Is this the end of anesthesiology?

[Devil's Advocate]

I am concerned about the future of anesthesiology for physicians. It seems the short won victory regarding physician supervision may soon be lost again. It seems as part of the resolution, governors can "opt-out" of the physician supervision rule if it is in the best interest of the people of that state. Now it seems that Idaho, Iowa, and Nebraska have already decided to opt-out, allowing CRNAs to practice independently. And with this, it is rumored that many other states are lining up to do the same. I received the newsletter from the president of the ASA this weekend and it is starting to look bleak. What do you all think?

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[njbmd]

•••quote:•••Originally posted by Devil's Advocate:
•I am concerned about the future of anesthesiology for physicians. It seems the short won victory regarding physician supervision may soon be lost again. It seems as part of the resolution, governors can "opt-out" of the physician supervision rule if it is in the best interest of the people of that state. Now it seems that Idaho, Iowa, and Nebraska have already decided to opt-out, allowing CRNAs to practice independently. And with this, it is rumored that many other states are lining up to do the same. I received the newsletter from the president of the ASA this weekend and it is starting to look bleak. What do you all think?•••••I don't think this spells the end of anesthesiology as a medical specialty at all. There are still plenty of areas of anesthesia where CRNAs may not practice independently (Critical care, Pediatric and Cardiovascular). Anesthsiologists are in very short supply these days and getting shorter. There is nothing wrong with CRNAs doing anesthesia for healthy folks with few medical problems but many folks undergoing surgery these days have complex medical problems and need an anesthesiologist on board. Many surgeons (especially this one) are not going to take on the added risk of covering liability for not consulting an anesthesiologist when necessary.

 

[navs]

I think this is a very fair area to be worried if ur an aspiring anesthetist. BUT...

I don't think it is as bleak as one would think.

1. The states that will opt out of the supervision rule are the states that CAN'T attract an anesthetist due to the rural nature of the state, a la Iowa, Nebraska, and Idaho.

2. Even in these states it is just an opt out of the supervision rule, not a ban on MDA's. I'm sure the surgeons working in many of the hospitals will still want an MDA if they can attract one to come to a rural town.

3. Even in those states as in ALL states in the country, CRNA's may increase in power with the routine cases, but it would be doubtful if they could ever be the primary providers for cardiac, pain, or peds anesthesia (which all require much more training).

4. The few large surgical centers (obviously int the larger cities) in such states will STILL have MDA's to administer anesthesia to a sicker population OR cardiac, pain, or peds cases.

SO, in my opinion is that the states are doing these opt outs not to hurt anesthetists, but because in smaller rural towns in many states they simply CAN'T recruit enough anesthetists to man the O.R.s. And unless u want to live somewhere in Iowa, Nebraska, Idaho, or somewhere else that is very rural u have nothing to worry about.

Just my thoughts on the subject.

 

[Ratty]

Navs is completely right. Well said.

The whole anxiety about CRNAs, esp from those who are not in anesthesiology, gets highly annoying. Just read the Mayo Proceedings article from October. CRNAs are no different than nurse midwives. No one is going into nursing these days, much less adding on extra years to become a CRNA. I think everyone should do real reading and research about the topic before jumping to conclusions. The future of anesthesiology is fine, and will always be. As a future resident, if people get scared of anesthesia because of CRNAs, then all that means are more jobs for me! (Besides, the opting-out rule applies to Medicare/Medicaid only, not for private insurers.)

 

[Sevo]

•••quote:•••Originally posted by navs:
•
4. The few large surgical centers (obviously int the larger cities) in such states will STILL have MDA's to administer anesthesia to a sicker population OR cardiac, pain, or peds cases.

•••••Actually, this is not true. There are a number of CRNA programs that do offer advance training for pediatric and cardiovascular cases. In fact, as I mentioned a while back on another thread, my medical center routinely has CRNAs in one heart room (rarely, if ever, supervised) and residents in the other.

Personally, I think that the laxity of the supervision rule can only be bad for the profession in the long term. Independent CRNAs are heaven-sent cheap alternatives for hospitals already trying to cut costs. They also make the MD anesthesiologist superflouous in large part, except in the management of ASA 4+ patients. This can only mean less jobs in the future.

