How bad is the CRNA problem. Will MDs always have a job

[BLADEMDA]

You know what amazes me about all this, anyone with half a brain knows our system will collapse if it continues in the direction it's going. Obamacare did nothing to address this.

Our leadership is ******ed.

I disagree. Obamacare leads to Hillarycare then socialized medicine. This will happen over the next 10-15 years. If Hillary wins the POTUS I expect the public option sooner rather than later.

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[MD Dreams]

I haven't read this entire post so this may have already been covered. But as an Anesthesiologist who medically directed in the past, I don't want to supervise nor direct in the future. I want to do my own cases, the way I like. I don't like to be responsible for someone else, especially if they are not good at what they do. I didn't go into medicine to be responsible for someone else's limitation. So, I for one, am not against independent practice. If they want autonomy let them have it, and let them take the responsibility and the consequences.

 

[BLADEMDA]

M B| Nurse - Anesthesiology
10 days ago



I am a CRNA working in an "anesthesia care team model" at a fairly large tertiary care center in the Southeast. I have immense respect for the MDA's I work with and am happy to have their experience and support available when needed. The fact is 95% of the anesthetics I provide don't require their expertise. The elephant in the room is that MDA's have become victims of their own collective success. They are far too expensive to be supported in the current 4 to 1 Medicare reimbursement model when applied across the board. The current culture of "us against them" (perpetuated by both sides) gets us nowhere near finding a solution to the crunch in U.S. healthcare from the perspective of safe and efficient anesthesia care. No conceivable economic model going forward will support the tremendous salary requirements of MDA's that have been championed not through value to the healthcare system but by collective and extensive lobbying efforts. Based upon publicly available labor statistics for our state MDA's are by far thebhighest compensated professionals The answer, in my humble opinion, lies in effectively assessing the medical and surgical acuity of our patients and fitting a model around MDA's in fewer numbers

 

[deleted126335]

M B| Nurse - Anesthesiology
10 days ago



I am a CRNA working in an "anesthesia care team model" at a fairly large tertiary care center in the Southeast. I have immense respect for the MDA's I work with and am happy to have their experience and support available when needed. The fact is 95% of the anesthetics I provide don't require their expertise. The elephant in the room is that MDA's have become victims of their own collective success. They are far too expensive to be supported in the current 4 to 1 Medicare reimbursement model when applied across the board. The current culture of "us against them" (perpetuated by both sides) gets us nowhere near finding a solution to the crunch in U.S. healthcare from the perspective of safe and efficient anesthesia care. No conceivable economic model going forward will support the tremendous salary requirements of MDA's that have been championed not through value to the healthcare system but by collective and extensive lobbying efforts. Based upon publicly available labor statistics for our state MDA's are by far thebhighest compensated professionals The answer, in my humble opinion, lies in effectively assessing the medical and surgical acuity of our patients and fitting a model around MDA's in fewer numbers

Opinions are like *******s. Everybody's got one and everyone thinks everyone else's stinks.
This CRNA has his/her views we have ours. ASAPAC starts a new fiscal year Oct.1

 

[aneftp]

M B| Nurse - Anesthesiology
10 days ago



I am a CRNA working in an "anesthesia care team model" at a fairly large tertiary care center in the Southeast. I have immense respect for the MDA's I work with and am happy to have their experience and support available when needed. The fact is 95% of the anesthetics I provide don't require their expertise. The elephant in the room is that MDA's have become victims of their own collective success. They are far too expensive to be supported in the current 4 to 1 Medicare reimbursement model when applied across the board. The current culture of "us against them" (perpetuated by both sides) gets us nowhere near finding a solution to the crunch in U.S. healthcare from the perspective of safe and efficient anesthesia care. No conceivable economic model going forward will support the tremendous salary requirements of MDA's that have been championed not through value to the healthcare system but by collective and extensive lobbying efforts. Based upon publicly available labor statistics for our state MDA's are by far thebhighest compensated professionals The answer, in my humble opinion, lies in effectively assessing the medical and surgical acuity of our patients and fitting a model around MDA's in fewer numbers

Wait a second here. Crna contradicts themselves here. We all know they have been trying to promote the collaborative model where MD does their own cases along side CRNA and MD is available for "consult" on higher acuity cases.

If that's the truth. And 1:4 medical direction model isn't needed. In saturated markets. If there are 4 rooms. MD does there own case and 3 crnas do their own room.

Where does that leave the extra CRNA? So crnas are effectively saying they need to get rid of 25% of their own work force? Right? The odd person out is the 4th CRNA!

Gotta love common reasoning. Cause there are approximately 2000 srna graduating and 1000 MD finishing residency each year. They need to start shutting down these puppy mill srna programs if they use the collaborative model.

 

[aneftp]

They are fighting on every front that might potentially advance their agenda. Whether it is the "collaborative model" or "How few anesthesiologists can we get away with?" The "puppy mills" are a two edged sword for them.

AANA has pretty much given up on the CRNA is equal and or greater than MD agenda.

They moved beyond that.

