So, bottom line... what is the future of anesthesiology for MDs?

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hikikomori

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The title speaks for itself.. I would appreciate input from current residents and attendings.

1. What is the job market outlook for future graduates in 2016? 10 years from now? 20 years?

2. What do you think the compensation would be for MDAs in light of Obamacare?
Yes, I know it would be lower, but per your crystal ball, what would the floor be, really?

3. Now that CRNA numbers continue to grow, how confident/secure are you with your profession as an MDA?

4. Any regrets? Do you wish to change specialty? If yes, to what?

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The title speaks for itself.. I would appreciate input from current residents and attendings.

1. What is the job market outlook for future graduates in 2016? 10 years from now? 20 years?

2. What do you think the compensation would be for MDAs in light of Obamacare?
Yes, I know it would be lower, but per your crystal ball, what would the floor be, really?

3. Now that CRNA numbers continue to grow, how confident/secure are you with your profession as an MDA?

4. Any regrets? Do you wish to change specialty? If yes, to what?

seriously?
 
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seriously?

I'm with you...

Do not start another post that has been answered a million times before. Please. :rolleyes:


MD anesthesia rocks. And YOU make a difference as an MD (a)nesthesiogist..
 
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Yep, seriously. I have been lurking in this forum for months, have been googling left and right looking for consistent answers. Not quite.

I am considering switching to anesthesia... So, those are legitimate questions. If a stranger came up to you with those questions, what would your one-minute spiel be?
 
Yep, seriously. I have been lurking in this forum for months, have been googling left and right looking for consistent answers. Not quite.

I am considering switching to anesthesia... So, those are legitimate questions. If a stranger came up to you with those questions, what would your one-minute spiel be?

Do a RECENT search.

:oops:
 
If a stranger came up to you with those questions, what would your one-minute spiel be?

My 1 mintue spiel "If I knew what the future was going to be I'd be in the stock market not medicine. Go into anesthesia if you enjoy the practice of anesthesia. Let the rest of the BS work itself out"
 
My 1 mintue spiel "If I knew what the future was going to be I'd be in the stock market not medicine. Go into anesthesia if you enjoy the practice of anesthesia. Let the rest of the BS work itself out"

:thumbup: exactly.
 
DONT DO IT.

Do something you can have more control over what you do and when you do it



Anesthesiologist pay is decent (not great) for what we have to deal with daily


I would do something that is not reliant on the hospital again. not anesthesia
 
DONT DO IT.

Do something you can have more control over what you do and when you do it



Anesthesiologist pay is decent (not great) for what we have to deal with daily


I would do something that is not reliant on the hospital again. not anesthesia

I wouldn't discourage folks just because you made the wrong career choice. If you're unhappy, then that is on you. For what it's worth, I think anesthesia is a cool field.

Every job has some form of crappy/annoying work. Were you one of those who never had a job until you finished all of your schooling?

Your posts are BS. Don't take it personally; I just think what you write is nothing but crap.

Don't know whether to "ignore" you or wait until you get banned again.
 
I wouldn't discourage folks just because you made the wrong career choice. If you're unhappy, then that is on you. For what it's worth, I think anesthesia is a cool field.

Every job has some form of crappy/annoying work. Were you one of those who never had a job until you finished all of your schooling?

Your posts are BS. Don't take it personally; I just think what you write is nothing but crap.

Don't know whether to "ignore" you or wait until you get banned again.

Darby is certainly a pessimist but don't dismiss what he says. He's an attending and you could certainly learn something from him, even if you disagree with his stance. Being "in control" and "not reliant on the hospital" are 2 things that any med student should consider before going into anesthesia. How do you feel about being forced to cover stat intubations @ 2am because that's the hospital policy even though you are not in house? How bout being forced to do non emergent cases on the weekend because it's conveient for the surgeon even though the policy says only emergent cases should go? These are very real problems you will face as an attending. Don't downplay them. Anesthesia has plenty of positives, no rounding, sleeping happy pts, no chronic issues, cool phys and pharm, but there are some downsides too. Any medical student should go into this field with their eyes open or the will be sorely disappointed.
 
