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

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Curious, who does invasive lines/procedures in your group?

Would you ever catch a Nurse putting in a central line without discussing it with you?

What about a spinal/epidural?
 
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Who reprimanded you?

my boss. as i said, he was VERY pro-crna; our model was one in which the crnas pretty much practiced independently although the hospital bylaws required supervision. it's one of many reasons i left that job.
 
my boss. as i said, he was VERY pro-crna; our model was one in which the crnas pretty much practiced independently although the hospital bylaws required supervision. it's one of many reasons i left that job.

Did you tell him to go F himself? I hope you did.


Another invertebrate chief, oh yea!!!!
 
Did you tell him to go F himself? I hope you did.


Another invertebrate chief, oh yea!!!!

he wasn't an invertebrate; it's not as if he had to bend to the will of the crnas or listen to their complaints because he was already on their side. he was just very greedy and the fact that he was bonkin one of them probably had something to do with it.
 
he wasn't an invertebrate;.

If he did not take your side in the matter, then his is an invertebrate. It's not like you were downright un civil to the crnas! right? Were you? You just wanted them to do as you said!! And neither the crnas nor he were down with that. SO yes he was an invertebrate. A lot of them in this specialty
 
Get the highest paying Podunk job you can find and pay it off asap.

-
“The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is.”

IlDestriero, how much do you think a new grad should ask for when applying to one of these podunk jobs?
 
IlDestriero, how much do you think a new grad should ask for when applying to one of these podunk jobs?

Just remember Bird, it's not how much you make, it's how much you earn per hour you work. q3 in house is a lot different than q5 rarely called in.
 
Just remember Bird, it's not how much you make, it's how much you earn per hour you work. q3 in house is a lot different than q5 rarely called in.

Thank you for the knowledge imFrankie!
 
For all our education physicians are some of the stupidest people in business. Medicine is a business and it seems our profession bends over backwards to screw ourselves. Allowing mid-levels to gain more and more access to independent practice. People on this thread claiming anesthesiologists are overpaid. As physicians we all should be behind each other protecting our scope of practice fighting the decresed pay on a yearly basis. We are some of the most skilled, educated people in the country and we keep trying to give away what we have worked so hard and sacrificed so much to attain. Makes no sense, we spend the ,ost money in the world on healthcare and physician salaries are the lowest by percentage.

All Dr's should go by if a you want to provide anesthesia to a patient, provide primary care medicine etc. Then go to medical school if no medical school physicians should fight to exclude these people having any type of independent practice rights
 
All Dr's should go by if a you want to provide anesthesia to a patient, provide primary care medicine etc. Then go to medical school if no medical school physicians should fight to exclude these people having any type of independent practice rights

[YOUTUBE]http://www.youtube.com/watch?v=wfUU6coziu4[/YOUTUBE]
 
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[YOUTUBE]http://www.youtube.com/watch?v=wfUU6coziu4[/YOUTUBE]
Jackets, I'm totally behind what you're saying but Lmfaoooooooooooooooooooooooooooooooooooooooooooooo bala :smuggrin:
 
[YOUTUBE]http://www.youtube.com/watch?v=wfUU6coziu4[/YOUTUBE]

Wow that was awful English. That's what you get typing on a IPhone in the bathroom and not checking what you wrote and what spell checker did.
 
[YOUTUBE]http://www.youtube.com/watch?v=m_mDTLphIVY[/YOUTUBE]
 
DIRECT Pathway
The following are the critical features of the pathway.

1. Residents entering the pathway will need one year of clinical training in addition to the year currently required. Two years of clinical training are considered essential. Residents may enter the new pathway from medical school or after two or more years of clinical training in other disciplines.
2. The core diagnostic imaging training is 27 months.
3. VIR residency (nonfellowship) training includes nine months, as described in the table below.
4. The sequence of scheduling the fellowship year and the final year of the core program is reversed.