As for the present-day nursing shortage? Despite the fall in nursing school applications over the last few years, there are more than enough nurses graduating to fill CRNA programs to capacity for years to come. In fact, CRNA programs aren't hurting for applicants now, especially given the fact that CRNAs start off making 3x as much as a regular RN. In fact, three of the unit nurses at our SICU are leaving to become CRNAS this fall once their required stints as critical care nurses are over.

 

[drusso]

I think that the CRNA issue is a huge one for MDA's and the response from organized anesthesiology has mostly been to run and hide their heads in the sand. More and more allied health practitioners are encroaching on the practice of medicine: Primary care is almost overall run by midlevels, most hospitals encourage nurse-midwifes to attend "uncomplicated" deliveries, CRNA's practically run the anesthesiology departments at some small community-based hospitals.

Physicians and medical students need to stand up and educate the public and policymakers about the huge differences in training between a physician (MD or DO) and a midlevel provider.

 

[navs]

In regards to Sevo's response,

I wrote that comment based on calling the AANA months back and posing the exact question to them about subspecialty training in a specific field such as cards, peds, or pain after completion of the CRNA training (like fellowships for MDAs) and the answer that I received is they don't offer any and all these subspecialty training is taken care of as part of the normal curriculum in the training of CRNAs.

If I am mistaken I'm sorry but that is what the "experts" told me and would like to know which programs you heard that do offer such fellowship-like training??

Good luck.

 

[bigfrank]

Drusso,

Excellent points; if physicians are silent on the issues, the vast majority of the american public will just think that cRNAs are a "branch" off of MDAs. It is our job to point out these vast differences; of training, competency, etc.

 

[Goofy]

I for one think CRNA horror stories are simply that. There are many causes that would benefit our profession if physicians could band together. Unfortunately, history has been unkind to this sort of thing. Additionally, phsyicians don't rally together very well.

The good news is that the public doesn't really need to know how awful CRNA's are (they aren't that bad) simply because insurance companies and hospitals wont allow CRNA autonomy to any appreciable extent even if these laws go through. The only reputable studies on the subject were conducted at UPENN which showed increased morbidity and mortality when CRNA's acted independantly of anesthesiologist. Surprise surprise. We don't need to convince the public of anything. Hospital reputation and ultimately the balance sheet will assure that the most senior expert is in charge. CRNA autonomy would be a real travesty of medical care in my opinion. These are nurses, not physicians, who know how to function simply because they have seen the situation 1000 times before. It counts for something, but ultimately a keen knowledge of pathophysiology, pharmacology is necessary to handle situations when something goes wrong. In such situations, my money is on the physician getting it right over the nurse.

All it takes is one screw up to nix the CRNA autonomy thing. I only see CRNA autonomy taking root in remote locales where anesthesiologists simply don't exist. And even then they will function under the aegis of the surgeon.

 

[Goofy]

•••quote:•••Originally posted by drusso:
•I think that the CRNA issue is a huge one for MDA's and the response from organized anesthesiology has mostly been to run and hide their heads in the sand. More and more allied health practitioners are encroaching on the practice of medicine: Primary care is almost overall run by midlevels, most hospitals encourage nurse-midwifes to attend "uncomplicated" deliveries, CRNA's practically run the anesthesiology departments at some small community-based hospitals.

Physicians and medical students need to stand up and educate the public and policymakers about the huge differences in training between a physician (MD or DO) and a midlevel provider.•••••Sorry Drusso, but I think you are sensationalizing a much smaller problem. CRNA represent very small competition to physician anesthesiologist, IMHO. I think blowing the horn and ringing warning bells only serves to scare excellent students away from a promising field with much more certainty than some posters on this thread would have you believe.

 

[Ratty]

Klebsiella makes a good point. I think plenty of good medical students (potential anesthesiologists) who do not research the issue of CRNAs well simply listen to rumors (especially spread by non-anesthesiologists) that they are "taking over the field" and then make the mistake of choosing some other specialty.

 

[doktor_prishel]

interesting you're saying crna's are too dumb to handle those things.. is it because you're worried that if they do get autonomy, they'll prove to be just as good as md's??
it's no surprise. i once bruised my ankle and went to a primary care physician, she told me i probably have carpal tunnel syndrome(lol) or shin splints. and she kept on saying all these horror stories... and all i wanted was an xray to see if i have a bruise or a fracture, so i had to go to a podiatrist!

but don't get me wrong, i also want to earn lots of money, i'll try to go into dermatology or EM.. but no reason to call nurses stupid!!