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When I interviewed for jobs after training, we NEVER asked the call schedule , the salary, we only put on our best face and " begged" for them to allow us to heal the sick. I have witnessed many changes since that time. We cannot predict the future. Practice the type of medicine you love and what challenges you to stay cutting edge. So treat yourself to a great mattress and a great job cause that's where you'll be most of your life.
I changed my specialty dream 4 times from college to residency. In a post match scramble, I bailed on my dream to become a medical oncologist when I made a geographic move to be with my wife and took an open Family Practice spot instead of Int Med. After I found FP to be not for me, I moved on to anesthesiology and have had a rewarding 20 yrs.
Enjoy every day.
 
When I interviewed for jobs after training, we NEVER asked the call schedule , the salary, we only put on our best face and " begged" for them to allow us to heal the sick. I have witnessed many changes since that time. We cannot predict the future. Practice the type of medicine you love and what challenges you to stay cutting edge. So treat yourself to a great mattress and a great job cause that's where you'll be most of your life.
I changed my specialty dream 4 times from college to residency. In a post match scramble, I bailed on my dream to become a medical oncologist when I made a geographic move to be with my wife and took an open Family Practice spot instead of Int Med. After I found FP to be not for me, I moved on to anesthesiology and have had a rewarding 20 yrs.
Enjoy every day.

The world has changed quite a bit as you said in the above. Your post seems a subtle dissing of the upcoming generation. I also am 20+ years out. I don't blame the current generation one bit for being concerned about their future and wanting to know exactly what is expected of them and how they will be compensated.
 
The world has changed quite a bit as you said in the above. Your post seems a subtle dissing of the upcoming generation. I also am 20+ years out. I don't blame the current generation one bit for being concerned about their future and wanting to know exactly what is expected of them and how they will be compensated.

His point is that too many go into it for lifestyle or money and not near enough altruistic traits that were the norm 20-30 years ago. I see it every day with new anesthetists and attendings who not infrequently seem shocked they actually have to work for those 6-figure salaries. Of course those that have that attitude won't last long in our place.
 
Darby is certainly a pessimist but don't dismiss what he says. He's an attending and you could certainly learn something from him, even if you disagree with his stance. Being "in control" and "not reliant on the hospital" are 2 things that any med student should consider before going into anesthesia. How do you feel about being forced to cover stat intubations @ 2am because that's the hospital policy even though you are not in house? How bout being forced to do non emergent cases on the weekend because it's conveient for the surgeon even though the policy says only emergent cases should go? These are very real problems you will face as an attending. Don't downplay them. Anesthesia has plenty of positives, no rounding, sleeping happy pts, no chronic issues, cool phys and pharm, but there are some downsides too. Any medical student should go into this field with their eyes open or the will be sorely disappointed.

I agree with you. I just don't care for that character.
 
Dr Doze, yup alittle disrespect there, but just alittle. I see some pretty apathetic students. We as students and even residents knew very little about salaries. There was no internet, just a few attendings or a returning senior who may throw you a bone and tell you alittle about practice mgmnt. Sad thing is, a middle class kid has a real tough road ahead to follow his medical dream like I did. Coming out of training 300-400k in debt is going to be quite a strain. I went to state/cheap schools had a bunch of loans, hussled, didn't spend and paid em before I bought "anything" other than some cool used stereo gear and sporting goods.
I get some med students, PA students and an occais. surg resident in my OR's. If they seem earnest I'll talk finance and most will say it's the first time they even thought about the magnitude of the loans. Now, most of the med students say they have no loans = affluent family > no loan worries.
If I owed 300k I'd be drilling all of us here for advice.
 
I agree with you. Anesthesiology was a path to a High paying specialist's job but Obamacare will likely wreck that. However, if Obamacare gets defunded/ destroyed by the GOP Senate and President Obama next year my attitude will definitely change about the future for this field.

