Is the anesthesia job market saturated?

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They're not. They're talking about lower salaries. They're talking about more administration and people using your medical license to make money for themselves.

There has been a medicare/medicaid correction (published in 2011) that increased reimbursement for anesthesia services, not cut it. (I'm looking for the link now. Info is available on ASA website.)

gotcha, thanx.

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They're not. They're talking about lower salaries. They're talking about more administration and people using your medical license to make money for themselves.

There has been a medicare/medicaid correction (published in 2011) that increased reimbursement for anesthesia services, not cut it. (I'm looking for the link now. Info is available on ASA website.)

Yes. We did get a raise. Yes, we are not seeing it as a whole.
 
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as... a whole...

AMCs are here. They ARE a threat. Let's not be blind.

Just depends who you work for.... That is#1

I've made 3x what some offer. 3x. Where does that extra income go if they have better negotiating power with insurance companies? You HAVE to ask that question.
 
Good question. We are making more than ever.
Change may be coming, but it ain't here yet.
Unless you work for the man, he tells you how bad it is getting while taking a bigger slice of your sweet sweet pie.
Well I just hope that you guys can help keep it at bay for another ten years AT LEAST - at least until I get mine. It seems that's what it's all about :shrug:
 
Well I just hope that you guys can help keep it at bay for another ten years AT LEAST - at least until I get mine. It seems that's what it's all about :shrug:

No, that's not what it's all about. It's about those doing the work getting fairly compensated when they are the ones actually doing the work and taking all the liability exposure.

A brief history about how we got to this point... will try to keep it tweet length.

Billing is a pain. Billing companies grew. Got more efficient. Got bright idea. Employ docs instead. Pay salary. Docs liked steady flat ground instead of roller coaster. Senior docs still owned their practice but started consolidating. Efficiency grew. Money coming in grew. Those who got in early were owners. They hold/held the cards. Others sold.

Flash forward. New grad? Salary only option for you now. Want to work in a nice place? Take what we give you or pound sand. And we'll tell you how you're going to work. 4:1 supervision? Q4 call? Like it or lump it. We own you.
 
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In other words if you work for a "practice" (that I otherwise call a "sweatshop", like the one I left in January) for which they are going to collectively bill $1.2M for your services over the course of the year, brag that they will collect 80-85% of that, then they are going to pay you $275K and some measly benefits, who wins? Not you.

Don't believe me? Even if you get six weeks vacation they still just have to collect $5500/day when you're there for your services to get to those numbers. If you're 4:1, that's peanuts in a busy place. Probably getting a lot more than that on the back of your hard work.
 
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No, that's not what it's all about. It's about those doing the work getting fairly compensated when they are the ones actually doing the work and taking all the liability exposure.

A brief history about how we got to this point... will try to keep it tweet length.

Billing is a pain. Billing companies grew. Got more efficient. Got bright idea. Employ docs instead. Pay salary. Docs liked steady flat ground instead of roller coaster. Senior docs still owned their practice but started consolidating. Efficiency grew. Money coming in grew. Those who got in early were owners. They hold/held the cards. Others sold.

Flash forward. New grad? Salary only option for you now. Want to work in a nice place? Take what we give you or pound sand. And we'll tell you how you're going to work. 4:1 supervision? Q4 call? Like it or lump it. We own you.
I meant that it's what a lot of the old guys are all about - they don't care about fairness as long as they get what they want. All I hope for is the opportunity to work hard and one day get mine. Hopefully the selfish medicare generation won't totally ruin it.
 
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I think there will be a pendulum swing back when enough people get pissed off about it.

It's awareness right now, and then eventually and hopefully action will take place.

For one, I don't get how it is against the law in Texas for a non-physician to have equity and profit off a physicians' practice but a doctor who basically functions as a non-physician being an outside investor is allowed to gobble up the market. That's not right. To have equity in a physicians' group, I think it needs to be shown that you have the capability to practice within the group and bring in revenue.
 
I meant that it's what a lot of the old guys are all about - they don't care about fairness as long as they get what they want.

Well, a lot of those "old guys" are essentially now treating the new residency grads fresh out of training exactly how they've treated the CRNAs for years. They just don't care. Instead of them doing the 4:1 supervision, they're happy to put you in that boat and collect the money you make off of that arrangement, keep most of it, and pay you a pittance.

You gotta do away with the exclusive contracts and you gotta turn the CRNAs loose. Completely.
 
