Possible silver lining?

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resiroth

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So I know this forum is very doom and gloom, but there are two things I thought about that might impact the future in a positive way (potentially).

The first is that yes, anesthesiologists make a lot less often because they're employees now...But that's a shift that's taking place with other specialties as well. This isn't so much a benefit for anesthesiology, rather a prediction that as other specialties also continue to shift toward being employees of hospitals their salary would drop too. I don't know accurate this is:
http://www.beckershospitalreview.co...tatistics-on-physician-compensation-2015.html
But it seems to indicate that other highly paid specialists will make around anesthesia levels or worse if they work in a hospital.

To be honest I'm not sure anything can be done to stem this shift in medicine, and I think it will hit other fields hard as well. The difference is that anesthesia has already been hit (at least to a greater extent) compared to urologists for ex. if that makes sense.

The other thing I think might actually help anesthesiologists (in a rather strange way) is Sedasys. Initially I was reading about it and thought that anesthesiologists would be screwed, but I think it will hit CRNAs much harder. If robots end up replacing the need for CRNAs, in conjunction with the glut of CRNAs being produced, they'll crumple.

I do think in this hypothetical scenario there still is one significant concern facing anesthesiology: too many residency positions. So in this potential 10 year out scenario where a lot of routine stuff is done by machines, CRNAs as a field is oversaturated/dead, anesthesiologists would be doing a ton of hard cases. Therefore we'd still be very crucial, but the demand for services would be lower.

So while demand would be more inelastic (they'd pay whatever the market demands because anesthesiologists would be in charge of things only anesthesiologists could do) the volume of cases would be lower which might mean there is an overabundance of supply.

While a general decrease in anesthesiologists is predicted: http://www.rand.org/content/dam/rand/pubs/research_reports/RR600/RR650/RAND_RR650.pdf (page 77) in the next 10 years, it's not clear whether this will translate to an actual shortage to me.

Finally I know I'm just a medical student, and I don't know nearly as much as many of you members here. That being said, please be respectful because I really am curious what you guys think, and there is no need for personal attacks :).

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Idk man. Gas had made its money from the intraoperative services, but apparently now anesthesia is so safe that nurses think they can do at least 90% of it. So now the leadership is focusing on providing more value in the "perioperative" setting, which seems like encroachment on Hospitalist turf. I just don't see anymore significant advancements in science/tech in anesthesia from reading the journals and consequently have no idea about the specialty's future. My school only gave us one 45 min. preclinical lecture on gas, and the lecturer had a very defeated attitude. Seems like the writing is on the wall.

It sucks bc I felt I really fit with the gas culture but I am likely gonna suck it up and do something else.
 
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....So now the leadership is focusing on providing more value in the "perioperative" setting, which seems like encroachment on Hospitalist turf.....

I think one of the most telling things about the current situation is that those in charge of making/directing policy have concluded that it is easier for doctors to take work away from other doctors than it is for doctors to reclaim their own practice from nurses.
 
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The reason why anesthesiology is threatened more so than other fields is because we're the ultimate "teachable" specialty. I like to pride myself at having great skills, but the reality is, yes, you can teach the dumbest nurse in the hospital how to intubate, put in lines, hell, even get 20 views on the TEE. That's why anesthesiologists are fighting a losing battle (and likely a similar battle primary care is going to have or is having). If you want true job security....pick up a knife and be somewhat good with it. I loved surgery but I just couldn't deal with the lifestyle.
 
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The reason why anesthesiology is threatened more so than other fields is because we're the ultimate "teachable" specialty. I like to pride myself at having great skills, but the reality is, yes, you can teach the dumbest nurse in the hospital how to intubate, put in lines, hell, even get 20 views on the TEE. That's why anesthesiologists are fighting a losing battle (and likely a similar battle primary care is going to have or is having). If you want true job security....pick up a knife and be somewhat good with it. I loved surgery but I just couldn't deal with the lifestyle.

Highly unlikely a CRNA is going to definitively tell a cardiac surgeon if a valve is to be repaired vs. replaced, if a perivalvular leak is acceptable or not, guide TAVR device sizing, check anastomotic gradients after a transplant, etc.

CT echo and complex peds is not a place for a CRNA to learn. IMO, if you are letting your CRNAs do high acuity cases while making surgical decisions then you are selling out your specialty while risking patient safety.
 