Now it's a equal pay/cost effective push the past 3-4 years. Even their own leaders have stated they want MDs to start doing their own cases and brush up on their skills to make delivery of healthcare more efficient and cost effective.

There will be crnas out of jobs with this push. And MD salaries will go down as well. It's all becoming a service industry and we all know it.

 

[Ronin786]

I really don't get how CRNAs can claim similar skills as MDs yet admit that they'd like to consult with an MD every once in a while. I don't see any MDs consulting with CRNAs.

 

[happygilmore]

I disagree. Obamacare leads to Hillarycare then socialized medicine. This will happen over the next 10-15 years. If Hillary wins the POTUS I expect the public option sooner rather than later.

Possibly.

But only if Hilary wins. I think a lot of people are fed up with the democrat policies from these last 8 years. If Rep can get a decent candidate who isn't an idiot, they should be able to win big.

But that may be asking too much.

 

[Mentalist]

But this is true in many fields.

Why pay a cardiologist to manage heart failure when an NP can do the same job?
Why pay a family medicine doc to run a clinic when an NP can as well?
Why pay an EM doc when you can pay a PA?

The future is not far away when a surgical PA will be doing appys and choles.

It is the nature of medicine in general, not just anesthesiology.

I feel obliged to agree.
Evolution is taking place in everything around us , while we are resisting it and doomed to fail.
This old tradition of medical teaching , medical schools, residencies should evolve if we want to survive.
I think a new system where we combine medical school and residency to get competent doctors in less time, less cost and more focused/tailored training is the key to future . For example having College of anesthetists or College of Internal Medicine or College of Surgeons etc..
to make an Internalist 6 years program/degree :
2 years of basic medical and clinical IM oriented Knowledge, then 4 years of Clinical training in IM.
to make an Anesthetist 6 years program/degree :
2 years of basic medical and clinical Anesthesia oriented Knowledge, then 4 years of Clinical training in Anesthesia.

 

[countingdays]

I feel obliged to agree.
Evolution is taking place in everything around us , while we are resisting it and doomed to fail.
This old tradition of medical teaching , medical schools, residencies should evolve if we want to survive.
I think a new system where we combine medical school and residency to get competent doctors in less time, less cost and more focused/tailored training is the key to future . For example having College of anesthetists or College of Internal Medicine or College of Surgeons etc..
to make an Internalist 6 years program/degree :
2 years of basic medical and clinical IM oriented Knowledge, then 4 years of Clinical training in IM.
to make an Anesthetist 6 years program/degree :
2 years of basic medical and clinical Anesthesia oriented Knowledge, then 4 years of Clinical training in Anesthesia.

It would make more sense to apply to medical school directly from high school, at least for the majority of each class. Sure 4 years of college is fun, but not really time or money well spent.

 

[Ronin786]

It would make more sense to apply to medical school directly from high school, at least for the majority of each class. Sure 4 years of college is fun, but not really time or money well spent.

How about transitioning medical school to 5-6 year programs like some other parts of the world?

It seems to work for England and Europe.

 

[Postictal Raiden]

I feel obliged to agree.
Evolution is taking place in everything around us , while we are resisting it and doomed to fail.
This old tradition of medical teaching , medical schools, residencies should evolve if we want to survive.
I think a new system where we combine medical school and residency to get competent doctors in less time, less cost and more focused/tailored training is the key to future . For example having College of anesthetists or College of Internal Medicine or College of Surgeons etc..
to make an Internalist 6 years program/degree :
2 years of basic medical and clinical IM oriented Knowledge, then 4 years of Clinical training in IM.
to make an Anesthetist 6 years program/degree :
2 years of basic medical and clinical Anesthesia oriented Knowledge, then 4 years of Clinical training in Anesthesia.

I've always thought of something similar. Why not combine the first two year of med school (pre-clinical years) with undergrad? Instead of having students doing an undergrad degree before even starting their medical curriculum, one could obtain a bachelor's degree in medical studies which includes all the premed as well as the medical science courses. Then, those who successfully completed undergrad AND passed USMLE step I can move on to do their two-year master's degree in clinical training. Similarly, those who successfully pass their rotations and USMLE step 2 can proceed with the residency match.

Like this, we shrink the route of medical education from 8 years (usually more) to only 6 years by eliminating all of the unnecessary courses students have to take during their undergrad. Heck, at least 60% of my undergrad courses have nothing to do with biology, much less medicine.

 

[BLADEMDA]

It's all about the money. The current system is more profitable for the Universities. And, since the students will eat a terd sandwich to get into a 4 year medical school after 4 years of Undergrad there is no real pressure to change the system.

It will be a decade or more before any such changes trickle down to the pathway for a M.D. in the USA.
So, the current 6 year programs (?2) and 7 year programs will remain ultra competitive with the vast majority of future physicians doing the 8 year route.