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For as much as people bitch about saturated markets and lack of real partnership tracks, I just do not see it in my market. I live in a mid size metropolitan area in "flyover country". We have a large international airport hub, all the major league sports teams, and tons of great stuff to do. There are 10 private anesthesia groups in town, and they all have real actual contractually defined partnership tracks and no history of not making track-hires partner. There are no non-partnership tracks in town (except at the VA and university). The jobs are all pretty cush with excellent income and lots of vacation. Maybe I'm just lucky I grew up nearby and love living here, but my local market is either totally unique or there are actually good jobs out there. Keep looking.
 
You live at the North Pole, as far as many of us are concerned. During winter, you probably take trips to Alaska to warm up. :p
 
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For as much as people bitch about saturated markets and lack of real partnership tracks, I just do not see it in my market. I live in a mid size metropolitan area in "flyover country". We have a large international airport hub, all the major league sports teams, and tons of great stuff to do. There are 10 private anesthesia groups in town, and they all have real actual contractually defined partnership tracks and no history of not making track-hires partner. There are no non-partnership tracks in town (except at the VA and university). The jobs are all pretty cush with excellent income and lots of vacation. Maybe I'm just lucky I grew up nearby and love living here, but my local market is either totally unique or there are actually good jobs out there. Keep looking.

Most people don't want to live where you live bc of the Canadian-like weather.
 
For as much as people bitch about saturated markets....

Most people don't want to live where you live bc of the Canadian-like weather.

I don't know. I've heard Minneapolis is a pretty killer city. Tons of nightlife. Great restaurants. The Vikings. Timberwolves. Prince, Bob Mould/Husker Du, The Replacements... They can't all be wrong. Reasonable real estate.

You hiring, B-Bone? (Haha. JK. I'm good where I am now.)
 
I've heard great stuff, too. That doesn't change the fact that my better half loves warm climates.
 
I've heard great stuff, too. That doesn't change the fact that my better half loves warm climates.

So does mine. But that didn't work out so well for us.
 
Most people don't want to live where you live bc of the Canadian-like weather.

I guess most people can suck it up and take a ****ty AMC/employee gig in Cali or America's Wang where the weather's better, but I have enough money/vacation to head to Hawaii twice a year and ski four weeks every winter with a trip to Europe or two in the mix. Money, location, and lifestyle. Pick two out of three.
 
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So does mine. But that didn't work out so well for us.
I think I might have a chance, now that she's seen what a crappy job can do to me. When about jobs, I'm slowly becoming a contrarian: go where other people are running from.
 
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I guess most people can suck it up and take a ****ty AMC/employee gig in Cali or America's Wang...

Well, America's Wang has a horrible raging case of herpes. And its rash is spreading up the southeastern U.S.
 
I think I might have a chance, now that she's seen what a crappy job can do to me. When about jobs, I'm slowly becoming a contrarian: go where other people are running from.

Good luck with that.
 
Geographic flexibility can allow a doc to more than double their hourly rate. As the real estate people say, location,
I guess most people can suck it up and take a ****ty AMC/employee gig in Cali or America's Wang where the weather's better, but I have enough money/vacation to head to Hawaii twice a year and ski four weeks every winter with a trip to Europe or two in the mix. Money, location, and lifestyle. Pick two out of three.

Now it is one out of three.
 
For as much as people bitch about saturated markets and lack of real partnership tracks, I just do not see it in my market. I live in a mid size metropolitan area in "flyover country". We have a large international airport hub, all the major league sports teams, and tons of great stuff to do. There are 10 private anesthesia groups in town, and they all have real actual contractually defined partnership tracks and no history of not making track-hires partner. There are no non-partnership tracks in town (except at the VA and university). The jobs are all pretty cush with excellent income and lots of vacation. Maybe I'm just lucky I grew up nearby and love living here, but my local market is either totally unique or there are actually good jobs out there. Keep looking.


Midwest offers the best opportunities in general. 30% of jobs (nationwide) do offer partnership tracks and a shot at the American dream. The majority of those jobs are in the Midwest.
 
For as much as people bitch about saturated markets and lack of real partnership tracks, I just do not see it in my market. I live in a mid size metropolitan area in "flyover country". We have a large international airport hub, all the major league sports teams, and tons of great stuff to do. There are 10 private anesthesia groups in town, and they all have real actual contractually defined partnership tracks and no history of not making track-hires partner. There are no non-partnership tracks in town (except at the VA and university). The jobs are all pretty cush with excellent income and lots of vacation. Maybe I'm just lucky I grew up nearby and love living here, but my local market is either totally unique or there are actually good jobs out there. Keep looking.