I know the odds are against the gutting of Obamacare but if it happens then I will be one of the first to post positively about a kid with $200K in debt going into this field. If the Ryan health care plan for CMS happens then the best days are ahead of us.

Like it or not this election cycle will determine this specialty's future.
 
I wouldn't discourage folks just because you made the wrong career choice. If you're unhappy, then that is on you. For what it's worth, I think anesthesia is a cool field.

Every job has some form of crappy/annoying work. Were you one of those who never had a job until you finished all of your schooling?

Your posts are BS. Don't take it personally; I just think what you write is nothing but crap.

Don't know whether to "ignore" you or wait until you get banned again.

You re a Pissant!

Thank you very much!!:laugh::laugh::smuggrin::laugh::laugh::laugh:
 
I agree with you. Anesthesiology was a path to a High paying specialist's job but Obamacare will likely wreck that. However, if Obamacare gets defunded/ destroyed by the GOP Senate and President Obama next year my attitude will definitely change about the future for this field.

I know the odds are against the gutting of Obamacare but if it happens then I will be one of the first to post positively about a kid with $200K in debt going into this field. If the Ryan health care plan for CMS happens then the best days are ahead of us.

Like it or not this election cycle will determine this specialty's future.
Blade, this sounds like a forecast for ALL of medicine in general. no one knows how things will play out: partial repeal, total repeal, etc. whatever the case, i would argue Anesthesia would still be better of than IM, peds, family med, etc. probably level with rads, pathology, etc. not as lucrative as ortho, cards, neuro surg. but guess what? that's where we are right now anyways. to all the students out there: please just do what you are passionate about.
 
Blade, this sounds like a forecast for ALL of medicine in general. no one knows how things will play out: partial repeal, total repeal, etc. whatever the case, i would argue Anesthesia would still be better of than IM, peds, family med, etc. probably level with rads, pathology, etc. not as lucrative as ortho, cards, neuro surg. but guess what? that's where we are right now anyways. to all the students out there: please just do what you are passionate about.


You repeatedly ignore this specialty's Medicare reimbursement problem. Please answer one simple question: If Medicare for everyone becomes the norm via the Trojan horse knwon as Obamacare what would your income be?

If that question is too hard then how about this one: What other specialty gets reimbursed at 30% of HMO/Commercial payor rates from the govt?

Hence, NO OTHER SPECIALTY (as you have listed) will get hurt more by a single payor system based on current Medicare rates.

So while we earn more than Family Medicine in 2012 that may NOT be the case in 2019 if Obamacare is left standing "as is."

So while Medical Students are free to "do what you are passionate about" they must be aware of the unique MEDICARE PROBLEM our specialty faces.
 
elephant1.jpg


Single Payor System based on Medicare= $180,000 annual income for Anesthesiology (if they don't cut it more)
 
Krauthammer predicted the complexity of the law eventually would doom it to failure, which would lead to a single-payer system within a decade.
“This is a new reform that when it kicks in within a couple of years will make the practice of medicine a nightmare,” he said. “If it's not repealed, I guarantee you that within a decade we will have a single-payer system. And if I had to choose between Obamacare and a Canadian or British system, I'd choose the single-payer system. At least it would be rational.”


Read more: http://www.mysanantonio.com/news/local_news/article/Columnist-If-health-care-reform-act-is-fully-3392700.php#ixzz20c505vDV
 
Despite the dangers lurking in this bill, this decision has positive implications for progressives as it sets the stage for the next fight: achieving single-payer health care reform.Vermont is already heading down this path, and hopefully this affirmation of the health care law will embolden other states to follow their lead.
The legislation in Vermont is being seen by many on the left as the next step after Obamacare. According on a laudatory article last year in left-wing Mother Jones:
As Gov. Peter Shumlin took his spot on the granite steps of the Vermont State House, a row of people fanned out behind him wearing bright red t-shirts proclaiming, “Health care is a human right.” The slogan sounded noble, and wildly unrealistic. Until the governor spoke.
“We gather here today to launch the first single-payer health care system in America,” began Shumlin, a Democrat who has been governor barely four months. “To do in Vermont what has taken too long: have a health care system, the best in the world, that treats health care as a right, and not a privilege."
Moments later, the governor made history, signing a law that sets Vermont on a course to provide health care for all of its 620,000 citizens through a European-style single payer system called Green Mountain Care. Key components include containing costs by setting reimbursement rates for health care providers and streamlining administration into a single, state-managed system. The federal health care reform law would not allow Vermont to enact single payer until 2017; Vermont is asking the administration to grant it a waiver so that it can get there even faster, by 2014.
 