 

[LeverArm]

I feel obliged to agree.
Evolution is taking place in everything around us , while we are resisting it and doomed to fail.
This old tradition of medical teaching , medical schools, residencies should evolve if we want to survive.
I think a new system where we combine medical school and residency to get competent doctors in less time, less cost and more focused/tailored training is the key to future . For example having College of anesthetists or College of Internal Medicine or College of Surgeons etc..
to make an Internalist 6 years program/degree :
2 years of basic medical and clinical IM oriented Knowledge, then 4 years of Clinical training in IM.
to make an Anesthetist 6 years program/degree :
2 years of basic medical and clinical Anesthesia oriented Knowledge, then 4 years of Clinical training in Anesthesia.

That is a really bad idea. A physician is a doctor first and a specialist second. Medical school is already basically only 3 years of core education and 1 year of fun/interviews. All physicians should go through the same basic training.

We can eliminate undergrad and do just premed requirements + MCAT for admission. Then shorten 4th year to a dedicated 2-3 months of applications and interviews and start residency in November or December instead of the following July. Then finally, we can also eliminate prelim year for most advanced specialties like anesthesiology, radiology, etc. Doing all that will shorten the path to become a residency-trained physician by 4 years without cutting out anything worth doing.

 

[KGflyboy]

I grew up in a city with a 6 year med school program. I like the idea of it, and wish I had gone. I took a few summer undergrad courses with 6 year med students during undergrad. The problem with these degrees is that a huge amount of the students can't and don't finish. It's nearly impossible for schools to identify high school students ready for the rigors of med school. If we can figure out how make more students in the 6 year programs successful, I think that type of program will spread over time.

 

[yappy]

I grew up in a city with a 6 year med school program. I like the idea of it, and wish I had gone. I took a few summer undergrad courses with 6 year med students during undergrad. The problem with these degrees is that a huge amount of the students can't and don't finish. It's nearly impossible for schools to identify high school students ready for the rigors of med school. If we can figure out how make more students in the 6 year programs successful, I think that type of program will spread over time.

I've heard this a huge problem in countries that select medical students form high school. I spoke to one student, who attended medical school in egypt, and he felt that many students peaked early in high school; and, the curriculum wasn't challenging enough to really test students the same way undergraduate studies do in the US.

 

[deleted126335]

Six year med programs have been around a long time. The original intention behind them was to train primary care physicians who didn't "need" the full science background. What happened was these programs attracted gung ho overachievers who disproportionately selected specialties. At least that was an analysis of the hstory of these programs that I read about 15 or so years ago.

 

[countingdays]

Six year med programs have been around a long time. The original intention behind them was to train primary care physicians who didn't "need" the full science background. What happened was these programs attracted gung ho overachievers who disproportionately selected specialties. At least that was an analysis of the hstory of these programs that I read about 15 or so years ago.

Med schools don't seek scientists. When I was applying foreign languages had the highest acceptance rate. Like 8 classes are useful prerequisites. The rest may be interesting and make you well rounded, but should be more optional than they are now.
Differential equations, history of the u s revolution, french 4, astronomy 3, entomology etc. were interesting but not money or time well spent and honestly didn't make me significantly more 'educated'.

 

[deleted126335]

Med schools don't seek scientists. When I was applying foreign languages had the highest acceptance rate. Like 8 classes are useful prerequisites. The rest may be interesting and make you well rounded, but should be more optional than they are now.
Differential equations, history of the u s revolution, french 4, astronomy 3, entomology etc. were interesting but not money or time well spent and honestly didn't make me significantly more 'educated'.

I am referring to what was the intended mission of these (six year med) programs30 ish years ago. I actually applied to two at that time and did not get into either. No idea what they are like now, how many there are, what their mission is, etc.

 

[cchoukal]

View attachment pro.pdf

View attachment against.pdf

There was a pair of editorials on the "shortened" medical training idea, but I'm not sure how to post them. Here are the links:

Pro: http://www.nejm.org/doi/pdf/10.1056/NEJMp1304681

Con: http://www.nejm.org/doi/pdf/10.1056/NEJMp1306457

in case the attachments don't load.

 

[BLADEMDA]

I am referring to what was the intended mission of these (six year med) programs30 ish years ago. I actually applied to two at that time and did not get into either. No idea what they are like now, how many there are, what their mission is, etc.

A mediocre med school can attract top talent if they offer a 7 year track. Students who could otherwise go to Yale would be willing to attend a 7 year program at an average school
These days the 7 year track is all about marketing and getting talented students.

IMHO , the 7 vs 8 year track isn't worth all the hoops and extra effort. But, the number of applicants to these programs shows a strong demand

 

[pgg]

My first year of undergrad I lived in the honors program dorm and of the ~80 people in the building perhaps a dozen were pre-med. I and one other person went to med school. The rest changed their minds or couldn't hack the prereqs, despite being high school superstars.

It's hard for me to see how med schools could consistently select high school kids with the desire, talent, and maturity to be doctors.

I also think there is value to a general and broad undergraduate education, and value to a general and broad medical education. We are better anesthesiologists because we were doctors before we became anesthesiologists.

There is already a faster, shorter path to create clinicians: be a PA, or be an advanced practice nurse.

 

[countingdays]

My first year of undergrad I lived in the honors program dorm and of the ~80 people in the building perhaps a dozen were pre-med. I and one other person went to med school. The rest changed their minds or couldn't hack the prereqs, despite being high school superstars.