 

[Mr. happy clown guy]

CRNA's have been tremendously helpful to me during my anesthesiology rotation...and I would venture a guess, that nurses performing the anesthesiology during cases for DECADES!! It is only with the onset of "chat pages" and the media attention, that we hear of it now. Much like PA's etc. I know of a LPN that is a surgeon's right hand man...that is the same thing many PA's aspire to be (and claim this can only be done with a mid-level degree...not so)! These things are nothing new.

 

[drusso]

•••quote:•••Originally posted by Klebsiella:
•

Originally posted by drusso:
[qb]Sorry Drusso, but I think you are sensationalizing a much smaller problem. CRNA represent very small competition to physician anesthesiologist, IMHO. I think blowing the horn and ringing warning bells only serves to scare excellent students away from a promising field with much more certainty than some posters on this thread would have you believe.•••••Look, I'm not trying to be a Cassandra about these things. I just think that students need to know what's really going on in a lot of medical fields. I did my anesthesiology rotation at a community-based program with a university-affiliated residency. The CRNA's ran most of the cases and were very vocal and very politically-savvy about getting more practice autonomy. The surgeons and surgery residents frankly did not seem to mind that non-physicians were running most of their cases.

Also, the hospital administration was very supportive of CRNA's in expanding their scope of practice and independent role in the OR. I'm certain that things are different in academic settings and hospitals with influential medical staff, but in cost-conscious community hospital settings, CRNA's have a huge economic advantage. I do not see MDA's staying cost competitive in these settings.

Sure, MDA's will always attend more complicated cases, and pursue fellowship training, but fellowship training opportunities are also now available to CRNA's in neuroanesthesiology, cardiopulmonary anesthesiology, etc. I know one CRNA who will be doing a special one-year trauma fellowship in order to obtain extra certification to run trauma cases at a Level II facility. This was unheard of even ten years ago.

Every time physicians just shrug their shoulders and say that non-physician providers can do "routine" things---run elective surgical cases, attend uncomplicated deliveries, provide primary care medical services, prescribe psychotropic medicine (as PhD psychologists have won authority to do in New Mexico) we send the message that 4 years of full-fledged medical school and 3-5 years of residency is no big deal and can condensed into a 2-year RN program and 18-24 months of "advanced practice" training.

Increasingly, economic pressures are providing political fuel for midlevels to expand their scope of practice. Maybe you're comfortable with that. I'm not. Medical students must carefully appraise how vulnerable their intended specialty is to practice intrusion by non-physician providers because such a consideration is an economic reality. No one really talks to medical students about these issues during medical school.

Do you think that applications to psychiatry residency programs are in the toilet because medical students are less fascinated by the complexity of the mind and mental illness than they were two decades ago? No, it's because the mental health field has let itself become over-run by non-physician providers while psychologists have been vicious in expanding their scope of practice. Do you think that applications are down to primary programs because medical students don't connect with the generalist "Marcus Welby" image of medicine any more? No, it's because PCPs are treated like crap by third-party payors and are being replaced by PAs and NPs in clinics around the country.

With the all time high levels of educational debt that medical students are incurring these days, they must pay careful attention to the political and economic realities of their intended field of specialization. Some specialties are intrinsically more vulnerable to the "dumbing down of medicine" than are others. I think to just "poo-poo" these issues is irresponsible.

 

[Sweaty Paul]

"Sorry Drusso, but I think you are sensationalizing a much smaller problem. CRNA represent very small competition to physician anesthesiologist, IMHO. I think blowing the horn and ringing warning bells only serves to scare excellent students away from a promising field with much more certainty than some posters on this thread would have you believe."

Klebsiella

Klebsiella,

First I have to apologize, I haven't ever figured out how you make those cool bolded quote things, I am one dumb computer operator.

Granted that CRNA's may not be much of a real threat to physcian anesthesiologists, however, they are a threat and should be considered a threat and treated as a threat. Furthermore, success gained by the CRNA's to acquire independant practice rights is, in my opinion, the first step towards PA and Nurse Practioners getting independant practice rights. At the risk of sounding elitist; the fact remains, if a CRNA wants the privledges of practicing independantly they too can go to medical school. The same goes for PA's and Nurse Practioners.

