebootin'" 4th grade, Pythias in second grade play.

Bahahahahaha!!!! Couldn't agree more and I can't stop laughing at that signature. Thank you for that!

 

[DaTruMD]

nvm

 

[urge]

Pat Everett captures what I have seen over my career in this recent article. If only more folks would take it to heart.

The main message is that we are all replaceable, starting with the "consultant" who wrote the article. He too will be replaced if he doesn't say what the hospital wants to hear.

 

[caligas]

."epidural man, post: 15777717, member: 153158"]I didn't read the article because at the end, the douche had a bunch of initials that somehow I am suppose to interpret and know what they mean.

If I had a list of pet-peeves, that would be the top of the list - people who put initials behind their name other than a degree. Ugh. it is SOOOO ANNOYING.

I'm sure many of you reading this do it also. Ask yourself this..."WHY!!!!? WHY?!!!! WHY?!!!!"

No one knows what most of those are. Seriously, no one does. It makes you look as pompous as pompous can be. Is that what you really want to show?

I can bet that if I feel this way, MANY others do - so be aware of that before you place those pointless letters.

Thanks for listening

Epidural Man, MD, MS, BS, AA, High School Diploma, Eagle Scout, Winner communitee talent show singing "feebootin'" 4th grade, Pythias in second grade play.[/QUOTE]


Certified Medical Practice Executive. Duh.

 

[Ignatius J]

That just shows how shallow (and uninformed) people are. For any surgery that's longer than 1-2 hours, as a patient, I want my anesthesiologist to occasionally read from his smartphone or iPad. I want him alert, not almost napping from the surgeon's stupid chit-chat with his OR court, and from watching the grass grow. It's like judging a pilot for having a coffee while the plain is on autopilot, or a driver for listening to the radio. A truly good professional should know her own limits, including the limits of reading.

We are trained to pick up auditive cues from the monitors despite the OR noise; reading (without replying) is no different, as long as one does not sink its entire attention and concentration into it (that's why it should be done in short bursts, of a few minutes only, intermingled with patient/monitor/surgeon checks, and only during "autopilot" "tramtrack" periods). I find exchanging text messages way more dangerous; the number of car accidents they cause is not a coincidence.

Too much vigilance will wear off even the best professional. There are tons of studies demonstrating a drop in audience attention during presentations, after more than 35-50 minutes, and that was before the current young generations with their extra-short attention spans. Why would the OR be any different?

I have seen at least one study that shows that the occasional reading does not diminish anesthesiologists' attention. Here's a brief overview of the literature: http://theanesthesiaconsultant.com/...laptops-or-smartphones-in-the-operating-room/

I cannot agree enough. The writing is on the wall, and that's why I advise all talented medical students to keep away.

I agree. Any anesthesiologist that tells you they legitimately pay direct attention every second of the case without reading from a device or book, or without small talking about life with other OR personnel, etc., is absolutely full of ****.