It's hard for me to see how med schools could consistently select high school kids with the desire, talent, and maturity to be doctors.

I also think there is value to a general and broad undergraduate education, and value to a general and broad medical education. We are better anesthesiologists because we were doctors before we became anesthesiologists.

There is already a faster, shorter path to create clinicians: be a PA, or be an advanced practice nurse.

There's a difference between shortening medical education and shortening undergrad. I can't by any stretch of the imagintion see how the majority of undergrad makes me a better doctor or even significantly more well rounded. The place most of the world becomes well rounded is high school and in one's free time.

My high school was easy so I needed college to develop better study habits, but I shouldn't have needed college for that and a lot of people don't.

Shortening medical education is a bad idea, in my opinion, and a race to the bottom with the np's, crnas, and pa's. I don't want the absolute minimum in medical education because I'm a doctor. I didn't need to pay tuition to read philosophy. I can do that in my spare time for free.

 

[jwk]

M B| Nurse - Anesthesiology
10 days ago



I am a CRNA working in an "anesthesia care team model" at a fairly large tertiary care center in the Southeast. I have immense respect for the MDA's I work with and am happy to have their experience and support available when needed. The fact is 95% of the anesthetics I provide don't require their expertise. The elephant in the room is that MDA's have become victims of their own collective success. They are far too expensive to be supported in the current 4 to 1 Medicare reimbursement model when applied across the board. The current culture of "us against them" (perpetuated by both sides) gets us nowhere near finding a solution to the crunch in U.S. healthcare from the perspective of safe and efficient anesthesia care. No conceivable economic model going forward will support the tremendous salary requirements of MDA's that have been championed not through value to the healthcare system but by collective and extensive lobbying efforts. Based upon publicly available labor statistics for our state MDA's are by far thebhighest compensated professionals The answer, in my humble opinion, lies in effectively assessing the medical and surgical acuity of our patients and fitting a model around MDA's in fewer numbers

Don't ya just love it? Fit a model around anesthesiologists in fewer numbers. Of course NO thought given to reducing the number of diploma mill CRNA's being churned out in record numbers each year.

And I love the extrapolation - too expensive to be supported in the current 4 to 1 Medicare reimbursement model when applied across the board.

Face it - CRNA's are like Democrats and Obama - they will say and do ANYTHING to get their way.

 

[gasdoc77]

The days are numbered for the profession of anesthesiology. I am an attending and have practiced 3 years in academics at a VERY reputable program and now have 3 years in private practice. I regret my choice of career daily. The reason for our inevitable extinction is two-fold. First, the field has become so exceedingly safe that it no longer requires critical thinking. Even the technical proficiencies are less of an issue with the many tools we have at our disposal. Next, those that came before us have relegated everything that we do to CRNA's. I do not blame the CRNA, I blame our predecessors. Furthermore, on a daily basis we set aside the culmination of our training and what we know to be the "right" way, if only to apease the surgeon's mere preference. Therefore, we have relinquished the decision-making to the surgeons and the technical aspects to the CRNA's. Thus, we are now ancillary to the equation. I contemplated doing a fellowship but then realized that there was little benefit in spending another year doing hearts, etc. only to again let my training take a backseat to the surgeon's demands. I did, however, take it upon myself to obtain TEE certification through the practice experience pathway becoming VERY proficient through my own study in hopes of being more respected. Now, I get to be antagonized by a CT surgeon who gets his jollies by belittling others in the room. I have vast experience in my few years of practice, had the numbers to pursue any specialty, and have skills that I would put against anybody, anyplace, at any time. Nevertheless, I receive the same treatment as the OR nursing staff. I don't think I will (or should) ever get used to the disrespect we endure on a daily basis. Furthermore, I feel trapped as I look at the job market and then look at my paycheck. So the question is, would you be willing to eat s&%t every day for a nice paycheck? You may say "yes" as a student/resident, as I did, but I assure you it is short sighted. When I see more and more anesthesia "specialties" that require fellowships (OB????), I shake my head. I thought OB "fellowships" were a covert way to extend the training for those that had issues arise during residency. These programs have a vested interest in promoting fellowships so they can get the subsidy $$$. Meanwhile, that year of "education" when translated down the road to your highest earning years will likely cost you more that all of your undergrad and med school combined. I realize you may be skeptical of what I say, but in a few years when you go to see your patient and a family member leans over and tells them "that's just the anesthesiologist", make note of that bristling sensation on the back of your neck: that's me saying "I told you so!"

 

[BLADEMDA]

The job market is tight and fellowships open doors. Doing a pediatric, pain, critical care or cardiac fellowship makes sense in such a tight market. The fellowship creates opportunities in both academic and private practice.