I owe close to $300k right now. F*CK.

Suggestions?

Yes.

I'm telling you the truth here: Most Specialties get 75-80% of their usual, customary COMMERCIAL fee from Medicare. This means many specialties will take a hit under Obamacare but NONE will take a hit like Anesthesiology.

A single payer system will result in a reduction of Physician incomes by approximately 1/4 to 1/3 for many specialties. Only Anesthesiology gets a 2/3 hair cut. Remember, the AANA is glad to take that single payer salary for its membership.
 
Obamacare is the gateway to socialized medicine. There is no doubt that Obamacare will collapse the health insurance and medical system we have now and will lead to a single-payer, socialized system as millions lose their employer-provided insurance and millions more are unable to pay skyrocketing private insurance rates. The mechanisms to facilitate this are already in the law, such as the Independent Payment Advisory Board, which will lead to a rationing of care because of deep cuts it is charged with making to Medicare. Board members begin their task $500 billion in the hole, as Obamacare removes that amount from Medicare to pay for Obamacare.
 
Is it possible to do pain as a concierge practice? Or just cash-only? No pills, just interventional stuff. I'd like to get out of the insurance/medicare system completely...
 
Medicare pays about 33 percent of average commercial payments for anesthesia services. This fact, well known to anesthesiologists, was one of the findings in a report published by the Government Accountability Office in 2007. The GAO study was based on a representative sample of anesthesia services performed in 41 Medicare payment localities. Other specialties, including pain medicine, collect an average of 80 percent or more of their commercial rates for Medicare patients.
 
Blade, I'm curious. Can you look 10 years out and let me know what you think the salaries will be under ObamaCare if it doesn't get repealed? (so, end of Obama care/start of single payer system.)

Just your informed opinion: A HIGH TO LOW for both PP and ACADEMIC. BFE v NYC

So, it's 2022, we're all driving flying Deloreans and Basketball is now played in a hover circle...

PGY 4 - no fellowship - Anesthesiologist:
Academic:
NYC: $_____ to $ ______
BFE: $_____ to $ ______

PP
NYC: $_____ to $ ______
BFE: $_____ to $ ______

I know it's time consuming, but could you do the Same for: (so BFE vs big city and PP vs academics for both BFE and big city)....

1) Gen Psychiatry $_____ to $ ______
2) Radiology $_____ to $ ______
3) Pediatrics $_____ to $ ______
4) OrthoSurgeon $_____ to $ ______
5) HeartSurgeon $_____ to $ ______
6) Fellowed Pain Anesthesiologist $_____ to $ ______
7) Fellowed Peds Anesthesiologist $_____ to $ ______
8) Neonatologist $_____ to $ ______
9) IM, straight, three years PGY, nothing more $_____ to $ ______
10) Hospitalist $_____ to $ ______
11) Family Medicine, straight, no fellowships $_____ to $ ______
12) Interventional Cards $_____ to $ ______

Am very curious to know what specialties you think will hold up most, gain most, lose most.
Is it just a leveling of the playing field all over? So, IM doesn't go down much, Anesthesia does, etc etc? OR/AND do you think some fields will retain their higher or lower compensations? In other words, should't a brain surgeon or a CT anesthesiologist who is doing more procedures, trained longer, still make 2x a FM doc? Based on rates, reimbursement and, gulp, training?

THANKS!

D712
 
Absolutely right.
One way or another, 10 or 20 years, it's coming. By design.
Hopefully the music will play a while longer.

