Program Director Said Don't Do Anesthesia

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Random Resident said:
Crnas are encroaching there too. Slower, but it's happening.
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I did hear something about that. Nonetheless, it will be too slow a transition. Too much liability and I doubt those who went to nursing school just to become CRNAs (the batch of nursing students the past 5-7 years who jump straight into ICU work upon finishing school just to become CRNAs) would be quick to jump to this setting. It's quite different from their traditional SRNA training and I could see themselves really targeting total independence in the OR first, learning joint blocks, in addition to other procedures, and possibly jumping into Crit Care before they consider expanding into outpatient interventional pain management. They could, however, dabble into medical management if they wanted to much more easily. Of course, I could be wrong about this, but there is too much liability at hand when it comes to entering a needle within the spine, even with fluoro guidance.
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Doctor4Life1769 said:
I did hear something about that. Nonetheless, it will be too slow a transition. Too much liability and I doubt those who went to nursing school just to become CRNAs (the batch of nursing students the past 5-7 years who jump straight into ICU work upon finishing school just to become CRNAs) would be quick to jump to this setting. It's quite different from their traditional SRNA training and I could see themselves really targeting total independence in the OR first, learning joint blocks, in addition to other procedures, and possibly jumping into Crit Care before they consider expanding into outpatient interventional pain management. They could, however, dabble into medical management if they wanted to much more easily. Of course, I could be wrong about this, but there is too much liability at hand when it comes to entering a needle within the spine, even with fluoro guidance.
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I know of an independent nurse who dabbles in interventional pain so it's happening out there. I'm pretty sure it was limited to ESI's, hopefully just lumbar.
 
FFP said:
Radiology and pathology are always open to technological risks. In imaging, the midlevels are the computer and image recognition software. Look at all the image pattern recognition in defense and law enforcement. Do you think none of that will end up being applied in medicine? I wouldn't bet against that, not with my career.

The best bets are complex procedural specialties that cannot be replaced by stents and tech-level jobs. By the way, how long before interventional radiologists or cardiologists or gastroenterologists will face competition from trained nurses, the same way APRNs do central lines and chest tubes and intubations, and generally anything that's pure eye-hand coordination?

And Oncology is probably ripe for the midlevel revolution, too, as most recipe-based specialties. Already they have midlevels checking on their patients, and this is just the beginning.

Go for a surgical specialty, OP.
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You are making the point I've made for a long time. The RATE of encroachment of mid-level providers in OTHER specialties already FAR exceeds that of our own. With this, will become a more unified political front in modulating that encroachment, but no doubt they are here to stay and will be an integral part of the healthcare delivery system in the U.S.

Doctors will have good jobs, those jobs will be changing, however, for many of us. It is what it is. But, if you are good, you will FOR SURE have a place earning much better than most, and in an exciting field (medicine in general). Yes, headaches will be worse or at least different, but it's still a good gig. Feel free to disagree, but that's how I see it.
 
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I do feel free to disagree. :D

It's a good gig only if you get to hire and fire your own midlevels. Otherwise it's a malpractice Russian roulette. It's like the Wild Wild West, where you could have been shot anytime by anybody, including one of your own, if you weren't careful all the time. Not my idea of a great job.

And nobody has as much midlevel encroachment as us, except maybe family medicine, and we all know how well they are doing.
 
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FFP said:
And nobody has as much midlevel encroachment as us, except maybe family medicine, and we all know how well they are doing.
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I actually think that family medicine physicians get more respect than anesthesiologists, they are still seen as physicians while we are seen as an expensive nurse alternative!
 
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Planktonmd said:
We had several threads about why Anesthesiology is terrible and that made me think about the reasons I love this specialty.
Here is what comes to my mind and I hope others could add to my list:

1- I make good money
2- I never get called in the middle of the night because a patient is constipated
3- I never do rectal exams
4- I get to wear Pajamas to work and I never wear a necktie
5- I do neat procedures all day long
6- I get to stick needles in people
7- I allow surgeons to cut people without killing them
8- I have plenty of free time to enjoy my pay check
9- After more than 20 years in practice I get up in the morning actually excited about going to work
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Plankton,

Just curious if the above is still relevant to you, or has your outlook on anesthesia changed much in five years?
 
One thing I've noticed (specifically on SDN) is that the general outlook for many specialties tends to be on the negative side.