 

[deleted126335]

The days are numbered for the profession of anesthesiology. I am an attending and have practiced 3 years in academics at a VERY reputable program and now have 3 years in private practice. I regret my choice of career daily. The reason for our inevitable extinction is two-fold. First, the field has become so exceedingly safe that it no longer requires critical thinking. Even the technical proficiencies are less of an issue with the many tools we have at our disposal. Next, those that came before us have relegated everything that we do to CRNA's. I do not blame the CRNA, I blame our predecessors. Furthermore, on a daily basis we set aside the culmination of our training and what we know to be the "right" way, if only to apease the surgeon's mere preference. Therefore, we have relinquished the decision-making to the surgeons and the technical aspects to the CRNA's. Thus, we are now ancillary to the equation. I contemplated doing a fellowship but then realized that there was little benefit in spending another year doing hearts, etc. only to again let my training take a backseat to the surgeon's demands. I did, however, take it upon myself to obtain TEE certification through the practice experience pathway becoming VERY proficient through my own study in hopes of being more respected. Now, I get to be antagonized by a CT surgeon who gets his jollies by belittling others in the room. I have vast experience in my few years of practice, had the numbers to pursue any specialty, and have skills that I would put against anybody, anyplace, at any time. Nevertheless, I receive the same treatment as the OR nursing staff. I don't think I will (or should) ever get used to the disrespect we endure on a daily basis. Furthermore, I feel trapped as I look at the job market and then look at my paycheck. So the question is, would you be willing to eat s&%t every day for a nice paycheck? You may say "yes" as a student/resident, as I did, but I assure you it is short sighted. When I see more and more anesthesia "specialties" that require fellowships (OB????), I shake my head. I thought OB "fellowships" were a covert way to extend the training for those that had issues arise during residency. These programs have a vested interest in promoting fellowships so they can get the subsidy $$$. Meanwhile, that year of "education" when translated down the road to your highest earning years will likely cost you more that all of your undergrad and med school combined. I realize you may be skeptical of what I say, but in a few years when you go to see your patient and a family member leans over and tells them "that's just the anesthesiologist", make note of that bristling sensation on the back of your neck: that's me saying "I told you so!"

I felt this way during the bad market of the nineties. It is truly disheartening to have invested so much time and effort and to have mastered your craft to the highest levels of practice and to not have it valued by surgeons, administrators, CRNAs, et al. Fortunately for me the job market turned and I relocated to a less than desirable area and made hay while the sun shined and saved well. I turned my interest toward finance and investing so that I would be able to say F*** Y** sooner.

My heart goes out to you. I know exactly what you ae feeling. Find a way to cope or disengage-Exercise, meditation, whatever.

Personal anecdote: I worked with a total bastard CT surgeon just like you describe. Standing up once publicly and calling him on his screw up while in the ORin front of his team got him off my back. Bring back open heart for bleeding, him screaming at us, Me: "I am not the one who left a hole in the atrial cannlation site doctor." Changed the dynamic forever for the better.

 

[aneftp]

Wow, this is a depressing topic.

But you gotta see both sides. Many CRNAs aren't happy with the current job situation either. Salaries have been going down for them in many areas of the country as well.

I don't think anesthesiologist are at a dead end by any means. Incomes going down? Yes. But dead end and extinction? Give me a break.

There aren't enough anesthesiologists out there to began with in many areas of the country (outside of major urban areas). CRNAs in "independent' practice are mainly in cushy GI, eye balls centers or out in rural America.

Many urban areas don't have enough 24/7 coverage as well despite CRNAs involved heavily in those areas. The MDs take the brunt of the calls.

More people are getting health insurance or free medicaid. More cases are coming. There is plenty of work for everyone. You really think many CRNAs want to work 50-70 hours a week to make money? You gotta remember the nursing mentality. There simply aren't enough of them to take over despite the push by the AANA.

No CRNA or MD wants to work and kill themselves to make X amount after several years. It's not sustainable. There comes a point where time with your kids and family matter more. Whether that be 5-10-15 years in practice.

People are retiring every day.

 

[LeverArm]

This is so freaking depressing. This whole conversation seems cyclical every decade or so. "Anesthesia is safe" argument is amazing to me because it's not the actual anesthetics but the high acuity of a patient who is not meant to survive, where I have seen anesthesiologists really shine in the room. As much as I try, I cannot see the nurse or even the surgeon for the most part do what anesthesiologists do in many of those cases. Am I wrong?

I despise the dinosaur anesthesiologists from the days when it was a joke field, bringing in nurses to do their job so that they can line their pockets. Even Canada doesn't have CRNAs but you guys in America think they can fully replace anesthesiologists? I guess this mindset is why the field is so cyclical - first some stupid law is passed then everyone gets scared away then the demand rises and so does the profit potential and everyone runs back. Rinse and repeat.

 

[Consigliere]

Wow, this is a depressing topic.

But you gotta see both sides. Many CRNAs aren't happy with the current job situation either. Salaries have been going down for them in many areas of the country as well.

I don't think anesthesiologist are at a dead end by any means. Incomes going down? Yes. But dead end and extinction? Give me a break.

There aren't enough anesthesiologists out there to began with in many areas of the country (outside of major urban areas). CRNAs in "independent' practice are mainly in cushy GI, eye balls centers or out in rural America.