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JCardiovascEchography_2014_24_4_103_147201_u23.jpg
 
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Yes, sevo, but at the rate people are going into cardiac anesthesia, there will be more cardiac anesthesiologists than CRNAs. :p

I am intentionally exaggerating, but you get my point. There is just a certain number of cardiac surgeries which need cardiac anesthesiologists (vs just consulting cardiologists and generalist anesthesiologists/CRNAs), and even those spots will become fewer once everybody gets greedy and starts doing CABG 1:2 or 1:3.
 
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A brief synopsis of what I've picked up from this forum:
  • If not anesthesia, then a surgical specialty (if you can stomach the life).
  • If not surgery, then IM. Then pulm/cc or cards (as probably the most appealing subspecialties to people who like anesthesia too). GI would be great if you can get in.
  • If still set on anesthesia, then cc if you want to be awesome or pain if you want lifestyle.
  • All other subspecialties are still anesthesia, but if you absolutely love anesthesia and don't want cc or pain, then cards or peds, move West, or Canada, or Down Under, and hope for the best. May the gas gods put the wind to your sails so you have a blessed voyage in your future!
 
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Or do whatever you want but if it's anesthesiology, expect to work more, possibly in an obscure area, and probably make less than our four fathers of the field.

Or be working in the Surgical Home but hell at that point you may as well IM and be a hospitalist
 
probably make less than our four fathers of the field.

I know anesthesia has it's own set of challenges, but I think the above statement rings true for just about every field. The majority of well established surgeons I know (across all specialties) are making less today than they did 20 years ago.
 
Or do whatever you want but if it's anesthesiology, expect to work more, possibly in an obscure area, and probably make less than our four fathers of the field.

Or be working in the Surgical Home but hell at that point you may as well IM and be a hospitalist
That's alotta fathers
 
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"Studies Find Computer-Assisted Personalized Sedation For Gastroenterology Procedures Works Well"

“Dr. Shafer offered a pragmatic viewpoint. In a hypothetical world of unlimited resources, you would always want an anesthesiologist in the room,” he said. “In a hypothetical world of unlimited resources, there should be an anesthesiologist on every airplane flight, in every restaurant and in every ambulance. Nobody dies from hypoxia if an anesthesiologist is managing the patient. However,” he added, “we don’t live in a world of unlimited resources. Anesthesiologists are a scarce resource. Sedasys allows rational use of anesthesiologists to care for patients who need our skills.”

What is this crap?

http://anesthesiologynews.com/ViewA...gy&d_id=1&i=October+2015&i_id=1232&a_id=33952
 
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i certainly envision a day where a single anesthesiologists is sitting at a mainframe controlling anesthesia for multiple rooms and just going between each room intubating and extubating. I mean, what is a CRNA but a robot anyway. If they can make the robot they'll certainly save some money. But then again, maybe they'll have the CRNA at the controls....wait, i'm helping them.....bad idea! bad idea! Abort post abort post!
 
I'm just a medical student but I'm not a traditional student, meaning I have an extensive real world work history prior to going into medicine. I say that because I feel it gives me an "outside" perspective on things if you will. In light of that the situation is fairly obvious. Two things are keeping the status quo intact. They are two significant things however.

One:
Liability. That's the elephant in the room that people sometimes talk about but don't really address. As long as the "physician" in the room is liable for bad outcomes anesthesiologists jobs aren't going anywhere. Period. CRNA's can be as independent as they want wherever they want but until CRNA's are held liable for malpractice in the EXACT same way current anesthesiologists are nothing will change. Surgeons are not taking all the risk alone, its just not going to happen.

Two:
Complex patients. Some patients are simply too sick for cookbook medicine. They require more than a master's level of education and on the job training. As long as you are VERY good at what you do and are willing to sit complex cases you will have a job. What that type of job will pay and where it will be located are different things altogether.

I truly believe the above and am going into anesthesia. Its simply what I enjoy the most. Maybe I'll regret it who knows but I've already seen enough near death in the OR to believe that I'll always have a job.
 
I truly believe the above and am going into anesthesia. Its simply what I enjoy the most. Maybe I'll regret it who knows but I've already seen enough near death in the OR to believe that I'll always have a job.
Damn.... Stick your head further in the sand why dont you? Even if you believe you will always have a job? WHat kind of job will it be? and where will it be.. These are major questions and concerns... I dont even wanna even think about how we will be practicing in ten years. It is conceivable that Ill still be around but im not too worried since i have a little bit of rainy day money saved.
 
