.(idiotic)video from colorado nurse anesthetists

[criticalelement]

video from the colorado nurse anesthetists.. pioneers my arse

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[bashwell]

Here are a couple of quotes from the surgeons in the video:

They [CRNAs] give a full spectrum of care to patients and are highly skilled and able to do what I need, that is, to put patients to sleep, to take good care of them, and wake them up, and bring them successfully through an operation.

I've gone 180 degrees in the opposite direction. I think the CRNAs we have at this hospital are providing the best anesthesia I've ever seen.

This is followed by a caption that reads:

There are no differences in patient outcomes when anesthesia services are provided by CRNAs, physician anesthesiologists, or CRNAs supervised by a physician.

Imagine if anesthesiologists were in a position to choose which surgeons they want to work with, and that surgical PAs could practice under the supervision of an anesthesiologist, and then anesthesiologists publicly made videos saying stuff like, "I used to be against working with surgical PAs, but I've since gone 180 degres in the opposite direction. I think the surgical PAs we have at this hospital are providing the best surgery I've ever seen".

 

[Baller MD]

Damn I feel sorry for this field.

 

[sleepallday]

@ 17:00 Bier block?? Is anyone still doing those?

 

[urge]

Don't you guys get a feeling that by over reassuring their patients they actually scare the crap out of them?

Can you imagine a pilot on the speaker going off about how well the flight will go?

If it's going to go so well, why do I need to be reassured so much?

 

[FollowTheMoney]

I started laughing when she said "anesthesia school"

 

[Carbocation1]

Thanks to this forum I will probably not go into Anesthesiology.

 

[Mad Jack]

This forum is literally the only reason I'm not going into anesthesiology.

 

[Consigliere]

The only reason you shouldn't go into anesthesiology is because you'll be working at a crummy job (if you get one) for the next 35 years.

 

[Carbocation1]

"There is less redundancy of services too when you can utilize crnas as full anesthesia providers."

Seriously, what is this BS???

 

[NOsaintsfan]

Problem is no one has the balls to take it to these people and get rid of them. They complain on SDN instead of actually doing something about it. I mean how can you even call yourself a physician and take it up the *** from a bunch of nurses? If Donald Trump was an anesthesiologist, you better believe CRNAs would be finished by tomorrow morning.

Sounds great! What would you suggest?

 

[FollowTheMoney]

1.) Publish studies that show independent CRNAs have a higher morbidity and mortality rate and are a liability to patient safety
2.) Pass a law that requires CRNAs to practice under an anesthesiologist in all 50 states, regardless of clinical setting or location
3.) Grant AAs practicing rights in all 50 states and transition to using them as the premier midlevel provider
4.) Pursue legal recourse against CRNAs for trying to call themselves "doctor" in a clinical situation

 

[deleted126335]

Don't forget to write your check to ASAPAC.

 

[FollowTheMoney]

Don't forget to write your check to ASAPAC.

Did you get that e-mail today too?

 

[Spinach Dip]

Sounds great! What would you suggest?

Probably doing something 10+ years ago as a start.

 

[67552931811]

Thanks to this forum I will probably not go into Anesthesiology.

This forum is literally the only reason I'm not going into anesthesiology.

Yeah

 

[bashwell]

1.) Publish studies that show independent CRNAs have a higher morbidity and mortality rate and are a liability to patient safety
2.) Pass a law that requires CRNAs to practice under an anesthesiologist in all 50 states, regardless of clinical setting or location
3.) Grant AAs practicing rights in all 50 states and transition to using them as the premier midlevel provider
4.) Pursue legal recourse against CRNAs for trying to call themselves "doctor" in a clinical situation

Great goals. Totally agree. But unfortunately much easier said than done. A more immediate objective is how to organize enough and/or key anesthesiologists to be able to make some of these things realistically happen. To get enough and/or key anesthesiologists interested in seeing these things through in terms of time commitment, resources, etc. Whatever it takes.

 

[FollowTheMoney]

It does not matter how many anesthesiologists get behind this, it comes down to $$$. If you have enough money backing an agenda, it cannot be stopped. Theoretically, if the ASAPAC had unlimited resources they could buy every politician in Washington and have a bill passed by tomorrow morning. That's the problem here... the lack of money to buy off anyone who needs to be bought off in order for this to happen. Any anesthesiologist who is literate in economics can figure out that if nothing changes the job market is going to shrink and the salaries are going to drop by 40-50%. Instead of allowing that to happen, every anesthesiologist needs to sacrifice an annual income's worth in order to save the profession and their career in the long run. You will come out way ahead in the long run preserving annual salaries of 350k and a stable job market if you are willing to drop some serious money now to solve the problem.