Many urban areas don't have enough 24/7 coverage as well despite CRNAs involved heavily in those areas. The MDs take the brunt of the calls.

More people are getting health insurance or free medicaid. More cases are coming. There is plenty of work for everyone. You really think many CRNAs want to work 50-70 hours a week to make money? You gotta remember the nursing mentality. There simply aren't enough of them to take over despite the push by the AANA.

No CRNA or MD wants to work and kill themselves to make X amount after several years. It's not sustainable. There comes a point where time with your kids and family matter more. Whether that be 5-10-15 years in practice.

People are retiring every day.

Boy is this an overly optimistic take on things.

 

[BLADEMDA]

This is so freaking depressing. This whole conversation seems cyclical every decade or so. "Anesthesia is safe" argument is amazing to me because it's not the actual anesthetics but the high acuity of a patient who is not meant to survive, where I have seen anesthesiologists really shine in the room. As much as I try, I cannot see the nurse or even the surgeon for the most part do what anesthesiologists do in many of those cases. Am I wrong?

I despise the dinosaur anesthesiologists from the days when it was a joke field, bringing in nurses to do their job so that they can line their pockets. Even Canada doesn't have CRNAs but you guys in America think they can fully replace anesthesiologists? I guess this mindset is why the field is so cyclical - first some stupid law is passed then everyone gets scared away then the demand rises and so does the profit potential and everyone runs back. Rinse and repeat.

Anesthesia has become a commodity like TV sets. That's how the surgeons and CEOs view the field. What is the price of a 55" TV flat screen today vs. 6 years ago?

CRNAs have used their lobby/union to get laws passed favorable to them. They have gained the upper hand in eventual "collaborative practice" in the USA. Meanwhile Anesthesiologists are largely becoming employees of hospitals and AMCs with this trend increasing each year.

Salaries won't be "rising" again due to the changing structure of employment and reimbursement for the field.

 

[BLADEMDA]

Wow, this is a depressing topic.

But you gotta see both sides. Many CRNAs aren't happy with the current job situation either. Salaries have been going down for them in many areas of the country as well.

I don't think anesthesiologist are at a dead end by any means. Incomes going down? Yes. But dead end and extinction? Give me a break.

There aren't enough anesthesiologists out there to began with in many areas of the country (outside of major urban areas). CRNAs in "independent' practice are mainly in cushy GI, eye balls centers or out in rural America.

Many urban areas don't have enough 24/7 coverage as well despite CRNAs involved heavily in those areas. The MDs take the brunt of the calls.

More people are getting health insurance or free medicaid. More cases are coming. There is plenty of work for everyone. You really think many CRNAs want to work 50-70 hours a week to make money? You gotta remember the nursing mentality. There simply aren't enough of them to take over despite the push by the AANA.

No CRNA or MD wants to work and kill themselves to make X amount after several years. It's not sustainable. There comes a point where time with your kids and family matter more. Whether that be 5-10-15 years in practice.

People are retiring every day.

As long as the person entering this field has realistic expectations about income and lifestyle then Anesthesiology is a reasonable choice. I believe there are far better choices but that is merely my opinion.

 

[Postictal Raiden]

As long as the person entering this field has realistic expectations about income and lifestyle then Anesthesiology is a reasonable choice. I believe there are far better choices but that is merely my opinion.

What are some of the realistic expectations in your opinion, Blade?

thanks

 

[Osteoimperfecta]

If you like anesthesiology, then do it. The politics will always be there in any field. Now, if Hilary Clinton wins, ALL of medicine will be in for a shock. Which specialities benefits in a single payer or government dominant system? Your guess is as good as mine. IMO, there will always be CRNAs and MDs in anesthesiology. How they get compensated? Again your guess is as good as mine.

 

[princekc]

But this is true in many fields.

Why pay a cardiologist to manage heart failure when an NP can do the same job?
Why pay a family medicine doc to run a clinic when an NP can as well?
Why pay an EM doc when you can pay a PA?

The future is not far away when a surgical PA will be doing appys and choles.

It is the nature of medicine in general, not just anesthesiology.

That's very true. The landscape had changed.

 

[aneftp]

As long as the person entering this field has realistic expectations about income and lifestyle then Anesthesiology is a reasonable choice. I believe there are far better choices but that is merely my opinion.

The average salary of anesthesiologist is around $325-350k depending which stats and polls you look at.

Being realistic means the top end anesthesiologist who can earn 600-800k (doing regular anesthesia cases outside of pain). Those days are ending. And that's the real crux of these posts.

Groups are selling themsleves out cause senior partners routinely prayed and made money off junior attendings doing less work. And that's really the truth. Senior partners see the end coming. They aren't going to work more than 5-7 years. Get a buyout while they can.

I don't think I am being overly optimistic. But there is still good income to be made in anesthesia. Just don't expect to see top end money in the future.

There are MDs who have made a killing the past 10-15 years. Some have hustled. Some of gotten lucky with good payer mix and haven't had to work and still made a killing.