-
"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."
 
Blade, I'm curious. Can you look 10 years out and let me know what you think the salaries will be under ObamaCare if it doesn't get repealed? (so, end of Obama care/start of single payer system.)

Just your informed opinion: A HIGH TO LOW for both PP and ACADEMIC. BFE v NYC

So, it's 2022, we're all driving flying Deloreans and Basketball is now played in a hover circle...

PGY 4 - no fellowship - Anesthesiologist:
Academic:
NYC: $_____ to $ ______
BFE: $_____ to $ ______

PP
NYC: $_____ to $ ______
BFE: $_____ to $ ______

I know it's time consuming, but could you do the Same for: (so BFE vs big city and PP vs academics for both BFE and big city)....

1) Gen Psychiatry $_____ to $ ______
2) Radiology $_____ to $ ______
3) Pediatrics $_____ to $ ______
4) OrthoSurgeon $_____ to $ ______
5) HeartSurgeon $_____ to $ ______
6) Fellowed Pain Anesthesiologist $_____ to $ ______
7) Fellowed Peds Anesthesiologist $_____ to $ ______
8) Neonatologist $_____ to $ ______
9) IM, straight, three years PGY, nothing more $_____ to $ ______
10) Hospitalist $_____ to $ ______
11) Family Medicine, straight, no fellowships $_____ to $ ______
12) Interventional Cards $_____ to $ ______

Am very curious to know what specialties you think will hold up most, gain most, lose most.
Is it just a leveling of the playing field all over? So, IM doesn't go down much, Anesthesia does, etc etc? OR/AND do you think some fields will retain their higher or lower compensations? In other words, should't a brain surgeon or a CT anesthesiologist who is doing more procedures, trained longer, still make 2x a FM doc? Based on rates, reimbursement and, gulp, training?

THANKS!

D712

This isn't a difficult question. A Single Payer system would likely increase primary care income SLIGHTLY higher compared to 2012. So. all one needs to do is get the MGMA data for a close estimate.

For most other specilaties a 20% reduction would be reasonable but I expect Ortho, Optho and Radiology to do worse (?30% reduction) as the govt. LIMITS elective procedures (or MRI scans for Rads). Ortho will take a hit as the govt. puts rules in place for elective joint replacement, etc.

Pain Medicine will likely take a hit of 25% (more if doing a lot of implants) because of IPAB.

Of all the actual Anesthesia OR subspecialties I would expect Peds to do the best under Medicare Plus as the govt. may include a Peds. Anesthesiologist incentive in the payment.

General and Cardiac Anesthesia will take a hit of 50% compared to today's MGMA data.

CRITICAL CARE Anesthesia should do well as this specialty becomes the gatekeeper for keeping health care expenses down in the last 90 days of life.
 
By the way, If I was offered the CANADIAN ANESTHESIOLOGIST REIMBURSEMENT SYSTEM today I would glady take it. I would also tell every medical student that Anesthesiology is DA BOMB for the future.

But, a single payer system based on Medicare 2012 rates means we will be lucky to earn half our Canadian Colleagues income.
 
The title speaks for itself.. I would appreciate input from current residents and attendings.

1. What is the job market outlook for future graduates in 2016? 10 years from now? 20 years?

2. What do you think the compensation would be for MDAs in light of Obamacare?
Yes, I know it would be lower, but per your crystal ball, what would the floor be, really?

3. Now that CRNA numbers continue to grow, how confident/secure are you with your profession as an MDA?

4. Any regrets? Do you wish to change specialty? If yes, to what?

1. Good Job Market around 2020 as ObamaCare sends many boomers into retirement. The next few years may be tough as the older guys try to get a few more years of good income before ObamaCare kicks into full force circa 2017.

2. $180,000 on the low end based on 100% Medicare

3. CRNAs are midlevels. Their skills range from poor/mediocre to excellent/outstanding. The vast majority are competent technicians will a limited knowledge base of medicine. CRNAs may gain traction as ObamaCare kicks into full gear but Anesthesiologists will still be needed.