I am not saying that NP, PA, and CRNA's don't provide a valuble and needed service, however, they haven't had the same level of education or training and subsequently, they shouldn't be afforded the same practice rights. I think that all physicians should be concerned about this and though the threat is small should try to become unified to stop this. UPenn study showed it clearly, more people will die if CRNA's are allowed to practice independantly. I thought as physicians and student physicians we took an oath "to do no harm." By avoiding this issue and not addressing it people will die, and through our lack of action we will have, though indirectly, allowed harm to happen.

Anyway, just my opinion. As for scaring students, I hope that wasn't the intent of the thread or of drusso's comments.

Sweaty Paul

 

[Juice]

Drusso,
To put it bluntly, I think you took one too many hits of the Desflurane on your rotation. CRNA's threaten the role of an MD??? Give me a break. The most successful anes practices in the country employ a significant number of CRNAs. Know why??? Because it allows the anes group to double bill. Something that became illegal in surgery about a decade ago. An MD can run 4 rooms with CRNAs, with bill splitting 50/50.
If you have any concern for these technicians to take over the field, look at the job market. The average, starting salary for anes last year was 215, and many grads could set their price/benefits. Especially if they were US citizens trained in the US. I am not in the field, but a few of my medstudent friends have started at over 250 before any signing bonus or incentives.
Sure the field needs to keep the CRNAs in check, but to think these people will replace the MD is foolish. Why do you think there is such a shortage of anesthesiologists now??? It is because this was the big scare in the 90s. However let it keep riding if you like. Salaries run on the supply demand curve, and anes salaries were up 30% last 2 years.
I myself am finishing a gen surg residency at a very large uiniversity. I will be doing a transplant fellowship. However my colleagues staying in gen surg are starting at anywhere from 110-160k. Yes, some practices in bumf*%$ midwest pay a lot more, but if you want to live in a major city forget it. One of my colleagues got an offer for 90k. And yes, this is from a top ten academic program. Now that is something students should know about. Imagine working your ass off, being AOA, getting into a top program, and then making 100k less than some anes doc who is sitting in a lounge drinking coffee while some CRNA is charting a foolish monitor. Perhaps this is for another board, but Drusso, the market is very strong for the anes doc. Unlike some of my predecessors, this group of doctors seem to be quite business savy. It must be all that spare time.

 

[Leotigers]

•••quote:•••Originally posted by Juice:
•Drusso,
To put it bluntly, I think you took one too many hits of the Desflurane on your rotation. CRNA's threaten the role of an MD??? Give me a break. The most successful anes practices in the country employ a significant number of CRNAs. Know why??? Because it allows the anes group to double bill. Something that became illegal in surgery about a decade ago. An MD can run 4 rooms with CRNAs, with bill splitting 50/50.
If you have any concern for these technicians to take over the field, look at the job market. The average, starting salary for anes last year was 215, and many grads could set their price/benefits. Especially if they were US citizens trained in the US. I am not in the field, but a few of my medstudent friends have started at over 250 before any signing bonus or incentives.
Sure the field needs to keep the CRNAs in check, but to think these people will replace the MD is foolish. Why do you think there is such a shortage of anesthesiologists now??? It is because this was the big scare in the 90s. However let it keep riding if you like. Salaries run on the supply demand curve, and anes salaries were up 30% last 2 years.
I myself am finishing a gen surg residency at a very large uiniversity. I will be doing a transplant fellowship. However my colleagues staying in gen surg are starting at anywhere from 110-160k. Yes, some practices in bumf*%$ midwest pay a lot more, but if you want to live in a major city forget it. One of my colleagues got an offer for 90k. And yes, this is from a top ten academic program. Now that is something students should know about. Imagine working your ass off, being AOA, getting into a top program, and then making 100k less than some anes doc who is sitting in a lounge drinking coffee while some CRNA is charting a foolish monitor. Perhaps this is for another board, but Drusso, the market is very strong for the anes doc. Unlike some of my predecessors, this group of doctors seem to be quite business savy. It must be all that spare time.•••••Is it really necessary to resort to insults? To put it bluntly, I think that was exactly drusso's point. CRNAs are not equivalent to Anesthesiologists and he doesn't think they should be. However, allowing them to practice unsupervised can hurt the market for Anesthesiologists. Why do you think Anesthesia groups currently make so much money double billing? This is because CRNAs need supervision from a physician. If you take this away, why the hell would a CRNA want to split the money with a physician? What they can do is charge slightly less than the physician and when it comes down to it, money talks. Will they replace an MD/DO on every single case? Certainly not, or at least I hope they aren't allowed to. However, to say it is not a threat at all is just plain ignorant. Log on to Physician's Online and peruse the Anesthesia board and you will see that Anesthesiologists are very much against this. If there was absolutely no impact at all then why do so many people care about the issue. I think the point that drusso was making is that we shouldn't allow CRNA's so much independence and not that they are equal -- which is what is sounds like what you thought he said.