Seeing as how i'll graduate in 6-7 years... hopefully by then global warming wouldve made Minneapolis warmer so i can find a job there
 
What exactly is good money? For a new grad?
300k plus bennies and 6+ weeks vacation?
350K plus bennies and 6+ weeks vacation?
400K plus bennies and 6+ weeks vacation?

For the guy from TX, I know you need connections, but are any of these new grads making 300K plus bennies? Seems like there are jobs abound in TX metropolitan areas, however the pay starts in the low to mid 200s. Is this the new norm?
 
The problem here is the growth of AMCs which have basically taken over all the anesthesia contracts in many of the cities, forcing the common folks to work as a salaried employee with no say in the actual business. Thus, whether u are a employee of Sheridan or NAPA or MedNex, in the end, u are simply a gerbel on a spinwheel churning cases and not building equity. The pay will be what they want it to be, and most likely will be governed by supply and demand. Thus, it doesnt matter what reimbursements are; if the AMCs can band together and low-ball then the doc will have no choice but to accept. Remember, lower salaries for the docs means higher margins for the business
 
... while the patients will get worse service for basically the same price, and will hate even more all those greedy doctors.

Except now it's the greedy AMCs and hospitals.
 
If pain were so good, we wouldn't see many pain docs switching back to OR anesthesia. Why do you think there are so many pain jobs on gaswork?
 
Now if an Anesthesiologist is best friends with a Urologist/ENT, is there any way to set up an agreement to provide anesthesia for all his patients and to bill as an independent contractor at the facility he works in (aka "eat what you kill")?

I detest the idea of some "management company" using our medical license as a means of pocketing 40% of our billings.

Also, if this problem gets really bad, do you think MD's can request the hospital administrators to stop renewing the contract with these AMC's and to just employ the doctors directly?
 
Now if an Anesthesiologist is best friends with a Urologist/ENT, is there any way to set up an agreement to provide anesthesia for all his patients and to bill as an independent contractor at the facility he works in (aka "eat what you kill")?
I don't see why not, as long as the facility allows it. If the local anesthesia group and the facility have the same owners/interests, it might not happen. ;)
Also, if this problem gets really bad, do you think MD's can request the hospital administrators to stop renewing the contract with these AMC's and to just employ the doctors directly?
If requested by a majority of the private surgeons, it will happen, especially if they threaten to go elsewhere otherwise. Hospital administrators know that the hand that feeds them is the surgeon.
 
Is there talk of getting rid of the 4:1 model? I haven't read anything about that.

Skill erosion is a very real problem for SOME people that supervise. I see it nearly everyday as a resident. If you don't use it you will lose it.

I saw this as well. It is very real. MDs in ACT models that walk away after the tube or LMA is in is a death nail to their careers unless they are very very senior.

I'm a new grad in an ACT model but with a residency program. I am fully aware that I need to stay hands on to maintain my skills. It is easy to do, but you can't get complacent.
 
Now if an Anesthesiologist is best friends with a Urologist/ENT, is there any way to set up an agreement to provide anesthesia for all his patients and to bill as an independent contractor at the facility he works in (aka "eat what you kill")?

In my area of the country most groups have exclusive contracts to provide anesthesia. So nobody can come into my hospital and do anesthesia unless they are employed by my group so long as we have the contract. I understand the West coast is completely different in this regard though and there are facilities that work exactly as you describe.

Also, if this problem gets really bad, do you think MD's can request the hospital administrators to stop renewing the contract with these AMC's and to just employ the doctors directly?
Money is what makes the anesthesia world go round. Lots of groups get a stipend for call, unproductive staffing, trauma response, etc. AMC's will promise to take less money. If hospital administrators thought they could do it on their own for cheaper, they would. Salaries, benefits, recruiting and retention and management all take money. At this point the market is worse than 5 years ago, but still not THAT bad, so if you offer a low ball salary at the present time you'll get a flood of what I call 'bottom feeders'. People with issues, no boards, license suspensions, substance abuse issues, personality disorders, lack of skills, etc. Plenty of them out there. As the market contracts and supply exceeds demand then strong people will take even crappy low paying jobs because that's what's there.
 
I saw this as well. It is very real. MDs in ACT models that walk away after the tube or LMA is in is a death nail to their careers unless they are very very senior.

I'm a new grad in an ACT model but with a residency program. I am fully aware that I need to stay hands on to maintain my skills. It is easy to do, but you can't get complacent.