A brief synopsis of what I've picked up from this forum:
  • If not anesthesia, then a surgical specialty (if you can stomach the life).
  • If not surgery, then IM. Then pulm/cc or cards (as probably the most appealing subspecialties to people who like anesthesia too). GI would be great if you can get in.
  • If still set on anesthesia, then cc if you want to be awesome or pain if you want lifestyle.
  • All other subspecialties are still anesthesia, but if you absolutely love anesthesia and don't want cc or pain, then cards or peds, move West, or Canada, or Down Under, and hope for the best. May the gas gods put the wind to your sails so you have a blessed voyage in your future!
General Cards or a Cards sub-specialty? EP has very interesting physio imo and you get to actually cure patients w/ the procedures. Safe from mid-levels, high reimbursement. More benign lifestyle compared interventional or general. Problem is job market seems saturated and the training requires 8 years after med school... I can't imagine having to move to BFE after 8 years of residency/fellowship for a job.
 
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Damn.... Stick your head further in the sand why dont you? Even if you believe you will always have a job? WHat kind of job will it be? and where will it be.. These are major questions and concerns... I dont even wanna even think about how we will be practicing in ten years. It is conceivable that Ill still be around but im not too worried since i have a little bit of rainy day money saved.

Stick my head in the sand? What am I missing? I realize that the field has major challenges and changes are coming. See my first point. I don't think it will happen any time soon however if the liability issue changes anesthesiology will look nothing like it does today. I'm not pretending that couldn't happen.

I am of the mind set that change is constant and in this field it is certain. I dont have the same income or practice expectations that you or other currently practicing anesthesiologists may have as such I'm not worried about my future changing. The speciality that I am entering is different than the one you entered and I'm ok with that.

Please don't mistake what I'm writing as me implying that I know the future, rather it's the exact opposite. I only know future practice will be different than current practice. I accept that and plan to fight for the speciality. I also will do what I can to arm myself by being the best I can be and will strongly consider fellowship.

I know many advocate for other specialties saying that gas is dead but what if you are like me and don't want to do surgery or family med or internal med, ect. My answer is to prepare for change by attempting to be irreplaceable.
 
Seriously, Anesthesiology is like the best forum.
 
Damn.... Stick your head further in the sand why dont you? Even if you believe you will always have a job? WHat kind of job will it be? and where will it be.. These are major questions and concerns... I dont even wanna even think about how we will be practicing in ten years. It is conceivable that Ill still be around but im not too worried since i have a little bit of rainy day money saved.

I have always said that if my salary goes to family med levels due to CRNA influx then I will be forced to do one of (or a combination) of the following: retrain, move to another country, or default on my loans. I would likely protect all my assets as best I can and then default.
 
Stick my head in the sand? What am I missing? I realize that the field has major challenges and changes are coming. See my first point. I don't think it will happen any time soon however if the liability issue changes anesthesiology will look nothing like it does today. I'm not pretending that couldn't happen.

I am of the mind set that change is constant and in this field it is certain. I dont have the same income or practice expectations that you or other currently practicing anesthesiologists may have as such I'm not worried about my future changing. The speciality that I am entering is different than the one you entered and I'm ok with that.

Please don't mistake what I'm writing as me implying that I know the future, rather it's the exact opposite. I only know future practice will be different than current practice. I accept that and plan to fight for the speciality. I also will do what I can to arm myself by being the best I can be and will strongly consider fellowship.

I know many advocate for other specialties saying that gas is dead but what if you are like me and don't want to do surgery or family med or internal med, ect. My answer is to prepare for change by attempting to be irreplaceable.
If your favorite car was a BMW. And i had the only BMW for sale. BUt i told you that the engine would probably die on you in six months. one year tops.. Would you still buy it you dense boy?
 
If your favorite car was a BMW. And i had the only BMW for sale. BUt i told you that the engine would probably die on you in six months. one year tops.. Would you still buy it you dense boy?


I love how you start by making a decent analogy, then effectively invalidate your point by tacking a needless ad-hominim onto the end.

This forum in a nutshell. :thumbup:
 
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I'm just a medical student but I'm not a traditional student, meaning I have an extensive real world work history prior to going into medicine. I say that because I feel it gives me an "outside" perspective on things if you will. In light of that the situation is fairly obvious. Two things are keeping the status quo intact. They are two significant things however.