The market is great for Anesthesiologist right now, that was never in dispute. Allowing CRNAs to practice unsupervised will hurt their salaries in the long run, however. If you take away the supervision, you also take away the "double billing", or at least most of it. Really, I think we are all on the same side here. CRNAs should NOT be allowed to practice unsupervised. In the short run, the effects many go unnoticed. In the long run, however, I think the effects will be detrimental. Is the idea that quality health care will be compromised for lower costs really a new concept here? This is just an ugly reality that we, as physicians, will have to deal with (and hopefully overcome) everyday.

 

[Leotigers]

To answer the original question, I certainly do not think this is the end of Anesthesiology. Many of my classmates and friends chose to go into Anesthesia and they are certainly against CRNAs practicing unsupervised. CRNAs will never replace a physician, but I certainly do think this is a bad think for Anesthesia. Even if this does not affect salaries, it does make a statement. For the isurance companies and hospitals, it will all be about money. Even if it shown that CRNAs carry a greater risk (which it hasn't been as far as I know), they will subtract the cost of that risk from the savings they make from using a CRNA instead of a physician. If they are saving a ton of money, it is probably a risk they will be willing to take, especially if the difference in risk is minimal. If you think about the role of PAs, NPs, and psychologists, who would've thought they would be allowed to do as much as they are now 20-30 years ago. If for nothing else, I think this just makes a bad statement in general, and it hurts all physicians. This is just my opinion, and I didn't do an Anesthesia rotation so I had no access to desflurane.

 

[Goofy]

While I disagree with much of what Dr. Russo has said, he/she presented the view cogently and convincingly. I don't think it is helpful to wage personal attacks at someone who has conducted her/him self in a mature fashion. After squabbling with some of the younger members of this community in the 'lounge', I can easily say I appreciate Dr. Russo's views.

 

[bigfrank]

Indeed, this is a very scary situation, and it should be treated very seriously. Logically, if there are people (cRNAs) who are doing many more cases for much cheaper, it will NATURALLY decrease the salary, prestige, and overall impact of the field of anesthesiology.

The public needs to be educated, and FAST. There is something very risky and overtly ignorant about letting cRNAs garner so much power and obtain so much autonomy: They have neither the training nor the right to do so.

 

[Sandpaper]

These sort of threads are always interesting to read. But what's more interesting is the often mum words of support from fields that enjoy little or no competition from NPs, PAs, and CRNAs (e.g Radiology, Derm). It is my impression that these fields feel "superior" because they have no competition and often have no empathy whatsoever to those struggling with mid-level providers. I am glad no one is trying to poach on your territory, but it would not hurt to lobby on the behalf of FPs, psychiatrists, and others who are in this fight. Are we not all colleagues who went through the same crap together to get where we are today? Just a thought.

 

[Goofy]

Hi Sandpaper,

I would be more than happy to rally for virtually any physician cause. Having said that, I think you have miscalculated competition in other fields. With a big move at cost cutting and the ability to read digital films, Radiology is becoming an infinitely more efficient specialty. What this means is that fewer radiologists are going to be able to read far more films in half the time. This represents significant competition in my opinion

You also mention dermatology. It might surprise you that derm is no longer the rich man's profession, although it does cater to the lifestyle oriented individual. Many primary care physicians, both internists and FP's are realizing there is not only quite a bit of money in derm, but that they can easily handle 99% of what a dermatologist sees. Worse, since primary care docs largely control these types of patients, they have enormous power to build up their own core dermatology practice.

I think all fields have elements of competition. I just don't see a reason to single out and ring the alarm bells over Anesthesia. It's a great specialty with incredible opportunity. CRNA's will continue to fight for more autonomy. In remote locales they will make small strides, but largely, the MD/DO will be overseeing surgical cases.

 

[Hopkins2010]

Has it gotten to the point yet that an anesthesiologist coming out of residency cant find a job?

I am interested in any personal anecdotes you guys might have about those coming out of residency who cant find a position.

 

[Sevo]

•••quote:•••Originally posted by baylor21:
•Has it gotten to the point yet that an anesthesiologist coming out of residency cant find a job?

