OPEN YOUR EYES

[2win]

Let me give you an easy example.
You are a stock holder. You have 100 shares at 10$.
Suddenly the company issues more shares.
The value of your stock share is 5$ - it is normal, dilution...
Who is winning - the company for sure. You are in red.
The same in anesthesiology programs.
They present an increase in the spots ( oh yea - approved by the whatever board as a success)...
Really?
Actually they decrease your VALUE!
Why a chair will do that?
Because is cheap work , appreciated by the hospital administrators...
Appreciation means $$$$ in the chair account.
We were ( ARE) sold out by them.
.....
Any increase in DERMATOLOGY positions?
Really?
Why NOT?
2win
think about that - there is no LOVE from their part - just empty words....

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[Carbocation1]

 

[Spinach Dip]

 

[2win]

yea - generation of imoji. funny - and dumb in the same time.

 

[Baller MD]

OPs logic is sound. Don't know why you're rolling your eyes. Haven't you encountered the numerous AMC takeover threads this year?

 

[criticalelement]

the ops point is that the aba and the asa is the enemy for creating more and more and more graduates thus decreasing your value..

 

[Colba55o]

the ops point is that the aba and the asa is the enemy for creating more and more and more graduates thus decreasing your value..

Not necessarily. Isn't one of the most vocal arguments of the AANA for crna independence a lack of MDs available to work in rural locations? I graduated a few years from a program that increased its residency slots, but crna slots have remained consistent.
An MD shortage is not what we want, it leads to understaffing, being overworked and with CRNAs being mass produced they will be more than happy to multiply and conquer

 

[nimbus]

Not necessarily. Isn't one of the most vocal arguments of the AANA for crna independence a lack of MDs available to work in rural locations? I graduated a few years from a program that increased its residency slots, but crna slots have remained consistent.
An MD shortage is not what we want, it leads to understaffing, being overworked and with CRNAs being mass produced they will be more than happy to multiply and conquer

I can tell you that during my 20 year career, cyclical shortages and recruiting difficulties have led to increased leverage during negotiations and increased unit values. They have been good for my bank account.

 

[aimedicine]

This type of thread pops up q3months...

 

[Planktonmd]

Some academic ******s including ASA leadership keep trying to market this silly logic to the new guys: "if we multiply we will concur" !!!

 

[Doctor Bob]

 

[scudrunner]

How many new programs/spots have been created over the last few years? And is it really enough to impact the whole specialty?

I think the biggest threat to anesthesia as a well-compensated specialty is this AMC buyout movement. Which may may or may not exist for the long haul. And even if it does, there may be shifts in compensation within those positions.

 

[ERRES2288]

How many new programs/spots have been created over the last few years? And is it really enough to impact the whole specialty?

I think the biggest threat to anesthesia as a well-compensated specialty is this AMC buyout movement. Which may may or may not exist for the long haul. And even if it does, there may be shifts in compensation within those positions.

Agreed the increase is not that substantial in the past few years. (around 3% per year since 2010). With salaries going forward, obviously AMCs will try to drive them down as much as possible but will only be able to do so depending on the supply/demand.

I could see there being a jump in demand (higher salaries) in 5-9 years after the wave of partners that sold out retire after their required obligation is meant.

 

[Man o War]

Here's the thing though guys and gals, the cost to the hospital DOES NOT CHANGE when they hire an AMC. In fact, I would argue after a couple of cycles and the AMCs getting greedy, it may even go up. I can't predict the future, but there is a chance this AMC BS will go by the wayside at some point. Yeah, they have flashy salesmen in suits, but is that model really sustainable long term? I see some flaws in that system.

 

[Planktonmd]

Please stop dreaming and come down to planet earth!
The bread and butter of anesthesia practice is simple everyday outpatient type cases that can be done by CRNAs, the CRNAs are cheaper and they have the support of the hospital administrators and the government who is pushing very hard for cheaper alternatives to greedy physicians.
Do you really still need a crystal ball to predict the future?