But the reality is anesthesia is a field where people like to maximize their time vs compensation (as any other field would do the same). My friend made 900k/year covering an outpatient surgery center i covered from time to time. And he barely worked 35 hours a week. Don't expect those jobs to last long these days.

 

[aneftp]

Anesthesia has become a commodity like TV sets. That's how the surgeons and CEOs view the field. What is the price of a 55" TV flat screen today vs. 6 years ago?

CRNAs have used their lobby/union to get laws passed favorable to them. They have gained the upper hand in eventual "collaborative practice" in the USA. Meanwhile Anesthesiologists are largely becoming employees of hospitals and AMCs with this trend increasing each year.

Salaries won't be "rising" again due to the changing structure of employment and reimbursement for the field.

I believe average salaries have gone down the past 2 years (according to a few studies). We are in a difficult time. The last time was in the mid 90s. My older brother was just finishing residency in 1995 and couldn't find a good job along the east coast (he was from a top 20 medical school and trained at Ivy League residency program). The market was that tight. So he did cardiac fellowship but still wasn't offered more than 120k in 1996. CRNAs were making 60-70k back than in many parts of the east coast.

It's been a good run for the past 10-12 years in terms of salary increases.

 

[Silent Cool]

I believe average salaries have gone down the past 2 years (according to a few studies). We are in a difficult time. The last time was in the mid 90s. My older brother was just finishing residency in 1995 and couldn't find a good job along the east coast (he was from a top 20 medical school and trained at Ivy League residency program). The market was that tight. So he did cardiac fellowship but still wasn't offered more than 120k in 1996. CRNAs were making 60-70k back than in many parts of the east coast.

It's been a good run for the past 10-12 years in terms of salary increases.

aneftp,

IYO, what has driven the drastic salary increases over the past 20 years? Was it simply the marked decrease in training spots that occurred around the year 2000? Were there significant reimbursement increases in that time?

thanx

 

[pgg]

I believe average salaries have gone down the past 2 years (according to a few studies). We are in a difficult time. The last time was in the mid 90s. My older brother was just finishing residency in 1995 and couldn't find a good job along the east coast (he was from a top 20 medical school and trained at Ivy League residency program). The market was that tight. So he did cardiac fellowship but still wasn't offered more than 120k in 1996. CRNAs were making 60-70k back than in many parts of the east coast.

It's been a good run for the past 10-12 years in terms of salary increases.

1996 was 17 years ago. At 3% annual inflation, $120K would be equivalent to about $200K now. ($60-70K for CRNAs becomes $100-115K.)

So if $200K in today's dollars is equivalent to the worst era in modern history, a time when programs filled with IMGs (the majority of whom went on to fail their boards), maybe $200K represents a realistic worst-case floor to anesthesia salaries?

I don't think it'll get that bad, but I totally agree that a 35-hour/wk surgicenter job paying $900K is absolutely an unsustainable anomoly. Somehow I doubt that even the flavor-of-the-moment-GI-buttscope-gig will be making 7 figures forever.

 

[aneftp]

1996 was 17 years ago. At 3% annual inflation, $120K would be equivalent to about $200K now. ($60-70K for CRNAs becomes $100-115K.)

So if $200K in today's dollars is equivalent to the worst era in modern history, a time when programs filled with IMGs (the majority of whom went on to fail their boards), maybe $200K represents a realistic worst-case floor to anesthesia salaries?

I don't think it'll get that bad, but I totally agree that a 35-hour/wk surgicenter job paying $900K is absolutely an unsustainable anomoly. Somehow I doubt that even the flavor-of-the-moment-GI-buttscope-gig will be making 7 figures forever.

People finishing anesthesia residency in 1995 were really top notch students (those people had graduated med school in 1991). If you look at past match results. There were almost no open spots in 1991 match and over 1000-1100 spots.

So around 1994/1995 when there was reports anesthesia (radiology also) was over saturated, the bottom completely fell out during 1995-1997. So those who entered residency in 1996-1999 had less competition. I believe the stats I saw were that only 600 slots filled in the 1996 match (and of that number only 200 were from US medical schools).

1995-1996 were truly tough years for anesthesia.

Yes worst case for 2013 and further seems to be around in the low 200K range. That's the starting salaries in many saturated anesthesia markets these days for new grads. I don't think salaries will go any lower on the low end. By the high end has definately seen it's better days. There will be less of that money available.

Expect to work 45-55 hours for 250-350K in the future. I don't think people will try to kill themselves working 65-70 hours if they knew they would only make 400-450K.

 

[countingdays]

People finishing anesthesia residency in 1995 were really top notch students (those people had graduated med school in 1991). If you look at past match results. There were almost no open spots in 1991 match and over 1000-1100 spots.

So around 1994/1995 when there was reports anesthesia (radiology also) was over saturated, the bottom completely fell out during 1995-1997. So those who entered residency in 1996-1999 had less competition. I believe the stats I saw were that only 600 slots filled in the 1996 match (and of that number only 200 were from US medical schools).

1995-1996 were truly tough years for anesthesia.