Here's a thread about the future outlook for cardiology, for example:
http://forums.studentdoctor.net/threads/save-cardiology-sos-call.1056774/


Planktonmd said:
I actually think that family medicine physicians get more respect than anesthesiologists, they are still seen as physicians while we are seen as an expensive nurse alternative!
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Family med is not any better lifestyle-wise compared to anesthesia (likely worse), and it is a field that is compensated considerably worse than anesthesiology. The average CRNA probably makes more than a family doc in the bigger cities.
 
Emergency Medicine has some of the exact same issues as Anesthesia when it comes to Midlevel encroachment and liability issues. They have PAs and NPs staffing almost half of the dept whilst seeing patients under the license of their "supervising physician" whom never sees a single one the patients yet is required to sign 30 charts at the end of their shift. I've seen some pretty horrible bounce backs in the ED that were sent home by midlevels the day before and the doc that signed the chart gets held liable.


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Planktonmd said:
All the above points are still applicable except the last one, I am no longer excited about going to work!
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Is that because you're looking forward to retirement too much after 25 years of practice? ;)
 
amLOLdipine said:
One thing I've noticed (specifically on SDN) is that the general outlook for many specialties tends to be on the negative side.

Here's a thread about the future outlook for cardiology, for example:
http://forums.studentdoctor.net/threads/save-cardiology-sos-call.1056774/




Family med is not any better lifestyle-wise compared to anesthesia (likely worse), and it is a field that is compensated considerably worse than anesthesiology. The average CRNA probably makes more than a family doc in the bigger cities.
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I think the lifestyle of FM is probably better than anesthesia. No over night calls, no emergencies. If you can stomach clinic then you're fine.
 
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kazuma said:
I know of an independent nurse who dabbles in interventional pain so it's happening out there. I'm pretty sure it was limited to ESI's, hopefully just lumbar.
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If only. I know of a CRNA in the western, rural portion of my state operating as a "chronic pain" provider. Does cervical epidurals. Yikes.
 
o.k. the doom and gloom on this board is getting out of hand.

settle the f.ck down guys. the sky isn't falling. challenges abound in medicine and the WORLD these days. it's a very tough economic climate "out there". IN GENERAL. just settle down. This is getting ridiculous.
 
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GA8314 said:
o.k. the doom and gloom on this board is getting out of hand.

settle the f.ck down guys. the sky isn't falling. challenges abound in medicine and the WORLD these days. it's a very tough economic climate "out there". IN GENERAL. just settle down. This is getting ridiculous.
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Or don't read this thread.
 
GA8314 said:
o.k. the doom and gloom on this board is getting out of hand.

settle the f.ck down guys. the sky isn't falling. challenges abound in medicine and the WORLD these days. it's a very tough economic climate "out there". IN GENERAL. just settle down. This is getting ridiculous.
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Not everything in life is about money. ;)

For example, I would practice anesthesia even for a CRNA salary in an otherwise great job. Would you?
 
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Doctor4Life1769 said:
I think the lifestyle of FM is probably better than anesthesia. No over night calls, no emergencies. If you can stomach clinic then you're fine.
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I'm pretty sure that many people going into anesthesia did so because the answer to that statement is a big fat "no".
 
Most gas docs I have encountered are very laid back individuals and are genuinely content with their choice. They have a very calming presence, in general. People looking for ego boosts through their work (ex: receiving thank you cards from pts) don't fit in quite as well. #goteamgas
 
Carbocation1 said:
Most gas docs I have encountered are very laid back individuals and are genuinely content with their choice. They have a very calming presence, in general. People looking for ego boosts through their work (ex: receiving thank you cards from pts) don't fit in quite as well. #goteamgas
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This has been my experience as well.
 
CRNAs make more than the avg FM doc. I would rather get paid CRNA wages as an anesthesiologist than sit in a clinic listening to vague complaints all day, and then come home to do more paperwork. Imagine talking to a patient who reads this book with a 4.5 star, 1600+ customer rating on amazon:

Medical Medium: Secrets Behind Chronic and Mystery Illness and How to Finally Heal

Anthony William, Medical Medium, has helped tens of thousands of people heal from ailments that have been misdiagnosed or ineffectively treated or that doctors can’t resolve. He’s done this by listening to a divine voice that literally speaks into his ear, telling him what lies at the root of people’s pain or illness, and what they need to do to restore their health. His methods achieve spectacular results, even for those who have spent years and many thousands of dollars on all forms of medicine before turning to him. Now, in this revolutionary book, he opens the door to all he has learned over his 25 years of bringing people’s lives back: a massive amount of healing information, much of which science won’t discover for decades and most of which has never appeared anywhere before.
 