 

[ERRES2288]

Please stop dreaming and come down to planet earth!
The bread and butter of anesthesia practice is simple everyday outpatient type cases that can be done by CRNAs, the CRNAs are cheaper and they have the support of the hospital administrators and the government who is pushing very hard for cheaper alternatives to greedy physicians.
Do you really still need a crystal ball to predict the future?

If this is the argument then almost all specialties except surgery are screwed. Bread and butter in most specialties can easily be handled by NPs and PAs.

 

[deleted162650]

CRNAs are cheaper

This is only true if the hospital is directly employing both Anesthesiologists and crna's (not all that common outside of academics), and even then they are only cheaper for the hospital. Medicare/Medicaid is billed/pays the same rate whether a crna or Anesthesiologist is providing the anesthesia. They are no cheaper to system, and may even be more expensive to a hospital who has to then fork over benefits and overtime vs an independent group of Anesthesiologists.

 

[Planktonmd]

If this is the argument then almost all specialties except surgery are screwed. Bread and butter in most specialties can easily be handled by NPs and PAs.

The anesthesia nurses are presenting themselves as an equal or superior alternative to anesthesiologists and they have the support of the government and health care business leaders.
This is a situation that no other specialty is facing.

 

[Ignatius J]

If this is the argument then almost all specialties except surgery are screwed. Bread and butter in most specialties can easily be handled by NPs and PAs.

Shoot, I know plenty of first assists who have been around a while who could do appys and choles without a sweat.

 

[Planktonmd]

This is only true if the hospital is directly employing both Anesthesiologists and crna's (not all that common outside of academics), and even then they are only cheaper for the hospital. Medicare/Medicaid is billed/pays the same rate whether a crna or Anesthesiologist is providing the anesthesia. They are no cheaper to system, and may even be more expensive to a hospital who has to then fork over benefits and overtime vs an independent group of Anesthesiologists.

Anesthesiologists and CRNAs will soon be either hospital employees or AMC employees and both those employers will want to hire the cheaper solution which is the nurses.
as an employer if you pay less salaries then you make more money even though Medicare and insurance reimburses the same.

 

[Ignatius J]

The anesthesia nurses are presenting themselves as an equal or superior alternative to anesthesiologists and they have the support of the government and health care business leaders.
This is a situation that no other specialty is facing.

Bullcaka. Ask an orthopedist about podiatrists. Or ophthalmologists about optometrists. Or outsourcing in radiology. Or NPs in primary care. Or midwives in OB/GYN.

Not only to ophthalmologists constantly have to try and halt scope of practice for optometrists, but they also have to go to their offices and kiss their ass to get referrals! Most of the chicken littles here would have their knees buckle if they had to do that sort of thing with cRNAs.

Newflash: There is a lot of money in medicine and people are going to try and do as little as possible to get their biggest cut of the pie.

 

[Planktonmd]

Bullcaka. Ask an orthopedist about podiatrists. Or ophthalmologists about optometrists. Or outsourcing in radiology. Or NPs in primary care. Or midwives in OB/GYN.

Not only to ophthalmologists constantly have to try and halt scope of practice for optometrists, but they also have to go to their offices and kiss their ass to get referrals! Most of the chicken littles here would have their knees buckle if they had to do that sort of thing with cRNAs.

Newflash: There is a lot of money in medicine and people are going to try and do as little as possible to get their biggest cut of the pie.

Nope... none of these examples comes even close to the magnitude of the CRNA problem, you will find out soon.

 

[ERRES2288]

So what is keeping AMCs from going greater than 4:1 model right now and dumping the docs for CRNAs?

 

[Man o War]

Hmmm. What kind of hospitals are we talking about here? CRNAs unsupervised would kill such a large number of patients in the places I've worked that the cost savings would not be worth it. When you add in all the call and after hours stuff anesthesiologists cover that you now have to pay nurses to cover, how much are you really saving? It's a drop in the bucket. A lot of risk exposure for not much return.

 

[Ignatius J]

Nope... none of these examples comes even close to the magnitude of the CRNA problem, you will find out soon.

Ah, a multi-specialty expert. You must be quintuple-boarded. Congrats.

While I digest your toxicity and wait for the Reckoning, pardon me if I continue to exercise gratitude and be thankful everyday for getting to do what I do.