I am interested in any personal anecdotes you guys might have about those coming out of residency who cant find a position.•••••The job market for anesthesia is very, very good right now. What should be done now is to lay the groundwork to keep it that way. Increasing residency positions and granting CRNAs autonomy is not the way to go.

Anesthesiologists need to get their heads out of the sand and stop the CRNA lobby before this autonomy thing goes beyond the boondocks.

 

[drusso]

Minnesota is latest to opt out of nurse anesthetist supervision rule

Last Updated: 2002-04-22 9:42:06 EDT (Reuters Health)

By Karen Pallarito

NEW YORK (Reuters Health) - Minnesota Gov. Jesse Ventura on Friday took advantage of a federal Medicare rule allowing the state to exempt its hospitals from a requirement that physicians supervise nurse anesthetists.

Minnesota is only the fourth state to opt out of the federal supervision requirement. In the last four months, Iowa, Nebraska and Idaho also have opted out, and several other predominantly rural states are considering whether to do so.

The Centers for Medicare and Medicaid Services issued a final rule last November that retains the long-standing federal supervision requirement but gives state governors the discretion to opt out if it is believed to be in citizens' best interests.

Dennis Bless, past president of the Minnesota Association of Nurse Anesthetists, praised Gov. Ventura's move, saying it would ensure that hospitals in rural and under-served areas would "continue to receive Medicare funds, and the patients they serve will have continued access to high quality healthcare."

But Dr. Phil Boyle, president of the Minnesota Society of Anesthesiologists (MSA), said the governor's decision represents "a setback" for patient safety. Ventura acted "against a strong recommendation from the Minnesota Board of Medical Practice," he noted.

Dr. Boyle vowed that the MSA would launch a public relations campaign about the administration of anesthesia and the need for patient safety standards. The Society also will try to convince the governor to reverse the decision and ask the state legislature to appoint a task force to examine "scope of practice" issues.

 

[bigfrank]

Hmmmm...........not the best of news for those applying into anesthesiology. I'll be anxiously ancitipating how all this turns out.

 

[halothane]

What nobody understands is that panic reactions to such news is what has created the present Anesth. physician shortage. Well guys panic more and go elsewhere...it only means Ill have more jobs to choose from

 

[godfather]

i think it should be pointed out that part of the state of minnesota's ruling is political and was anticipated. Jesse Ventura's mom was actually like bill clinton's mom a crna.

 

[dadocca]

I'm going to bump one of the original threads because it's inspiring to see the same fears being thrown around a dozen years ago are still present today. Love it, hate it, disagree with it and say that this time it really is the end this time but really it's threads like this that give me hope. People sure seemed much more rational back then than many of the present day posters.

 

[deleted126335]

If you remember the story of the boy who cried wolf...the wolf eventually did show up.

 

[dadocca]

If you remember the story of the boy who cried wolf...the wolf eventually did show up.

Would you have said that 12-20 years ago as well?

 

[deleted126335]

When I get new information, I change my mind.

I was pessimistic for a few years when I was underemployed during the 90s and finding a decent job was tough. But the med students staying away from anesthesia for several years fueled my optimism and the bull market for anesthesiologists from about 1999-2010. That catalyst is unlikely given the supply of med students and overall numbers of slots in the match in all specialties.

Trends are negative: supply of new MD grads, old guys hanging on, CRNAs winning more than losing political agendas, Obama administration openly friendly to midlevel expansion, Massive economic pressures on on health care facilities show no signs of abating, MD only practices converting to an ACT model, Midlevel expansion in most specialties, Growth of AMCs and hospital employment,.., etc.

Happy to change my mind if you give me some new information.

 

[Spinach Dip]

I think it's hilarious that these physicians were talking about "informing the public" 12 years ago.... something which has still received only the most topical of attention.

But don't worry. I'm sure if you complain about the problem enough (and do nothing to act on it) eventually it will go away.

 

[BLADEMDA]

I'm going to bump one of the original threads because it's inspiring to see the same fears being thrown around a dozen years ago are still present today. Love it, hate it, disagree with it and say that this time it really is the end this time but really it's threads like this that give me hope. People sure seemed much more rational back then than many of the present day posters.

There will be employment for Anesthesiologists in the future. There is a need for our skill set. That said, the employment model is one of limited salary set by a Management company or hospital CEO/CFO. This means much lower income for new graduates with a long term downward trend. In addition, finding a job in the desired geographical location will likely be difficult.