In academics. Many places have the most senior faculty avoid new CA-1s in july and August like the Ebola virus.

Many have skills so eroded. Not sure if they can handle difficult patients anymore without either CRNA or senior anesthesia help.

An act model with 90% supervision is bad for ones careers especially when u are starting out.
 
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In academics. Many places have the most senior faculty avoid new CA-1s in july and August like the Ebola virus.

Many have skills so eroded. Not sure if they can handle difficult patients anymore without either CRNA or senior anesthesia help.

An act model with 90% supervision is bad for ones careers especially when u are starting out.

So thats why all the senior attendings at my hospital are on vacation these couple of months..
 
MS3 here wanted to get your opinion on a thread from MD student forum. Do you have a ton of concern hearing Doc's driving healthcare policy decisions **** on Anesthesia or do you think the field can hold its own should push come to shove?


Very interesting debate regarding whether or not there is a doctor shortage and all that entails. So at 27:46 - the host asks which specialties if he could cut (or least cut in huge numbers) he would. 30:44 - Ezekiel Emanuel (he is quite childish and insufferable throughout the entire video) lists the 2 specialties he thinks there are too many of in general - Anesthesiology and Radiology. All part of his overall goal to try to get the Primary Care to Specialist ratio away from the 30:70 ratio as it is now, along with changing payment methods to hospitals and providers (of course). Does he have a point?
 
I recently read this on a blog..

http://www.blog.greatzs.com/2014/08/cheapskate-anesthesiologists.html

idk if the blogger is on sdn as well but basically its about anesthesiologists not contributing much to ASA. somehow i feel like even though ASA may not be the best organization in the world but what else do anesthesiologists have that will fight for us at all?
 
As more and more of us become employees, the only way the ASA and ASAPAC will get our loyalty will be if they manage to either reverse the trend, or establish a national union to fight for the employed anesthesiologists. Otherwise, they are rapidly becoming just another AMA, asking for about a workday's net income just for their annual membership fee. Mmm... I don't think so!

Why would an employed physician care about the level of reimbursement for anesthesia services etc., when 75% of those reimbursements end up in the pockets of his employer? Oh, they will cut our incomes even more? They do it anyway if they can.

The ASA has let the AMC situation get out of hand. Somehow I don't remember the ASA ever speaking out against AMCs. Surprise! Those AMCs don't care about donating to the ASA(PAC), no more than employees do. That's what those donation numbers really mean! The membership has a much different mentality now. The same way a renter has a different mentality from a houseowner.

Not to speak about the ABA, which has become an entire (re)certification industrial complex. Guess what, ASAPAC? All the money I would have given you is going to the ABA. If you convince them to get rid of many of those useless and/or expensive MOCA stuff, I promise I'll reverse the flow.

P.S. But all of you who are (still) partners should feel really ashamed. :p
 
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MS3 here wanted to get your opinion on a thread from MD student forum. Do you have a ton of concern hearing Doc's driving healthcare policy decisions **** on Anesthesia or do you think the field can hold its own should push come to shove?

No it can't. In response to the original question"is the anesthesia job market saturated?": it's soaking wet and dripping, baby!
 
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As more and more of us become employees, the only way the ASA and ASAPAC will get our loyalty will be if they manage to either reverse the trend, or establish a national union to fight for the employed anesthesiologists. Otherwise, they are rapidly becoming just another AMA, asking for about a workday's net income just for their annual membership fee. Mmm... I don't think so!

Why would an employed physician care about the level of reimbursement for anesthesia services etc., when 75% of those reimbursements end up in the pockets of his employer? Oh, they will cut our incomes even more? They do it anyway if they can.

The ASA has let the AMC situation get out of hand. Somehow I don't remember the ASA ever speaking out against AMCs. Surprise! Those AMCs don't care about donating to the ASA(PAC), no more than employees do. That's what those donation numbers really mean! The membership has a much different mentality now. The same way a renter has a different mentality from a houseowner.

Not to speak about the ABA, which has become an entire (re)certification industrial complex. Guess what, ASAPAC? All the money I would have given you is going to the ABA. If you convince them to get rid of many of those useless and/or expensive MOCA stuff, I promise I'll reverse the flow.

P.S. But all of you who are (still) partners should feel really ashamed. :p
The ASA and ASAPAC are in bed with the AMCs and they are not going to reverse anything my friend
 
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P.S. But all of you who are (still) partners should feel really ashamed. :p

Really? Where do you think those $1,000 per year checks to ASAPAC come from. Some of us have been writing them and letters to legislators and doing it right for a long time in our daily conduct. Not all of us.
Some of us should be ashamed. Not all of us.
 