 

[bashwell]

Again, great ideas. Just not sure how likely or realistic it is for "every anesthesiologist...to sacrifice an annual income's worth in order to save the profession". Logically it could make sense, but people don't always act in logical or rational ways, people are often emotionally driven, prefer short term solutions with few sacrifices to the long term benefits with bigger sacrifices, their self interest may outweigh the more important collective good of the specialty, etc. Obviously I hope I'm wrong.

 

[FollowTheMoney]

If the leadership within the ASA or ASAPAC went through the logistics of what it would take to get those bills passed and presented the plan and money required to finance it I think every anesthesiologist would take it very seriously. It is one thing to say "Donate to the ASAPAC because these CRNAs are a problem" and it's another to say "I've spoken with prominent members in the house and senate and went through the due diligence to to figure out what it would take to get these bills passed and the estimated report is we need to raise 30 million dollars to guarantee that it happens, which would equate to x amount per anesthesiologist. Let's save the profession, stabilize the job market and our incomes, and ensure our patients get the highest quality of care"

 

[Planktonmd]

This forum is literally the only reason I'm not going into anesthesiology.

That's your choice not the forum's effect!
People here speak of their experiences and opinions then you must be able to make your own intelligent decisions.

 

[Sublimazing]

I started laughing when she said "anesthesia school"

Same, it felt like they were describing Clown College

 

[Psai]

I like the part where they say that a doctor is overtrained and overqualified but they now have "doctorates" without any significant change in curriculum. Also, anesthesiology assistants are not qualified despite going to "anesthesia school"

 

[FollowTheMoney]

 

[Mad Jack]

I love how the surgeon says they're highly skilled and able to do what she needs to them to do. Makes them sound like talented children.

 

[FranzLO]

I love how the surgeon says they're highly skilled and able to do what she needs to them to do. Makes them sound like talented children.

They put them to sleep, wait there while they sleep, then wake them up. CRNAs!

 

[FollowTheMoney]

They put them to sleep, wait there while they sleep, then wake them up. CRNAs!

Pretty much sums it up. A glorified babysitter, nothing more and nothing less.

 

[FollowTheMoney]

I love how the surgeon says they're highly skilled and able to do what she needs to them to do. Makes them sound like talented children.

Translation: They cost me less and behave exactly how I want them to so I'm a happy businessman.

 

[Man o War]

If 95% of the CRNAs I've worked with are unleashed unsupervised, we will have all the ammo we need to never have this independent practice discussion again, because the results will be disastrous. I feel bad for the casualties they will leave in their wake, it's a terrible price to pay for this stupid experiment.

 

[Gern Blansten]

I went into anesthesiology in the mid 90's and was told I would not have a job. Most people avoided the field and it has worked out very well for me. All specialties have their issues. Ours are simply more visible.
The real answer is likely to not even go into medicine at all, but that ship has sailed for anyone who is already in the process and in so much debt that they cannot pay it off unless they continue.
Ortho-the podiatrists wish to operate all the way up to the knee
General surgery-canibalized by their own subspecialists plus, endoscopic technology may soon allow for GI docs to do appys and a few other intra-abdominal procedures.
Dermatologists-nurse practitioners invading a lot of areas
Ophthalmology-optometrists continue to lobby to do more, even including cataracts; gaining ground
Family medicine-NP's have blown that specialty up in the last 10 years. In addition, they are getting chipped away at by PharmD's who work at drug stores and do vaccines now. The majority no longer do any OB. The era of the country doc who does it all seems to be almost completely gone.
Psychiatry-psychologists do much of the same stuff and are gaining ground in prescribing. Definitely are referred to as "doctors" in the clinical setting.
Cardiac surgeons-advances in non invasive measures have hurt their numbers
Radiology-high quality imaging allows film reading to be done in remote locations, such as India. Will only become more prevalent.
OB/Gyn-nurse midwives making a large amount of gains. Have lobbied to be allowed to perform c-sections. Probably not much chance of that happening, but they are trying. I expect the number of midwife deliveries to continue to climb.
Neurosurgeons-the turf battles with Interventional radiology and pain physicians continues; Their ace in the hole is that trauma centers need them for trauma accreditations, so they have continued to be in high demand, for limited amount of work.
Vascular surgeons-some crossover and competition with interventional radiology, but seem to be doing okay at the moment. The majority of their stuff is now done with less invasive catheter and wire techniques.
Pediatrics-likely will see further progression in this field by NP's
Neonatology-already dominated by highly specialized NP's

I'm sure there are others.