The CRNA independence issue is a SLOW growing cancer which has caused the specialty much grief over the past ten years. The odds are another Democratic administration (e.g., H. Clinton) will advance their agenda even further.

There is always hope but don't forget to include reality in the mix.

 

[dadocca]

There will be employment for Anesthesiologists in the future. There is a need for our skill set. That said, the employment model is one of limited salary set by a Management company or hospital CEO/CFO. This means much lower income for new graduates with a long term downward trend. In addition, finding a job in the desired geographical location will likely be difficult.

The CRNA independence issue is a SLOW growing cancer which has caused the specialty much grief over the past ten years. The odds are another Democratic administration (e.g., H. Clinton) will advance their agenda even further.

There is always hope but don't forget to include reality in the mix.

Assuming a new graduate from a good progran has no location preference and has completed a cardiac or peds or similar fellowship but can only find an employee position. What can such an anesthesiologist expect to make today?

 

[caligas]

Assuming a new graduate from a good progran has no location preference and has completed a cardiac or peds or similar fellowship but can only find an employee position. What can such an anesthesiologist expect to make today?

300k

 

[aneftp]

300k

Rather than talk salary in general terms.

It's more important to discuss work hours and call responsibility.

Considering most crnas I know work strict 40 hour weeks. No call no weekends. 3-4 days a week for $160-180k.

You will see less and less incentives for MDs to work more. Just let the crnas do call q5-6 days and let them make $300k working 60 hours a week. I'll just work 3 days a week with many 4 day weekends for $160-180k and no call no weekends.

 

[BLADEMDA]

Rather than talk salary in general terms.

It's more important to discuss work hours and call responsibility.

Considering most crnas I know work strict 40 hour weeks. No call no weekends. 3-4 days a week for $160-180k.

You will see less and less incentives for MDs to work more. Just let the crnas do call q5-6 days and let them make $300k working 60 hours a week. I'll just work 3 days a week with many 4 day weekends for $160-180k and no call no weekends.

The salary trend for them is down as well. I expect management companies and hospitals will cut them by 10 percent and put a call burden on them as well.

Anesthesiologists will seek better hours, less call and work reduction because income will be capped by the employer at $300-$350k

 

[BLADEMDA]

Assuming a new graduate from a good progran has no location preference and has completed a cardiac or peds or similar fellowship but can only find an employee position. What can such an anesthesiologist expect to make today?

I expect a newly minted Anesthesiologist in 2018 with a cardiac or pediatric fellowship to start around $280-$300K and progress to $350-$400 depending on the hours, workload, case mix, call burden and number of CRNAs being supervised.

 

[DoctorDude]

I expect a newly minted Anesthesiologist in 2018 with a cardiac or pediatric fellowship to start around $280-$300K and progress to $350-$400 depending on the hours, workload, case mix, call burden and number of CRNAs being supervised.

In all honesty 280-300k is STILL a huge amount of money that will allow you to live very comfortably. I know that salaries have been higher in the past but given that mostly all of us really can't see ourselves doing anything else, "compromising" for 300k a year doesn't seem so bad.

Blade, in terms of salary, what is your opinion on change in lifestyle from 300k vs let's say 450k? In the long-term scheme of things, does it make a big difference?

 

[caligas]

Few if any anesthesiologists should spend 450k or even 200k per year, thus the variable is not lifestyle rather how rapidly one can accumulate wealth. 150k less per year w2 means roughly 100k per year plus growth less in accumulated wealth. In 20 years thats several million dollars.

 

[BLADEMDA]

In all honesty 280-300k is STILL a huge amount of money that will allow you to live very comfortably. I know that salaries have been higher in the past but given that mostly all of us really can't see ourselves doing anything else, "compromising" for 300k a year doesn't seem so bad.

Blade, in terms of salary, what is your opinion on change in lifestyle from 300k vs let's say 450k? In the long-term scheme of things, does it make a big difference?

Yes. Over the long term (20 years) it may mean a huge difference to the quality of your retirement years. Want to retire early? Want to maintain the same lifestyle you had as an attending? Want to spend money traveling around the world by taking an expensive vacation every year? Want to send your three kids to private schools then the Ivy League followed by grad school?

It ain't gonna happen so easily at $300K.

 

[BLADEMDA]

When I get new information, I change my mind.