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No it can't. In response to the original question"is the anesthesia job market saturated?": it's soaking wet and dripping, baby!

It's dripping with CRNAs... most of whom are unfortunately not hot and soaking wet ...
 
Bumping this thread. Sorry to rain on everyone's parade but the job market seems absolutely horrible. Maybe ok in BFE but in a desirable location I'll be lucky to make low 200s.... Which is what the CRNAs make where I am at now.... Is anyone else having a different experience bc im board certified and can do everything except for maybe hearts and I can't find a decent job.
 
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Bumping this thread. Sorry to rain on everyone's parade but the job market seems absolutely horrible. Maybe ok in BFE but in a desirable location I'll be lucky to make low 200s.... Which is what the CRNAs make where I am at now.... Is anyone else having a different experience bc im board certified and can do everything except for maybe hearts and I can't find a decent job.

You wrote that you're board certified - how long have you been out of residency and what have you been doing?

What desirable locations are you looking at?
 
Out almost three years. Been doing everything - Ob, pnb for ortho, vascular, thoracic, peds... Everything but neuro and hearts. Looking at dallas primarily but open to any big city with mostly good weather


Sent from my iPhone using Tapatalk
 
Out almost three years. Been doing everything - Ob, pnb for ortho, vascular, thoracic, peds... Everything but neuro and hearts. Looking at dallas primarily but open to any big city with mostly good weather


Sent from my iPhone using Tapatalk

just out of curiosity .. what region did you do your residency?
 
Sorry to hear that. That hasn't been the case for grads from my program. This will be the second person we've sent to TX in 3yrs. Everyone I know has landed jobs usually in their top 1-3 cities making reasonable salaries. All but one persons job this year leads to partnership (usually 1-2 years).

Not that you had this issue, this is more for current residents. Individuals that were lazy, disruptive or difficult to work with in residency might experience difficulty finding a job. Often times partners call programs to get the scoop on how the applicant was in residency. In this market a less than stellar recommendation could be all it takes for the group to not invite the applicant to interview. I know of specific instances where this has continued to haunt individuals for years after they graduate.

Have you tried networking with friends from residency or attendings you trained under? That's been the most effective way to land a job from what I've seen.
 
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Residency in a top program in the Midwest. They've tried to hire me back there so I doubt I'd have bad recommendations from there... They said nice enough things about me three years ago for me to land this gig.... Kazuma which program? The market seems a hell of a lot tighter than three years ago when I was looking as a new grad.
 
Residency in a top program in the Midwest. They've tried to hire me back there so I doubt I'd have bad recommendations from there... They said nice enough things about me three years ago for me to land this gig.... Kazuma which program? The market seems a hell of a lot tighter than three years ago when I was looking as a new grad.

As I mentioned, that wasn't directed at you, it was a warning to current residents who constantly complain and are difficult to work with. Seems like common sense but some people need this reminder.

I'm in Western region and that's where almost all of us have stayed (W. Coast, Northwest, Mtn west, Southwest inc TX etc). It's definitely getting tighter but we've all been lucky enough to continue to land good jobs. Most people I know got their job through some degree of networking. While cold calling works, its much easier if you know someone in the group that can go to bat for you. I would start by contacting your buddies from residency to see if anyone you know is in an area you'd like to work.
 
Bumping this thread. Sorry to rain on everyone's parade but the job market seems absolutely horrible. Maybe ok in BFE but in a desirable location I'll be lucky to make low 200s.... Which is what the CRNAs make where I am at now.... Is anyone else having a different experience bc im board certified and can do everything except for maybe hearts and I can't find a decent job.
This number alone doesn't mean anything.
Is that for an academic job were full time is 3 or 3.5 days a week?
Partner track at a place where partners make 4-600 after a few years?
Working for an AMC?
Day surgery center with no late/call/weekends?
12+ weeks vacation?
Base pay without including significant incentive compensation and/or call bonus?

Kaiser pays more than that after a couple years.
AMCs that we've read about here and elsewhere pay more than that to start.
Many (most?) academic jobs pay more than that, some far more, especially after you advance beyond clinical instructor. (Unless you're at a place where full time is 3 clinical days a week.)
Low 200s is around what you would make at the lowest paying academic jobs I have heard about.
Look harder.
 
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