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Carbocation1 said:
CRNAs make more than the avg FM doc. I would rather get paid CRNA wages as an anesthesiologist than sit in a clinic listening to vague complaints all day, and then come home to do more paperwork. Imagine talking to a patient who reads this book with a 4.5 star, 1600+ customer rating on amazon:

Medical Medium: Secrets Behind Chronic and Mystery Illness and How to Finally Heal

Anthony William, Medical Medium, has helped tens of thousands of people heal from ailments that have been misdiagnosed or ineffectively treated or that doctors can’t resolve. He’s done this by listening to a divine voice that literally speaks into his ear, telling him what lies at the root of people’s pain or illness, and what they need to do to restore their health. His methods achieve spectacular results, even for those who have spent years and many thousands of dollars on all forms of medicine before turning to him. Now, in this revolutionary book, he opens the door to all he has learned over his 25 years of bringing people’s lives back: a massive amount of healing information, much of which science won’t discover for decades and most of which has never appeared anywhere before.
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He charges $500 per half hr for consultation and is fully booked for months.
 
Doctor4Life1769 said:
Right, that's why a decent number go into interventional pain right?
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If by "decent number" you actually mean "small minority" then, yeah, right.

And of that small minority, most of them are doing it for the lucrative and enjoyable interventional procedures, and view the clinic time as the grudgingly tolerated price of admission.
 
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FFP said:
Not everything in life is about money. ;)

For example, I would practice anesthesia even for a CRNA salary in an otherwise great job. Would you?
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I absolutely would not have gone into anesthesiology if I thought income levels would be $150-165k per year for a 40 hour week. No. I would not.

Now, I'm an attending anesthesiologist and that is my skill set, and if things got to that point in the future, then I suppose I'd have no choice (but, we always have choices...) and I'd do that if I had no better option. However, I'd be looking for other, better options FOR SURE. And I generally love what I do.
 
If FM docs are making upper 100s/lower 200s, and you guys are saying that CRNAs make that much if not more, then how low can anesthesiologists' salary drop? Is it possible that they'd drop so low, that a board certified anesthesiologist makes the same as a CRNA?
 
Ibn Alnafis MD said:
If FM docs are making upper 100s/lower 200s, and you guys are saying that CRNAs make that much if not more, then how low can anesthesiologists' salary drop? Is it possible that they'd drop so low, that a board certified anesthesiologist makes the same as a CRNA?
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This is already happening. As was noted in another thread: If a CRNA is making $150k with 6 weeks of vacation that is $81 per hour for a 40 hour work week. Multiply $81 per hour x 60 hours a week (with call) x 46 weeks with time and a half for overtime and you get $260k. Now look on Gaswork and find an Anesthesiologist job that pays $260k.
 
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skypilot said:
This is already happening. As was noted in another thread: If a CRNA is making $150k with 6 weeks of vacation that is $81 per hour for a 40 hour work week. Multiply $81 per hour x 60 hours a week (with call) x 46 weeks with time and a half for overtime and you get $260k. Now look on Gaswork and find an Anesthesiologist job that pays $260k.
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Wow.
 
skypilot said:
This is already happening. As was noted in another thread: If a CRNA is making $150k with 6 weeks of vacation that is $81 per hour for a 40 hour work week. Multiply $81 per hour x 60 hours a week (with call) x 46 weeks with time and a half for overtime and you get $260k. Now look on Gaswork and find an Anesthesiologist job that pays $260k.
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Baller MD said:
Wow.
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Look at the details on some of those $250k postings, though.

"All MD group, doing 100% own cases, mostly ortho and plastics cases. No inhouse call."
http://www.gaswork.com/post/189198
 
amLOLdipine said:
Look at the details on some of those $250k postings, though.

"All MD group, doing 100% own cases, mostly ortho and plastics cases. No inhouse call."
http://www.gaswork.com/post/189198
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Don't miss the part at the bottom of the description that this is $250k for a "PART TIME" position, not 60hrs with call as quoted above in the CRNA pay.


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I've been noticing more and more jobs offering only 4 weeks vaca. What's up with this? Is it reasonable to negotiate 8-10 weeks?
 
Most groups in my neck of the woods are production based and equitable. Take as much vacation as you want provided you don't mind the lost income. Take less if you'd like a little fatter paycheck.
 
KashN said:
Don't miss the part at the bottom of the description that this is $250k for a "PART TIME" position, not 60hrs with call as quoted above in the CRNA pay.


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It's still at least a 350-400k job offering 250k. It's expensive to be mommy track.
 