I was pessimistic for a few years when I was underemployed during the 90s and finding a decent job was tough. But the med students staying away from anesthesia for several years fueled my optimism and the bull market for anesthesiologists from about 1999-2010. That catalyst is unlikely given the supply of med students and overall numbers of slots in the match in all specialties.

Trends are negative: supply of new MD grads, old guys hanging on, CRNAs winning more than losing political agendas, Obama administration openly friendly to midlevel expansion, Massive economic pressures on on health care facilities show no signs of abating, MD only practices converting to an ACT model, Midlevel expansion in most specialties, Growth of AMCs and hospital employment,.., etc.

Happy to change my mind if you give me some new information.

Doze,

Your post summarizes the issues in a nutshell. The small crack in the dam started with Bill Clinton's "opt out" law. The AANA knew it would take at least two decades to get to the point of real independent CRNA practice. Don't confuse the time it takes to effect change with the change itself. The AANA is winning drop by drop and they know time is on their side.

 

[aneftp]

The problem I see with all of this is non medical college educated salaries are better for the buck.

Many of my wife's college friends have just a BA or BS degree in say psychology Yet govt and govt contractors jobs are pushing in the low 100s by the time they are in their late 20s. Now they make $110-130k.

There are a lot of overpaid workers everywhere. Working 40 hours a week.

The average household income around the Washington DC area is well over $100k.

There is a assault in medicine especially specialist salaries. Yet other professional fees like my attorney fees are increasing. My personal attorney used to charge $350/hr. Than $400/hr. Now he charges $500/hr. His super partner charges $800/hr. It's simply crazy.

Pharmacist can work 3 days week. 12 hours a day and easily pull $130k. No weekends or late nights either.

 

[anbuitachi]

Getting much and much harder to find desireable jobs in decent areas, but that probably goes for most other specialties.. recent grad (anes w/ pain) i heard about only received a few offers, ranging from 175-200k+ starting salary, but with poor benefits and location. overall she was disappointed as it wasn't what she was expecting

 

[Ezekiel2517]

Getting much and much harder to find desireable jobs in decent areas, but that probably goes for most other specialties.. recent grad (anes w/ pain) i heard about only received a few offers, ranging from 175-200k+ starting salary, but with poor benefits and location. overall she was disappointed as it wasn't what she was expecting

Pain isn't what is once was but there are far better offers than that, in desirable locations as well esp. if she trained at a reputable program. I know this b/c I know a few people who have just finished or will be finishing their pain fellowships

 

[anbuitachi]

Pain isn't what is once was but there are far better offers than that, in desirable locations as well esp. if she trained at a reputable program. I know this b/c I know a few people who have just finished or will be finishing their pain fellowships

yea it was NY tristate area. i think she graduated from columbia. don't know the rankings but my guess its at least a decent program

 

[LeverArm]

yea it was NY tristate area. i think she graduated from columbia. don't know the rankings but my guess its at least a decent program

I somehow doubt that an anesthesiologist, fellowship-trained in interventional pain from Columbia is making as much or less than an average all-talk psychiatrist. But I continue to believe this specialty will grow in the long-term and can absorb hits like those it took this year. Many people are in legit pain and want management or maybe even a cure one day so the money is out there for academics, researchers, physicians, etc. to put in the time and effort to find new modalities. It may very well become its own specialty one day but I think anesthesia should continue to own it until then.

 

[bronx43]

I somehow doubt that an anesthesiologist, fellowship-trained in interventional pain from Columbia is making as much or less than an average all-talk psychiatrist. But I continue to believe this specialty will grow in the long-term and can absorb hits like those it took this year. Many people are in legit pain and want management or maybe even a cure one day so the money is out there for academics, researchers, physicians, etc. to put in the time and effort to find new modalities. It may very well become its own specialty one day but I think anesthesia should continue to own it until then.

Lol, a lot of people have a lot of things - like DM, cancer, heart disease, COPD, etc. Doesn't mean jack for the medical fields.

 

[LeverArm]

Lol, a lot of people have a lot of things - like DM, cancer, heart disease, COPD, etc. Doesn't mean jack for the medical fields.

True... means that there will always be work for the doctors specializing in those areas. Pain is also different in that there aren't too many treatments that have been tried out and not enough people/physicians understand it. Also different because pain patients actually care about their pain (unlike their DM, cancer, heart disease, COPD, etc).