PGY 1 & 2 24 months Approved Clinical Training*
PGY 3 12 months 10 Diagnostic Imaging + 2 IR
PGY 4 12 months 9 Diagnostic Imaging + 3 IR
PGY 5 12 months 12 Accredited IR Fellowship
PYG 6 12 months 8 Diagnostic Imaging + 4 IR Primary certification exam in Diagnostic Radiology
12 months 12 Clinical Practice Subcertification exam in IR
* Clinical training in an ACGME-approved program. Clinical training might include a transitional year plus another year in internal medicine, surgery, etc., or possibly in an integrated clinical year in Diagnostic Radiology. Most likely, 2 years of clinical training will be in another clinical discipline with entry directly into this provisional pilot.

5. The primary certificate and subspecialty certificates (CAQ) will not change, but the sequence of timing of training and administration of the examination for the certificates will change for this pathway.
6. Contact Mike Darcy, M.D.; Al Nemcek, M.D.; Anne Roberts, M.D.; or Gary Becker, M.D., for more information.
 
Since the writing is on the wall regarding the future of this specialty (heavy CMS cuts and CRNAs winning) I think anesthesiologists need to adapt by encroaching into other fields of medicine. Since anesthesiologists are known as "proceduralists", I think they should get into IR before these DIRECT programs start expanding. If we can get trained in IR specifically during residency or at least be eligible for the fellowships, I think anesthesiologists can maintain a very nice income. Thoughts?

https://docs.google.com/viewer?url=http://www.sirweb.org/fellows-residents-students/IRresidency.doc


I have no idea what IR has to do with Anesthesiology whatsoever.
 
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The difficult part of IR is not the procedures of gaining IV or arterial access and moving catheters around using seldinger technique. It is the multiple variations of anatomy of different organ systems which I avoided in the first place.
 
Since the writing is on the wall regarding the future of this specialty (heavy CMS cuts and CRNAs winning) I think anesthesiologists need to adapt by encroaching into other fields of medicine. Since anesthesiologists are known as "proceduralists", I think they should get into IR before these DIRECT programs start expanding. If we can get trained in IR specifically during residency or at least be eligible for the fellowships, I think anesthesiologists can maintain a very nice income. Thoughts?
I think that's almost as ridiculous as bumping a 2-1/2-year-dead thread to propose it. :)

You're a med student. If you want to do IR ... you can do IR.

The irony is that to avoid the anesthesiology market forces related to CMS and CRNAs, you'd be doing a radiology residency ... and they already have an abysmal job market for new grads, to the point that fellowships are already obligatory.
 
Don't worry, the Perioperative surgical home will save us. /s
 
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If the perioperative home is implemented, I'm out. CENSEO!
 
New alternative to PSH as published in A&A: http://www.newswise.com/articles/ho...s-prepare-for-the-perioperative-surgical-home

Do you guys prefer this "super-specialist model" over the PSH paradigm? I read the original article but am still not even sure what it means... is it basically an integrated fellowship? I thought physician anesthesiologists are over-trained and too expensive as it is?

Btw, I thought all the doom and gloom was just here on sdn, but am surprised by to how well acknowledged it is in the literature...

How Should Anesthesiologists Prepare for the 'Perioperative Surgical Home'?
Expert Coalition Makes Recommendations for Paradigm Shift in Anesthesiology Training
Released: 14-Apr-2015 11:55 AM EDT
Source Newsroom: Wolters Kluwer Health: Lippincott Williams and Wilkins
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CitationsAnesthesia & Analgesia
Newswise — April 14, 2015 – The perioperative surgical home (PSH) is an emerging approach to improve care for patients undergoing surgery, and anesthesiologists are preparing to play a key role in leading it. But how will the PSH approach affect patients, the health care system, and the specialty of anesthesiology? These urgent questions are addressed by a coalition of senior anesthesiologists in a special article published by Anesthesia & Analgesia.