One:
Liability. That's the elephant in the room that people sometimes talk about but don't really address. As long as the "physician" in the room is liable for bad outcomes anesthesiologists jobs aren't going anywhere. Period. CRNA's can be as independent as they want wherever they want but until CRNA's are held liable for malpractice in the EXACT same way current anesthesiologists are nothing will change. Surgeons are not taking all the risk alone, its just not going to happen.

Two:
Complex patients. Some patients are simply too sick for cookbook medicine. They require more than a master's level of education and on the job training. As long as you are VERY good at what you do and are willing to sit complex cases you will have a job. What that type of job will pay and where it will be located are different things altogether.

I truly believe the above and am going into anesthesia. Its simply what I enjoy the most. Maybe I'll regret it who knows but I've already seen enough near death in the OR to believe that I'll always have a job.
I'm with you @NOsaintsfan, and only want the best for this specialty's future, but to play devil's advocate:

All this may be true, but it doesn't necessarily mean there'll be a need for more jobs for anesthesiologists. It could mean no change in jobs available for anesthesiologists or perhaps even a decrease in available jobs for anesthesiologists. That's because anesthesiologists could be increasingly asked to be in a supervisory role over CRNAs. The whole ACT that's already, what, now like 50% of all jobs? And it seems to be only growing. So it could be there'll be a greater need for CRNAs or AAs, but a decreased need or no change in need for anesthesiologists overall.

Or if there is an increased need for anesthesiologists, it could drive down salaries, and/or not change or even increase work hours. Got to get through more cases after all! That's how to make the hospital or group more money, or at least maintain the money they're/we're making.

Of course, this isn't fair to the anesthesiologist. But how much do hospitals or groups or others really care?

Also, there's a point at which the anesthesiologist:CRNA ratio could become too medico-legally risky for a hospital to want to maintain. But at what point will this happen? 1:4, 1:6, 1:8, 1:10, etc.? That's the question in my mind at this point.
 
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. That's because anesthesiologists could be increasingly asked to be in a supervisory role over CRNAs. The whole ACT that's already, what, now like 50% of all jobs? And it seems to be only growing. So it could be there'll be a greater need for CRNAs or AAs, but a decreased need or no change in need for anesthesiologists overall.

Or if there is an increased need for anesthesiologists, it could drive down salaries, and/or not change or even increase work hours. Got to get through more cases after all! That's how to make the hospital or group more money, or at least maintain the money they're/we're making.

Of course, this isn't fair to the anesthesiologist. But how much do hospitals or groups or others really care?

Also, there's a point at which the anesthesiologist:CRNA ratio could become too medico-legally risky for a hospital to want to maintain. But at what point will this happen? 1:4, 1:6, 1:8, 1:10, etc.? That's the question in my mind at this point.

That's a serious concern, w/o a doubt. 1:4 should be the max, and even tighter for seriously risky cases. I fear for outcomes. I have visions of the anesthesiologist watching like 10 huge screens--like some technical TV sports director, but it's not like looking directly at the patient and then the other data at once. The general public should be very afraid. They won't allow this in most peds hospitals--at least not initially or for a while.

And then there are less people even considering anesthesiology b/c of such concerns and fears as have been noted. I honestly believe a number of hospitals will push this as far as they can. You need more anesthesiologists in Chief of Medicine roles. That couldn't hurt. But when the surgeons complain enough, I think more would listen.
 
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If your favorite car was a BMW. And i had the only BMW for sale. BUt i told you that the engine would probably die on you in six months. one year tops.. Would you still buy it you dense boy?

OK I get it. You call me dense, I'll be the first to admit their is plenty I don't know. So what's your overall point? That the speciality is dead and I should pick something else? Or do you have some other advice you would like to share?
 
I'm with you @NOsaintsfan, and only want the best for this specialty's future, but to play devil's advocate:

All this may be true, but it doesn't necessarily mean there'll be a need for more jobs for anesthesiologists. It could mean no change in jobs available for anesthesiologists or perhaps even a decrease in available jobs for anesthesiologists. That's because anesthesiologists could be increasingly asked to be in a supervisory role over CRNAs. The whole ACT that's already, what, now like 50% of all jobs? And it seems to be only growing. So it could be there'll be a greater need for CRNAs or AAs, but a decreased need or no change in need for anesthesiologists overall.

Or if there is an increased need for anesthesiologists, it could drive down salaries, and/or not change or even increase work hours. Got to get through more cases after all! That's how to make the hospital or group more money, or at least maintain the money they're/we're making.