Specialties that are likely more shielded than others:
Plastic Surgery-cash business depends a lot on the economy at the time.
Urology-not much encroachment from others
Cardiology-highly specialized
Emergency Medicine-likely safe, but very high burnout rate due to the terrible patient population. I've never seen a specialty that universally dislikes such a large percentage of their patients as much as this one. Treated very poorly by surgeons and accepting medicine docs at many locations. Also, urgent care centers staffed by NP's could skim off the less complex patients.
Ortho-likely will fend off the podiatrist's encroachment
Nuclear medicine-a small specialty that is highly specialized. However, if treatment plans were to render their specialty obsolete in the next 20 years, could be an issue.
Hospitalists-seem to have found a niche, but they will not be immune to the NP's either. Also, the burnout factor is likely huge, despite the 2 weeks on, 2 weeks off cycle that many do.
Thoracic surgery-still a need for good ones but new technology could soon allow more bronchoscopic (pulmonologists) approaches to problems.

So, there are really very few medical fields that are unaffected. Anesthesiology is just on the leading edge. Newer technologies will likely make formerly challenging procedures much less difficult and open up a lot of areas for lesser trained individuals. Recall that starting IV's was considered a big deal many decades ago and was only done by physicians. Thirty years ago, physicians were treated with respect. Now physicians are pawns and are told what to do by CEO's, politicians, and nurses in hospital executive leadership positions.
Lessons learned through experience are disappearing as older physicians retire. The newer generation will not have the experience to be much better than NP's due to duty hours restrictions and the disappearance of good educators who recall the value of the physical exam and excellent history taking skills. The art of medicine is disappearing as is the ability to identify the zebras when they do occur. If it can't be scanned or tested for by shotgun lab approach, then it will likely be missed. Politicians will see nurses as the caring and empathetic cheaper choice, because that is what they will be told to believe.
Believe me when I tell you, anesthesiology is not the only specialty that will be hit hard by these new changes. For that reason, I say, pick a specialty you can enjoy, don't over commit financially by creating a large and expensive lifestyle, and try to enjoy what you do for a living.

 

[FollowTheMoney]

If 95% of the CRNAs I've worked with are unleashed unsupervised, we will have all the ammo we need to never have this independent practice discussion again, because the results will be disastrous. I feel bad for the casualties they will leave in their wake, it's a terrible price to pay for this stupid experiment.

I think hospitals, insurance companies, and the government won't care because the amount of money they would save in the long run by going with midlevel providers would compensate for worse outcomes and potential settlements. There's nothing that will save Anesthesiologists unless they physically get a bill passed mandating they have to be present and oversee these midlevel providers.

 

[bashwell]

I went into anesthesiology in the mid 90's and was told I would not have a job. Most people avoided the field and it has worked out very well for me. All specialties have their issues. Ours are simply more visible.
The real answer is likely to not even go into medicine at all, but that ship has sailed for anyone who is already in the process and in so much debt that they cannot pay it off unless they continue.
Ortho-the podiatrists wish to operate all the way up to the knee
General surgery-canibalized by their own subspecialists plus, endoscopic technology may soon allow for GI docs to do appys and a few other intra-abdominal procedures.
Dermatologists-nurse practitioners invading a lot of areas
Ophthalmology-optometrists continue to lobby to do more, even including cataracts; gaining ground
Family medicine-NP's have blown that specialty up in the last 10 years. In addition, they are getting chipped away at by PharmD's who work at drug stores and do vaccines now. The majority no longer do any OB. The era of the country doc who does it all seems to be almost completely gone.
Psychiatry-psychologists do much of the same stuff and are gaining ground in prescribing. Definitely are referred to as "doctors" in the clinical setting.
Cardiac surgeons-advances in non invasive measures have hurt their numbers
Radiology-high quality imaging allows film reading to be done in remote locations, such as India. Will only become more prevalent.
OB/Gyn-nurse midwives making a large amount of gains. Have lobbied to be allowed to perform c-sections. Probably not much chance of that happening, but they are trying. I expect the number of midwife deliveries to continue to climb.
Neurosurgeons-the turf battles with Interventional radiology and pain physicians continues; Their ace in the hole is that trauma centers need them for trauma accreditations, so they have continued to be in high demand, for limited amount of work.
Vascular surgeons-some crossover and competition with interventional radiology, but seem to be doing okay at the moment. The majority of their stuff is now done with less invasive catheter and wire techniques.
Pediatrics-likely will see further progression in this field by NP's
Neonatology-already dominated by highly specialized NP's

I'm sure there are others.