Dr. Richard C. Prielipp of University of Minnesota School of Medicine, Minneapolis, and colleagues discuss anesthesiology's evolving role in the PSH era, and present an alternative view of their specialty's future—including a proposal for transforming anesthesiology training. " We believe we afford our specialty the best opportunity to thrive by intrepid resolve to change the way we educate a new generation of anesthesiologists who provide highly specialized care for individual patients, supervise the anesthetic management for all patients, generate new knowledge, and effectively coordinate care to add value to the perioperative process," they write.

The Perioperative Surgical Home—the Future of Anesthesiology?
Developed as part of larger efforts to improve coordination and management of patient care, the PSH covers the full continuum of care for surgical patients—from the preoperative period, to the surgery itself, through postoperative care and after discharge from the hospital. Anesthesiologists are expected to play a key role as "integrators" of the PSH approach, and major pilot projects are underway to demonstrate its feasibility and effectiveness.

But PSH places anesthesiology at a crossroads, Dr. Prielipp and coauthors believe. While anesthesiologists have become more active in providing patient care over the years, there are questions regarding their roles and responsibilities in the PSH era. This and other trends, including the growing role of nurse anesthetists and other alternative anesthesia providers, even raises questions about anesthesiology's long-term financial viability.

While Dr. Prielipp and coauthors perceive many challenges of the PSH approach, they do not view these as "irreconcilable barriers" to its adoption. Rather, they write, "Our view is that while the PSH incorporates some important aspects of a future model of anesthesia care, it or its current iterations may not be sufficiently robust and responsive to market demands."

They outline an "alternative vision" of anesthesiology in the PSH era, highlighting the changes needed to adapt to a rapidly changing future. "The time is now for the specialty...to take a much broader perspective that incorporates, but does not let the PSH alone dominate our dialogue," Dr. Prielipp and colleagues write. In their vision, anesthesiologists will remain actively involved in managing a wide range of high-risk patients, while supervising routine care provided by nurse anesthetists and others.

The authors also propose a new approach to anesthesiology, including "broader and deeper focused" training in one of five fields: adult, pediatric, critical care, or academic anesthesiology or pain medicine. They believe this transition to anesthesiology "super-specialists" will entail "fewer but more skilled and more experienced anesthesiology graduates generated from the pool of highly resourced training programs."

Dr. Prielipp and coauthors acknowledge that such a transformation would be much more complex than adopting the PSH model. However, they write, "If implemented, our proposed paradigm for anesthesiology training represents a seismic shift in traditional education and practice."

While it is an "innovative and important" development in anesthesiology, Dr. Prielipp and colleagues believe, "the PSH alone is insufficient to secure our future." They hope their article will help to drive a "national discourse" about ways to secure the future of anesthesiology, amid the current focus on implementing the PSH model. They conclude, " We need to consider the implications of the PSH and its alternatives for anesthesiologists, health systems and, most importantly, for our patients."
 
What a truckload of horsesh_it.
 
I read these articles and I think again and again, "WTF are you talking about?"
Followed by, "are these people really anesthesiologists?"
As if we are not already super specialists with a fellowship? The only way I could have deeper focused training would be to do a peds residency. Unless they are proposing that, this peds super focus is bull shït. And news flash number 2, most peds cases can be done just fine with a regular old full service anesthesiologist. Hell, it's so easy, a nurse can do it.
You can't just do a couple of extra months in the PICU for example and say your somehow better. Or, perhaps we should do a peds internship, which will require a super specialty decision while still in medical school.
The only thing that makes me sadder is that leadership in my own department is buying into this pile of stool. Fortunately it is so nebulous and ill defined, they haven't really done much at all, other than talk about it and see what others are doing.

PS motherfückers, the horse is out of the barn, so the superspecialist anesthesiologists are still are going to have to compete with and/or supervise significant numbers of "superspecialist" CRNAs from their week long super specialty training programs.
 