 

[lakersbaby]

Ask any prominent faculty at your academic institution about he CRNA problem and they downplay the hell out of it. These are the same people in the leadership of ASA. As a resident don't be afraid to ask questions and voice your concerns. We are fighting a losing battle but should still fight.

 

[Planktonmd]

Ah, a multi-specialty expert. You must be quintuple-boarded. Congrats.

While I digest your toxicity and wait for the Reckoning, pardon me if I continue to exercise gratitude and be thankful everyday for getting to do what I do.

I did not mean to rain on your parade, but if you are so happy about your choice and so optimistic about the future my "toxicity" should not affect you.

 

[Planktonmd]

So what is keeping AMCs from going greater than 4:1 model right now and dumping the docs for CRNAs?

That would be the future

 

[Twiggidy]

Instead of you residents and young attending giving snarky responses, you need to take to heart what some of the more seasoned people who have dealt with hospital admins for a long time are saying. It's easy to get all excited when you finish intern year or get that first attending check, but there is a storm coming and one side does have more backing than the other. I don't know if it means a bunch of anesthesiologist will be at the soup kitchen, but we may find ourselves in the pay scale of the internist and Peds peeps. I wouldn't be shocked

 

[ERRES2288]

I truly think it would only take a couple really bad outcomes via independent crna to reverse this trend. National media gets ahold of it. Imagine a billboard advertising for a hospital "do you want a nurse or doctor putting you to sleep for your surgery? We have all doctors" Big reason to go to a certain hospital for lay public I think. Hence can be used as marketing tool for hospital admins.

 

[deleted171991]

I truly think it would only take a couple really bad outcomes via independent crna to reverse this trend. National media gets ahold of it. Imagine a billboard advertising for a hospital "do you want a nurse or doctor putting you to sleep for your surgery? We have all doctors" Big reason to go to a certain hospital for lay public I think. Hence can be used as marketing tool for hospital admins.

I am sorry to tell you that it's wishful thinking.

At this point, everybody is in bed with CRNAs (metaphorically or physically). The hospital administrators, the ASA, the politicians, the AMCs, everybody who profits. If you think they are not safe now, how do you think they were 15 years ago, when they were given independent practice in Iowa? The more time passes, the safer they will become, at least for the easy cases. That's why 2win is so right. We should all fight for significantly decreasing the number of anesthesia residency spots, not increasing them.

 

[ERRES2288]

I guess we will see how the future plays out but I'm happy with my choice because outside of the surgical subspecialties I just don't think there is a better specialty currently. Most other fields have their own issues. I do agree though that decreasing residency slots can only be a good thing.

 

[IlDestriero]

How many new programs/spots have been created over the last few years? And is it really enough to impact the whole specialty?

I think the biggest threat to anesthesia as a well-compensated specialty is this AMC buyout movement. Which may may or may not exist for the long haul. And even if it does, there may be shifts in compensation within those positions.

I think the greatest risk to our compensation is bundled payments.

 

[Mad Jack]

The anesthesia nurses are presenting themselves as an equal or superior alternative to anesthesiologists and they have the support of the government and health care business leaders.
This is a situation that no other specialty is facing.

Yet. Give it time.

 

[2win]

I've read carefully all the responses and I see clearly a difference in response based on experience and maturity.
Let me make it clear.
The bright minds that got in anesthesia in the last 20 years or so , and I say bright because they had great scores, were not chose because of their potential to bring something different in the field.
It was and it is a simple triage based on the scores.
The goal was and it is to find manpower for a field that was deficient at that time.
They realized though that diluting us we have less power to negotiate the salary or the retribution.
So a good start it is to ask your PD and chair why it is necessary to increase the position in the residency and if this will affect your marketability in the future.
Or even better - ask WHY not decreasing the spots will promote the well ( financial) being of this specialty.
Please post your answers and the name of the PD or chair.
At least maybe we'll have one... honest answer. Maybe.
The academics is in the bed with the system - forget the PR...it is only PR.
I am not saying that they will not teach you the skills of anesthesia - but at the end of the day they are part of a system that pays for their pension, vacation and CME...and they are forced to play the game of the "enterprise"
"We increased our residency positions - that's great!"
Let me translate.
We need to cover few more OR-s and you are cheaper than CRNA-s.
The CEO is happy - they saved money. The chair is happy because he will get some $$$ ( call it distinction, name , power, vacation., safety.) from the CEO.
Hypocrisy?
Oh yea.....
They know themselves very well the reality - but they can't speak.
They have to play the game.
It is easier than PP maybe or they lost their willingness ( or they are too old) to change.
Going back to $$$ and needs.
I totally understand.
Who is getting harmed though?