Specialties that are likely more shielded than others:
Plastic Surgery-cash business depends a lot on the economy at the time.
Urology-not much encroachment from others
Cardiology-highly specialized
Emergency Medicine-likely safe, but very high burnout rate due to the terrible patient population. I've never seen a specialty that universally dislikes such a large percentage of their patients as much as this one. Treated very poorly by surgeons and accepting medicine docs at many locations. Also, urgent care centers staffed by NP's could skim off the less complex patients.
Ortho-likely will fend off the podiatrist's encroachment
Nuclear medicine-a small specialty that is highly specialized. However, if treatment plans were to render their specialty obsolete in the next 20 years, could be an issue.
Hospitalists-seem to have found a niche, but they will not be immune to the NP's either. Also, the burnout factor is likely huge, despite the 2 weeks on, 2 weeks off cycle that many do.
Thoracic surgery-still a need for good ones but new technology could soon allow more bronchoscopic (pulmonologists) approaches to problems.

So, there are really very few medical fields that are unaffected. Anesthesiology is just on the leading edge. Newer technologies will likely make formerly challenging procedures much less difficult and open up a lot of areas for lesser trained individuals. Recall that starting IV's was considered a big deal many decades ago and was only done by physicians. Thirty years ago, physicians were treated with respect. Now physicians are pawns and are told what to do by CEO's, politicians, and nurses in hospital executive leadership positions.
Lessons learned through experience are disappearing as older physicians retire. The newer generation will not have the experience to be much better than NP's due to duty hours restrictions and the disappearance of good educators who recall the value of the physical exam and excellent history taking skills. The art of medicine is disappearing as is the ability to identify the zebras when they do occur. If it can't be scanned or tested for by shotgun lab approach, then it will likely be missed. Politicians will see nurses as the caring and empathetic cheaper choice, because that is what they will be told to believe.
Believe me when I tell you, anesthesiology is not the only specialty that will be hit hard by these new changes. For that reason, I say, pick a specialty you can enjoy, don't over commit financially by creating a large and expensive lifestyle, and try to enjoy what you do for a living.

Nice post, Gern Blansten!

 

[nimbus]

Neurosurgeons-the turf battles with Interventional radiology and pain physicians continues; Their ace in the hole is that trauma centers need them for trauma accreditations, so they have continued to be in high demand, for limited .

Don't forget spine. We have 8 neurosurgeons on staff and the vast majority of their cases are spine. I'd say there are 10 spines for every intracranial case we do. They are competing with the orthopedists for this work.

They actually seem to have a symbiotic relationship with IR and pain. And also with the radiation oncologists at the local gamma knife center.

As for trauma coverage, our orthopedists, cardiac surgeons and neurosurgeons get a coverage stipend that is almost 2x anesthesia. And we are required to be in house while they are not. We are all essential for a trauma program but they have more leverage because there a fewer of them.

Not all specialties are equally valued.

 

[bashwell]

I'd add there are some IM subspecialties that still seem to be decent choices for people with equal interests in IM and anesthesiology. They're changing and face their own issues too, like Gern Blansten pointed out, but nevertheless still offer decent overall money/lifestyle. Also I don't think midlevels are as present threats to these IM subspecialties as they seem to be in anesthesiology today. There's more mutual respect and collegiality in and among these specialties and with other specialties due to things like shared patient care between different specialties with curative goals for patients (e.g. surgical oncology, rad onc, and heme/onc). Of course, as with every specialty, there are tradeoffs and intangibles, some of which may be more or less palatable depending on one's personality, interests, values, family, and so forth.

 

[BW15]

That video is very upsetting, if they wanted to be doctors that practice anesthesiology, they should have gone to medical school instead of trying so hard to find a back door path.

What I believe is that it only takes 1 politician or influential leaders loved one to suffer from the hands of an over confident CRNA for an agenda to be made to limit their practice by people who can actually follow through with it. However, these types of patients are usually smart enough to request a physician anesthesiologist for themselves and their families.