YMMV, but here's Dr. Eduardo Tolentino's reasoning for "why anesthesiology is the best specialty":

1. Income is pretty good compared to other specialties.
2. You get instant satisfaction.
3. No one calls you when you're not on call. Average call is 3-4x per month.
4. No overhead expenses. No need to pay for an office, nurses, billing, etc.
5. You don't have to find your own patients. Surgeons find patients for you.
6. Patients are usually nice to you.
7. Patients are usually clean (unlike patients on the floor).
8. You work in your pajamas.
9. You deal with one patient at a time.
10. Malpractice is pretty low compared to other specialties.
11. You don't have to look for charts like on the floor.
12. You can sit down unlike surgeons.
13. After residency, you make money right away. You don't have to wait 6-8 years which is the usual amount of time to get your practice going, be nice to lots of other specialties to refer patients to you, etc.
14. It's not really hard work. In between you get to relax a little bit. It's just at the beginning and the end which are stressful. So long as you monitor the patient closely, you can relax a little bit.
15. You are dealing with a different case every time. You get to do different procedures, regional blocks, etc.
 
That list sounds like it was written by a non-anesthesiologist.
#4: wrong. While overhead is very low compared to other specialties, it ain't zero. Please contact me with the name of a billing company that works for free.
#5: also a downside as mentioned many times in this board
#7: maybe if you have an ASC only gig
#9: ever heard of ACT model?
#13: ever heard of a buy-in?
#14: seriously?? Ask anyone that runs 3-4 rooms how much chill time they have

All that being said, I still think it's the best job in the hospital (at least for now).
 
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scutdoc said:
YMMV, but here's Dr. Eduardo Tolentino's reasoning for "why anesthesiology is the best specialty":

1. Income is pretty good compared to other specialties. (for the amount of work and stress, it isn't)
2. You get instant satisfaction. (Doing what? That disappears quickly)
3. No one calls you when you're not on call. Average call is 3-4x per month. (You'll be called a million times when you're there, though. Call much more in most places)
4. No overhead expenses. No need to pay for an office, nurses, billing, etc.
5. You don't have to find your own patients. Surgeons find patients for you. (Read - you're easily replaceable)
6. Patients are usually nice to you. (See how nice they are when something goes awry)
7. Patients are usually clean (unlike patients on the floor). (Who cares?)
8. You work in your pajamas. (Big deal)
9. You deal with one patient at a time. (IF you happen to get one of the dwindling physician only jobs. ACT model? Busy)
10. Malpractice is pretty low compared to other specialties. (True)
11. You don't have to look for charts like on the floor. (Instead you'll be looking for them in the holding area)
12. You can sit down unlike surgeons. (Not much though)
13. After residency, you make money right away. You don't have to wait 6-8 years which is the usual amount of time to get your practice going, be nice to lots of other specialties to refer patients to you, etc. (You'll be raped by senior partners making money off the sweat of your labors, however)
14. It's not really hard work. In between you get to relax a little bit. It's just at the beginning and the end which are stressful. So long as you monitor the patient closely, you can relax a little bit. (Busy ACT practice = ZERO relaxation)
15. You are dealing with a different case every time. You get to do different procedures, regional blocks, etc. (It's all just work after a while.)
Click to expand...
 
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SaltyDog said:
That list sounds like it was written by a non-anesthesiologist.
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At least according to this, he's an MD:

https://www.doximity.com/pub/eduardo-tolentino-md
#4: wrong. While overhead is very low compared to other specialties, it ain't zero. Please contact me with the name of a billing company that works for free.
#5: also a downside as mentioned many times in this board
#7: maybe if you have an ASC only gig
#9: ever heard of ACT model?
#13: ever heard of a buy-in?
#14: seriously?? Ask anyone that runs 3-4 rooms how much chill time they have

All that being said, I still think it's the best job in the hospital (at least for now).
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I agree. Tolentino probably doesn't work in an ACT model. That probably explains most the differences in answers.
 
Consigliere, thank you for the answers. I mostly agree if ACT. Tolentino probably doesn't work ACT however so maybe that's why he has had a positive experience. Some ACTs seem better than others, though I suppose you could always say any ACT supervising CRNAs is inherently unfair to physicians given our (non) relationship with CRNAs. Edit: I support AAs, but I know they are few and far between.
 
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For some, Medicine is a calling, like becoming a Priest. For others, it is a means by which to achieve a decent income with good job security, hopefully allowing one to enjoy life. I fall into the latter camp - I shut my mouth, pick up the broom, and get to work.
 
Knew tolentino personally , he's most definitely an anesthesiologist and a fabulous one at that. He used to do all his own cases but now is in a group with crna's I believe
 
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