4. I'm too old to change specialties. My only regret is not understanding how billing/reimbursement worked when I was a medical student and then a Resident. That knowledge would NOT have changed my specialty but would have changed my practice location.
 
4. I'm too old to change specialties. My only regret is not understanding how billing/reimbursement worked when I was a medical student and then a Resident. That knowledge would NOT have changed my specialty but would have changed my practice location.


When do you think it would be a good time to learn about billing/reimbursement? I have a feeling whatever I learn now would be drastically changed by the time I finish residency.
Also, what are some good resources to learn about that stuff?
 
When do you think it would be a good time to learn about billing/reimbursement? I have a feeling whatever I learn now would be drastically changed by the time I finish residency.
Also, what are some good resources to learn about that stuff?

You are learning about it right now. Despite the likely changes in reimbursement over the next ten years those specialties on top of the Medicare heap in 2012 have a running start over those at the bottom of the heap. Unfortunately, Anesthesiology is likely at the very bottom of this Medicare system Obama wants to expand to include everyone.


For example, Neurosurgery will still be a $700K specialty under ObamaCare while Anesthesiology falls to $180k (based on 100 percent Medicare reimbursement for all patients). Hence, while Neuorsurgeons feel the sting of ObamaCare it is nothing like the pain that Anesthsiologists are likely to feel. On top of that Sebelius supports Opt Out for all States concerning CRNA practice.

Remember, the US Federal govt pays a CRNA the exact same reimbursement for a case as it does an Anesthesiologist. So while $180K may seem low for a Physician income it is perfectly fine for an anesthesia nurse. Hence, Obamacare may keep cutting anesthesia until even the nurses scream.
ObamaCare could result in Anesthesiology being reimbursed at a lower level than Family Practice. But,
Maybe the hospital will employ you to do other things provided you have the skills.
 
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I'm not so sure the Canadian waits are really worth getting upset about.

Obviously they get emergency care promptly.


But honestly, who gives a rat's ass if someone who's spent the last 40 years wrecking their knees and hips at McDonalds has to wait 7 or 8 months before they get their FREE joint replacement?

WTF does "breast cancer w/MRI" mean? 168 day wait for what?

141 days for cataract surgery? It's not like cataracts form overnight, normal vision today, blind tomorrow. A 4-5 month wait for a FREE procedure to fix gradually deteriorating vision isn't ridiculous.


I'd be interested in seeing exactly for which cancers, and under what circumstances, surgery is delayed, and what clinical consequences are alleged. Somehow I'm skeptical that this totally neutral, non-agenda-driven graph is quite as honest and objective as it's pretending to be.
 
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I'm not so sure the Canadian waits are really worth getting upset about.

Obviously they get emergency care promptly.


But honestly, who gives a rat's ass if someone who's spent the last 40 years wrecking their knees and hips at McDonalds has to wait 7 or 8 months before they get their FREE joint replacement?

WTF does "breast cancer w/MRI" mean? 168 day wait for what?

141 days for cataract surgery? It's not like cataracts form overnight, normal vision today, blind tomorrow. A 4-5 month wait for a FREE procedure to fix gradually deteriorating vision isn't ridiculous.


I'd be interested in seeing exactly for which cancers, and under what circumstances, surgery is delayed, and what clinical consequences are alleged. Somehow I'm skeptical that this totally neutral, non-agenda-driven graph is quite as honest and objective as it's pretending to be.


Sure. I bet it's worse than the graph because you must get approval to be on the waiting list in the first place. Under Obama just getting approval from IPAB may take several months andthen you get on the list. There is no other way to limit health care dollars without the rationing of care to the citizens
 
There is no other way to limit health care dollars without the rationing of care to the citizens

I totally agree with you, just not so sure the Canadian way is really that bad, once society has decided it wants universal free healthcare. We could do worse than Canada.

And there's different degrees of rationing. I'd have less heartburn over rationing / delaying elective inguinal hernia repairs than I would over rationing / delaying colectomies for cancer.
 
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