 

[Psai]

I went into anesthesiology in the mid 90's and was told I would not have a job. Most people avoided the field and it has worked out very well for me. All specialties have their issues. Ours are simply more visible.
The real answer is likely to not even go into medicine at all, but that ship has sailed for anyone who is already in the process and in so much debt that they cannot pay it off unless they continue.
Ortho-the podiatrists wish to operate all the way up to the knee
General surgery-canibalized by their own subspecialists plus, endoscopic technology may soon allow for GI docs to do appys and a few other intra-abdominal procedures.
Dermatologists-nurse practitioners invading a lot of areas
Ophthalmology-optometrists continue to lobby to do more, even including cataracts; gaining ground
Family medicine-NP's have blown that specialty up in the last 10 years. In addition, they are getting chipped away at by PharmD's who work at drug stores and do vaccines now. The majority no longer do any OB. The era of the country doc who does it all seems to be almost completely gone.
Psychiatry-psychologists do much of the same stuff and are gaining ground in prescribing. Definitely are referred to as "doctors" in the clinical setting.
Cardiac surgeons-advances in non invasive measures have hurt their numbers
Radiology-high quality imaging allows film reading to be done in remote locations, such as India. Will only become more prevalent.
OB/Gyn-nurse midwives making a large amount of gains. Have lobbied to be allowed to perform c-sections. Probably not much chance of that happening, but they are trying. I expect the number of midwife deliveries to continue to climb.
Neurosurgeons-the turf battles with Interventional radiology and pain physicians continues; Their ace in the hole is that trauma centers need them for trauma accreditations, so they have continued to be in high demand, for limited amount of work.
Vascular surgeons-some crossover and competition with interventional radiology, but seem to be doing okay at the moment. The majority of their stuff is now done with less invasive catheter and wire techniques.
Pediatrics-likely will see further progression in this field by NP's
Neonatology-already dominated by highly specialized NP's

I'm sure there are others.

Specialties that are likely more shielded than others:
Plastic Surgery-cash business depends a lot on the economy at the time.
Urology-not much encroachment from others
Cardiology-highly specialized
Emergency Medicine-likely safe, but very high burnout rate due to the terrible patient population. I've never seen a specialty that universally dislikes such a large percentage of their patients as much as this one. Treated very poorly by surgeons and accepting medicine docs at many locations. Also, urgent care centers staffed by NP's could skim off the less complex patients.
Ortho-likely will fend off the podiatrist's encroachment
Nuclear medicine-a small specialty that is highly specialized. However, if treatment plans were to render their specialty obsolete in the next 20 years, could be an issue.
Hospitalists-seem to have found a niche, but they will not be immune to the NP's either. Also, the burnout factor is likely huge, despite the 2 weeks on, 2 weeks off cycle that many do.
Thoracic surgery-still a need for good ones but new technology could soon allow more bronchoscopic (pulmonologists) approaches to problems.

So, there are really very few medical fields that are unaffected. Anesthesiology is just on the leading edge. Newer technologies will likely make formerly challenging procedures much less difficult and open up a lot of areas for lesser trained individuals. Recall that starting IV's was considered a big deal many decades ago and was only done by physicians. Thirty years ago, physicians were treated with respect. Now physicians are pawns and are told what to do by CEO's, politicians, and nurses in hospital executive leadership positions.
Lessons learned through experience are disappearing as older physicians retire. The newer generation will not have the experience to be much better than NP's due to duty hours restrictions and the disappearance of good educators who recall the value of the physical exam and excellent history taking skills. The art of medicine is disappearing as is the ability to identify the zebras when they do occur. If it can't be scanned or tested for by shotgun lab approach, then it will likely be missed. Politicians will see nurses as the caring and empathetic cheaper choice, because that is what they will be told to believe.
Believe me when I tell you, anesthesiology is not the only specialty that will be hit hard by these new changes. For that reason, I say, pick a specialty you can enjoy, don't over commit financially by creating a large and expensive lifestyle, and try to enjoy what you do for a living.

Excellent post. It's a shame that medicine is being cut apart and taken over by lesser trained people but that seems to be the way things are going these days. There are so many problems arising from people doing things they shouldn't be doing because they don't know what they need to know. But the people in charge only care about numbers. Everyone gives lip service to patient care but they don't really care. They only care about the bottom line

 

[Man o War]

E

 

[Consigliere]

1.) Publish studies that show independent CRNAs have a higher morbidity and mortality rate and are a liability to patient safety

First of all, these studies will NEVER be done. Secondly, what if they show there is no difference in morbidity and mortality rate? Then what?