Of course, this isn't fair to the anesthesiologist. But how much do hospitals or groups or others really care?

Also, there's a point at which the anesthesiologist:CRNA ratio could become too medico-legally risky for a hospital to want to maintain. But at what point will this happen? 1:4, 1:6, 1:8, 1:10, etc.? That's the question in my mind at this point.

I have considered this and it absolutely may happen but life is a risk. Got any advice besides pick another speciality?
 
Or do whatever you want but if it's anesthesiology, expect to work more, possibly in an obscure area, and probably make less than our four fathers of the field.
Crawford Long, William Morton, John Snow, Horace Wells? ;)
 
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If your favorite car was a BMW. And i had the only BMW for sale. BUt i told you that the engine would probably die on you in six months. one year tops.. Would you still buy it you dense boy?
That would depend on the price, the availability of other cars, and the flaws those other cars had.

Enough with the personal attacks.
 
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Jeesh. PMS running rampant on this forum lately. If some of you are so miserable and hate this specialty so much, quit. Let some of these younger guys/gals with better attitudes take your job. I'm sure they'd be more than happy to.
 
I'm curious, when did most of you older attendings who are so down on anesthesia enter the field? I'm guessing that for a good number of you it was in the 90s. Which then begs the question why did you pick it then when the outlook at the time was so poor?
 
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I think a less obvious problem on this forum is some people read doom and gloom into what is actually reasonable and sound advice.

While it's true there are some attendings on this forum who are miserable (I won't name names), there are likewise many attendings here who have a lot of knowledge and experience that's valuable and worth listening to, which they don't need to share, yet some people dismiss what they say as doom and gloom. (Maybe it's hard for some to tell which is which, but that's why sound judgment and discernment aren't passive skills but need to be actively developed).

Besides, even if it's true some attendings are miserable, it doesn't necessarily mean all their statements are false. A miserable person can still tell truths and make factual statements.

Anyway, I'm not old, I really like anesthesiology as a specialty, but I still see some big challenges ahead for anesthesiology. Thankfully in my case I have the option of working in a place which doesn't face most of these big challenges.
 
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My job is great....could not think of a specialty I would rather practice.
 
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Please see what I wrote in my first post in this thread (the 3rd and 4th bullet points):

http://forums.studentdoctor.net/threads/possible-silver-lining.1166098/#post-17027190

Thank you, I appreciate the advice and am entering this field with the idea of doing exactly what you suggest. As to your most recent post I appreciate the words of caution from you and others. I welcome any thoughts about the future of the specialty, especially if it is coming from currently practicing docs. I realize its easy to dismiss the negatives by getting caught up in what I may love about the field. What some need to appreciate is that people (like me) are still going to enter this field and want to make it better. It's frustrating when you get personally attacked for your decision. It would be more productive for all if we acknowledged the problems going forward and focused on things that can possibly improve the field instead of simply proclaiming that the field is dying and that anyone who picks gas is stupid. I f everyone simply walks away the field will certainly die.
 
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Yes, but there is a big difference between being smug and negative all the time, and having an honest discussion about issues we face. Honestly, what I've observed over the years is we are our own worst enemies. Napping in the lounge while cases are running (one of my old partners), having a patient request an epidural from a doctor and not a CRNA, and walking into the room only to tell the patient the nurse is better at epidurals than you so you should really choose the nurse (an attending I worked with), not sitting on hospital committees and being active on Med Exec, peer review, etc (nobody likes this but it is an essential part of being part of the team who later decides how good/bad your next contract is), trading stocks all day on the computer in the surgery lounge in full view of all the surgeons (who are our customers btw, I can't believe so many anesthesiologists don't grasp that), not keeping up our skills and knowledge as medicine advances and surgeons want to try new things, sending a CRNA out to talk to a family before a risky case so you can sit in the lounge and drink coffee, the list goes on and on. The fact is, if you choose anesthesia, one of your biggest jobs is managing perceptions. If you don't want to do that and jump through the hoops that come along with that, then you should choose another specialty. I love what I do and would highly recommend it to any med student or resident AFTER having this talk with them.
 