 

[2win]

Ask any prominent faculty at your academic institution about he CRNA problem and they downplay the hell out of it. These are the same people in the leadership of ASA. As a resident don't be afraid to ask questions and voice your concerns. We are fighting a losing battle but should still fight.

Love it!

 

[Doctor4Life1769]

Yet. Give it time.

I can tell you this much.
Patients HATE seeing a PA/NP instead of a family or internal medicine physician in the clinics. I have never met a patient who confused an NP/PA for a primary care physician, nor have I met one who chose a midlevel provider over a physician.

When it comes to anesthesia, patients dont give a flying ****. To them, you look the same, you talk the same, you do the same. Anesthesiologists are getting enough bad rep in the media, self-inflicted and otherwise. Who was involved in talking **** during a recorded colonoscopy? Who was involved in Joan Rivers' demise? Who does Obama call greedy? While the message should be simple and clear, anesthesiologists are better than nurses, nobody is talking **** about CRNAs except the folks on this forum. I bet half of them still kiss a CRNAs happy ass every morning while giving them a 30 min coffee break.

 

[Doctor4Life1769]

I've read carefully all the responses and I see clearly a difference in response based on experience and maturity.
Let me make it clear.
The bright minds that got in anesthesia in the last 20 years or so , and I say bright because they had great scores, were not chose because of their potential to bring something different in the field.
It was and it is a simple triage based on the scores.
The goal was and it is to find manpower for a field that was deficient at that time.
They realized though that diluting us we have less power to negotiate the salary or the retribution.
So a good start it is to ask your PD and chair why it is necessary to increase the position in the residency and if this will affect your marketability in the future.
Or even better - ask WHY not decreasing the spots will promote the well ( financial) being of this specialty.
Please post your answers and the name of the PD or chair.
At least maybe we'll have one... honest answer. Maybe.
The academics is in the bed with the system - forget the PR...it is only PR.
I am not saying that they will not teach you the skills of anesthesia - but at the end of the day they are part of a system that pays for their pension, vacation and CME...and they are forced to play the game of the "enterprise"
"We increased our residency positions - that's great!"
Let me translate.
We need to cover few more OR-s and you are cheaper than CRNA-s.
The CEO is happy - they saved money. The chair is happy because he will get some $$$ ( call it distinction, name , power, vacation., safety.) from the CEO.
Hypocrisy?
Oh yea.....
They know themselves very well the reality - but they can't speak.
They have to play the game.
It is easier than PP maybe or they lost their willingness ( or they are too old) to change.
Going back to $$$ and needs.
I totally understand.
Who is getting harmed though?

Don't forget the rise in SRNA training programs by these same Chairs who supposedly have the best interest of the profession and of the future of the residents that they train.

It's all about $$

 

[lakersbaby]

Don't forget the rise in SRNA training programs by these same Chairs who supposedly have the best interest of the profession and of the future of the residents that they train.

It's all about $$

Call them all out!!! Chairmen and other prominent attendings speaking at CRNA conferences. That happens all the time and they are attendings from YOUR program. I know you can't directly call them out but let it be known to all your fellow residents that that is bull!@#$. Spread it like wildfire at all residency programs that CRNAs are not your friends. No matter how great a relationship you have with them at your hospital they don't think crap about you. They consider themselves far better than you especially if you're a resident. Do your best to stand out as a physician don't just run out the OR jumping for a joy when a CRNA relieves you. Finish your case if its almost over, or at least give a physician worthy sign out and tune the patient up well and show them you are not worthless. Don't give them a reason to look down on your, be superb in your training and be vigilant as an attending. If you are lazy everyone will know and you will feed their fire.