 

[Mad Jack]

First of all, these studies will NEVER be done. Secondly, what if they show there is no difference in morbidity and mortality rate? Then what?

Then anesthesiologists would have no case, but we'd at least have our answer.

 

[Spinach Dip]

First of all, these studies will NEVER be done. Secondly, what if they show there is no difference in morbidity and mortality rate? Then what?

Then it would be proof that the current practice (of 4 years of med school followed by 4 years of residency) is an archaic holdover which needs to be changed.

 

[FollowTheMoney]

Then anesthesiologists would have no case, but we'd at least have our answer.

Then it would be proof that the current practice (of 4 years of med school followed by 4 years of residency) is an archaic holdover which needs to be changed.

I'm willing to bet the data will show a considerable difference between anesthesiologists and nurse anesthetists. However, I think anyone can tell you the current structure of medical school and residency borders on archaic and inefficient. I'm sure you could produce a great anesthesiologist in 5 years instead of 8.... 3rd and 4th year of medical school is irrelevant for anesthesia and intern year could be done away with.

 

[nimbus]

I'm willing to bet the data will show a considerable difference between anesthesiologists and nurse anesthetists. However, I think anyone can tell you the current structure of medical school and residency borders on archaic and inefficient. I'm sure you could produce a great anesthesiologist in 5 years instead of 8.... 3rd and 4th year of medical school is irrelevant for anesthesia and intern year could be done away with.

Get rid of 3rd and 4th year and internship? So you think you would be just as good a doctor without those silly medicine, surgery and ob/gyn clerkships?

What you are describing is basically CRNA school. If that is true, maybe the CRNAs have a point.

 

[Urzuz]

.... 3rd and 4th year of medical school is irrelevant for anesthesia and intern year could be done away with

What kind of a practice do you work in? Or rather, what medical school and internship did you go to? If you truly feel like you learned and gained nothing from your clerkships AND your internship, I feel sorry for you. And I'm not talking about learning useless facts you never apply...I'm talking practical, fundamental knowledge that not only makes you a well-rounded physician, but a great anesthesiologist.

 

[Mad Jack]

I'm willing to bet the data will show a considerable difference between anesthesiologists and nurse anesthetists. However, I think anyone can tell you the current structure of medical school and residency borders on archaic and inefficient. I'm sure you could produce a great anesthesiologist in 5 years instead of 8.... 3rd and 4th year of medical school is irrelevant for anesthesia and intern year could be done away with.

And then anesthesiologist wouldn't actually be doctors, and the surgeons would be entirely correct in treating them as less than equals.

 

[FollowTheMoney]

What kind of a practice do you work in? Or rather, what medical school and internship did you go to? If you truly feel like you learned and gained nothing from your clerkships AND your internship, I feel sorry for you. And I'm not talking about learning useless facts you never apply...I'm talking practical, fundamental knowledge that not only makes you a well-rounded physician, but a great anesthesiologist.

Let's back up here for one second. I am in no way advocating that we should cut it from 8 years to 5 years, I was speaking hypothetically about what what alternative routes could be taken to to expedite this process of becoming an anesthesiologist. Obviously 3rd and 4th clerkships and intern year are vital to helping you become a well rounded physician and anesthesiologist. Are there ways to consolidate the training? I don't have any data or evidence to indicate that it should or should not be done. One has to wonder how CRNAs can do a big % of what Anesthesiologists do with so much less training. The sheer fact that they are practicing independently and it's not completely backfiring has to make you wonder if everything physicians go through is entirely necessary to becoming a great anesthesiologist. I definitely think the structure of medical school is old fashioned in some ways and I think there are ways we could help streamline people on certain pathways without compromising their ability to gain a well rounded experience. There is profound knowledge and expertise that comes with clinical exposure, I don't think anyone can deny that. However, what clinical exposure you get and how relevant it is to what you do could be adjusted. I think I misspoke and gave off the wrong impression of what I meant by consolidating the 3rd, 4th and intern year.

 

[Twiggidy]

This has nothing to do with who's better than who or who's being taught more than who, this is all about advances in technology which has made anesthesia safer and allowed people with less skills to encroach the field.