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Yes, but there is a big difference between being smug and negative all the time, and having an honest discussion about issues we face. Honestly, what I've observed over the years is we are our own worst enemies. Napping in the lounge while cases are running (one of my old partners), having a patient request an epidural from a doctor and not a CRNA, and walking into the room only to tell the patient the nurse is better at epidurals than you so you should really choose the nurse (an attending I worked with), not sitting on hospital committees and being active on Med Exec, peer review, etc (nobody likes this but it is an essential part of being part of the team who later decides how good/bad your next contract is), trading stocks all day on the computer in the surgery lounge in full view of all the surgeons (who are our customers btw, I can't believe so many anesthesiologists don't grasp that), not keeping up our skills and knowledge as medicine advances and surgeons want to try new things, sending a CRNA out to talk to a family before a risky case so you can sit in the lounge and drink coffee, the list goes on and on. The fact is, if you choose anesthesia, one of your biggest jobs is managing perceptions. If you don't want to do that and jump through the hoops that come along with that, then you should choose another specialty. I love what I do and would highly recommend it to any med student or resident AFTER having this talk with them.

Thank you for the candid and honest comments. This is exactly the type of stuff that genuinely interested students such as myself want to hear.
 
Yes, but there is a big difference between being smug and negative all the time, and having an honest discussion about issues we face. Honestly, what I've observed over the years is we are our own worst enemies. Napping in the lounge while cases are running (one of my old partners), having a patient request an epidural from a doctor and not a CRNA, and walking into the room only to tell the patient the nurse is better at epidurals than you so you should really choose the nurse (an attending I worked with), not sitting on hospital committees and being active on Med Exec, peer review, etc (nobody likes this but it is an essential part of being part of the team who later decides how good/bad your next contract is), trading stocks all day on the computer in the surgery lounge in full view of all the surgeons (who are our customers btw, I can't believe so many anesthesiologists don't grasp that), not keeping up our skills and knowledge as medicine advances and surgeons want to try new things, sending a CRNA out to talk to a family before a risky case so you can sit in the lounge and drink coffee, the list goes on and on. The fact is, if you choose anesthesia, one of your biggest jobs is managing perceptions. If you don't want to do that and jump through the hoops that come along with that, then you should choose another specialty. I love what I do and would highly recommend it to any med student or resident AFTER having this talk with them.

Man what the ****
 
Man what the ****

Always an interesting forum. I'm not in Anesthesia but it seems the real problem you face is that you don't control the patients. If patients had any real choice about who administers their anesthesia during surgery, it would be a much better position to be in. That is the real reason why midlevels cant get a true foothold on many other fields.

This may be a stupid question but why don't anesthesiologists start having preop clinics along with the surgeons they work with? I guarantee many patients would say- wait- a nurse is doing my anesthesia in 4 weeks? I want a doctor. Its not really a choice the day-of when they are in a gown in the hospital.
 
Always an interesting forum. I'm not in Anesthesia but it seems the real problem you face is that you don't control the patients. If patients had any real choice about who administers their anesthesia during surgery, it would be a much better position to be in. That is the real reason why midlevels cant get a true foothold on many other fields.

This may be a stupid question but why don't anesthesiologists start having preop clinics along with the surgeons they work with? I guarantee many patients would say- wait- a nurse is doing my anesthesia in 4 weeks? I want a doctor. Its not really a choice the day-of when they are in a gown in the hospital.

Because despite what most doctors say about nurses taking over the field, they knowingly/unknowingly encourage its process. They don't want the hassle of doing it themselves. Supervising CRNA means more $$.
 
\ the real problem you face is that you don't control the patients. \

Boom.

But go deeper with it. The problem is that we offer nothing outside of our skill for anesthesia. We bring no $$$$$ to the table. As a matter fact, we're the one taking money off the table. @Man o War makes good points in the post about perception, BUT we also have to be careful, for the very reason that we can't go into a board room and act like a mover and shaker, because we don't do anything for the hospital. If the group at the hospital causes a ruckus, it's off with their heads and bring in the next bunch. (This is especially so if you're in a highly desirable area of the country)

Now some hospitals are seeing that there's a cheaper option, especially with certain legislative moves that have been made, yes, there is a negative outlook on the field. This is why, again as @Man o War put, you have to be careful how you are perceived (myself included). There will be the day that not as many of us are needed (and that's where the doom and gloom comes from) but when that day comes, you want to be on the good list, not the bad one. Again, working on playing the game better myself. This is all true and everyone knows it. CRNAs, robots, etc....all moves to make it some this one area is taking less money off the hospitals table.
 
When single payer happens, no specialty will bring in $$$ and all specialties will be on equal footing.
 
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