Yes worst case for 2013 and further seems to be around in the low 200K range. That's the starting salaries in many saturated anesthesia markets these days for new grads. I don't think salaries will go any lower on the low end. By the high end has definately seen it's better days. There will be less of that money available.

Expect to work 45-55 hours for 250-350K in the future. I don't think people will try to kill themselves working 65-70 hours if they knew they would only make 400-450K.

Expect to work 60 hours for <200k if you are a new grad. Older docs and amc's will attempt to maintain their own salaries at your expense if possible. An independent crna movement will shift supply/demand to allow lowering of new grad md and crna salaries.

New grad's will have more in common with crnas than with older docs and the independent crna kamikazes will hurt both groups.

 

[IlDestriero]

Some people will absolutely work 70 hour weeks, because 450k is much better than 300k. It would be nice to shoot for 600, but you have to take what you can get. If you have big dreams or big debt, you work.

 

[aneftp]

Some people will absolutely work 70 hour weeks, because 450k is much better than 300k. It would be nice to shoot for 600, but you have to take what you can get. If you have big dreams or big debt, you work.

I don't think so. I posted before of these the generation me attitudes. It's not just anesthesioigists. It's also newer CRNA. Older CRNAs complain the new generation of CRNAs don't want to work hard either.

If they has to choose a 130k surgery center job working 35-40 hours a week vs a 250k hospital job working 60 hours. You will be quite surprised by how many would choose the surgery center jobs these days.

 

[deleted126335]

I don't think so. I posted before of these the generation me attitudes. It's not just anesthesioigists. It's also newer CRNA. Older CRNAs complain the new generation of CRNAs don't want to work hard either.

If they has to choose a 130k surgery center job working 35-40 hours a week vs a 250k hospital job working 60 hours. You will be quite surprised by how many would choose the surgery center jobs these days.

An additional benefit of working like that was rewarded with security and appreciation and recognition. Commitment like that is no longer rewarded with the secondary benefits. Also taxes are higher.

 

[countingdays]

An additional benefit of working like that was rewarded with security and appreciation and recognition. Commitment like that is no longer rewarded with the secondary benefits. Also taxes are higher.

 

[BLADEMDA]

Expect to work 60 hours for <200k if you are a new grad. Older docs and amc's will attempt to maintain their own salaries at your expense if possible. An independent crna movement will shift supply/demand to allow lowering of new grad md and crna salaries.

New grad's will have more in common with crnas than with older docs and the independent crna kamikazes will hurt both groups.

That's what I mean by "realistic expectations" in a nutshell. Then, the AMC will eventually get you to full salary around $300K for 50 hours a week.

 

[Stank811]

I won't work for less than 1 million, 35 hours a week, 10 weeks of vacation...what are my chances? What are you guys basing your extremely low numbers on....if I am making less than 300k for 50hrs a week I will ask to be supervised and refuse to work over 35hrs a week for 200k?

 

[imfrankie]

I won't work for less than 1 million, 35 hours a week, 10 weeks of vacation...what are my chances? What are you guys basing your extremely low numbers on....if I am making less than 300k for 50hrs a week I will ask to be supervised and refuse to work over 35hrs a week for 200k?

Stop being a doctor and make 100k per person per year off of 10 others and be the pimp-daddy you want to be.

 

[invitro]

Seeing as it was only a few years ago that I was a fourth year medical student deciding about anesthesiology, I guess I should give my two cents. I really like the field. Pediatric anesthesia in particular is challenging and interesting and for me pays an absurdly high amount for the satisfaction I derive from it. It's great to look forward to work!

Now do I see myself having to deal with a lower salary? Sure. But honestly I would do this job for 200k and work 50-60hrs a week. Probably even 175k. 200k in the south goes a long way...provided you invest and save/live below your means. For a single guy you can live like a king...for a family of 3-4 it's not that much worse. Plus it's easier if you send your kids to public school and don't need a mcmansion/benz. Even easier if you raise your kids right and they get scholarships to state schools lol. Working for those hours and that wage I don't see MDs going anywhere soon....particularly if you are fellowship trained and board certified....you are a bargain for the hospital in terms of the quality patient care you give compared to a CRNA.

I guess you just have to have realistic expectations...200k is decent and in all likelihood that's a low estimate for where salaries will end up. Working in a poor state and in an academic center in a children's hospital that is 80-90% medicaid I still am paid significantly higher than that. Benefits are good too. Also it's sobering to see the peds subspecialists (PICU/peds cardiology/NICU attgs etc) that work just as hard (actually harder) and make LESS. Can you imagine a interventional peds cardiologist making 175k to start? After doing SEVEN years of training! But yet the peds subspecialists I work with are fine...even happy! And no, none of them came from money or were rich outside of medicine.

I remember as a fourth year worrying about my choice so much, but in the end it worked out great. My greatest worry was having a job and making a decent wage. I definitely surpassed my expectations. I guess the only advice I would have for those pursuing the field today is just become as clinically proficient as you can in residency, consider a fellowship and of course pass your boards (preferably on the first attempt). You won't be as rich as a neurosurgeon, but you probably won't have as many ex-wives (or husbands.)

 

[mycatishuge]

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