If we want to blame anything, the blame:

Glidescopes
Ultrasounds
Hemodynamically stable drugs
etc, etc, etc

and yes, maybe even a touch of laziness on anesthesiologists part.

I don't blame CRNA's. The saw the door of opportunity open and put a battering ram through it. Trust me, if anesthesia was dangerous and risky like the old days, it would be a different story. Now, we tell patients, "You're more likely to get hit by a car than to die under anesthesia." It's literally so easy a caveman could do it. But this is why Peds and maybe some cardiac, is yet to be encroached. I know some places have nurses do hearts and probably some do peds, but I think those days of CRNAs diving into those fields fully a ways away.

The main problem
Anesthesiologist have sh***y lobbying.

 

[FollowTheMoney]

This has nothing to do with who's better than who or who's being taught more than who, this is all about advances in technology which has made anesthesia safer and allowed people with less skills to encroach the field.

If we want to blame anything, the blame:

Glidescopes
Ultrasounds
Hemodynamically stable drugs
etc, etc, etc

and yes, maybe even a touch of laziness on anesthesiologists part.

I don't blame CRNA's. The saw the door of opportunity open and put a battering ram through it. Trust me, if anesthesia was dangerous and risky like the old days, it would be a different story. Now, we tell patients, "You're more likely to get hit by a car than to die under anesthesia." It's literally so easy a caveman could do it. But this is why Peds and maybe some cardiac, is yet to be encroached. I know some places have nurses do hearts and probably some do peds, but I think those days of CRNAs diving into those fields fully a ways away.

The main problem
Anesthesiologist have sh***y lobbying.

I actually agree with this 100%

 

[jwk]

Probably doing something 10+ years ago as a start.

I started bitching about them 35 years ago!

 

[WholeLottaGame7]

I went into anesthesiology in the mid 90's and was told I would not have a job. Most people avoided the field and it has worked out very well for me. All specialties have their issues. Ours are simply more visible.
The real answer is likely to not even go into medicine at all, but that ship has sailed for anyone who is already in the process and in so much debt that they cannot pay it off unless they continue.

So, there are really very few medical fields that are unaffected. Anesthesiology is just on the leading edge. Newer technologies will likely make formerly challenging procedures much less difficult and open up a lot of areas for lesser trained individuals. Recall that starting IV's was considered a big deal many decades ago and was only done by physicians. Thirty years ago, physicians were treated with respect. Now physicians are pawns and are told what to do by CEO's, politicians, and nurses in hospital executive leadership positions.
Lessons learned through experience are disappearing as older physicians retire. The newer generation will not have the experience to be much better than NP's due to duty hours restrictions and the disappearance of good educators who recall the value of the physical exam and excellent history taking skills. The art of medicine is disappearing as is the ability to identify the zebras when they do occur. If it can't be scanned or tested for by shotgun lab approach, then it will likely be missed. Politicians will see nurses as the caring and empathetic cheaper choice, because that is what they will be told to believe.
Believe me when I tell you, anesthesiology is not the only specialty that will be hit hard by these new changes. For that reason, I say, pick a specialty you can enjoy, don't over commit financially by creating a large and expensive lifestyle, and try to enjoy what you do for a living.

Great post, and I would have posted something similar if I had the time/energy. The bolded is something I agree with 100%

I think you're overstating the threat to radiology. There are pretty strict rules in place about who can read (have to be licensed as MD in US, sometimes have to actually be in the states, etc). The problems with radiology are more about the pinching reimbursements (CXRs are something ridiculous, like $3) and job opportunities (nobody's retiring).

I also feel like the threat to EM and hospitalists is a little bigger than you stated. Midlevels galore in those fields and probably similar to anesthesia in that they will siphon off the easier, less complicated patients.

Don't forget spine. We have 8 neurosurgeons on staff and the vast majority of their cases are spine. I'd say there are 10 spines for every intracranial case we do. They are competing with the orthopedists for this work.

But even spine will start taking a hit as more and more data comes out that a lot of these spine surgeries have no different or worse outcomes than non-surgical management. Plus companies will not want to pay for these redo-redo-redo-redo spines. Not that it's an existential threat to the field, but it will be to their reimbursement.

 

[Carbocation1]

What's the latest with AA licensure? If they become licensed in all 50 states and become the premier non-physician provider in the ACT model I would seriously consider this specialty. The crnas can all go work in the icu, where there is a huge shortage.