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Even this article is a bunch of smoke and mirrors. What does it really suggest?
Nothing, other than cutting the number of graduates, which is nothing new and implying everyone probably needs a fellowship. Who wants to be the first "adult" super specialty fellow?
God it is sickening.
I can't imagine the vile bilious reflux that the PP guys get while reading this.
 
God it is sickening.
I can't imagine the vile bilious reflux that the PP guys get while reading this.

I did a shot of Bicitra to chase the Nexium after reading this donkey dung.
 
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F*ck... what are medical students supposed to do then if they don't like chronic care management, surgery, or EM?
 
Everyone says doom and gloom, yet Wall Street and venture capital is buying into anesthesia.
.
They WERE buying into it, but BLADEMDA I believe posted a thread that suggests that NAPA is for sale by the venture capitalists that bought it five years ago.
 
That is for you to figure out, not anybody else.
I want to do gas but when successful attendings here spout gloom and doom, I hesitate bc I value their opinions. That being said, I haven't met a gas doc in real life who is disappointed with their career choice.
 
Anesthesia income up 6% from last year acc. to new medscape report, 4th highest amongst all physicians at 358K: http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=3

Great Z's: "In summary, anesthesiologists who filled out Medscape's survey made more money this time than the last one. We're still satisfied with our jobs. And we're very glad we didn't go into Internal Medicine. Hopefully this will provide additional incentive for all the new anesthesiology residents who just matched into a program."

http://www.blog.greatzs.com/2015/04/the-2015-medscape-anesthesiology.html
 
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I would be exceedingly happy making 300-400K working ~50 hrs/week or so.


I thought the same thing as a Med Student until I earned $300K then got to earn $600K. Your take home pay will be eaten up by taxes, FICA, 401K, etc so don't expect to live lavishly on $300K. Sure, you will be comfortable on $300K but you won't feel wealthy with a W-2 of $300K.

Taxes
Disability
FICA/SS
Health Insurance
401K (max out)
Student Loans
F.U. Account
After Tax Investments/Savings

Don't respond with the usual B.S. about comparing Physicians to Janitors as I'm comparing Physician Anesthesiologists to Physician Ortho/ENT/etc.
 
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I would be exceedingly happy making 300-400K working ~50 hrs/week or so.


Be careful what you wish for because you will likely get it when it comes to salary and work week in Anesthesiology. I'd like to add there is a big difference in the real world between $300K and $400K with Anesthesiologists quickly falling to the lower of the two as salaried positions become the norm. Many of us have stressful jobs to be earning only $300K while others do solo MD anesthesia at an outpatient center where that pay is quite good.

I've posted many times that Anesthesiologists are needed in the USA and that the pay scale is likely to be in the $250-$350 range for a graduate circa 2019.
 
I would be exceedingly happy making 300-400K working ~50 hrs/week or so.

you shouldn't be when some suit is stealing half of your earnings and then the government takes half of what's left while they both tell you what to do
 
I read these articles and I think again and again, "WTF are you talking about?"

I get confused by the nebulous concept too. I think the "perioperative surgical home" is just rebranding of what we already do- that's what makes it confusing. It's like Puff Daddy turning into P. Diddy.
 
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Terrible job markets and not for people who are not visual learners.

Uh... Both fields are entirely visual! That's all they f ucking do is look at stuff and make diagnoses based on what it looks like.

Market be damned, those are your only options unless you suck it up and do something you said you don't like.
 
Be careful what you wish for because you will likely get it when it comes to salary and work week in Anesthesiology. I'd like to add there is a big difference in the real world between $300K and $400K with Anesthesiologists quickly falling to the lower of the two as salaried positions become the norm. Many of us have stressful jobs to be earning only $300K while others do solo MD anesthesia at an outpatient center where that pay is quite good.

I've posted many times that Anesthesiologists are needed in the USA and that the pay scale is likely to be in the $250-$350 range for a graduate circa 2019.
Blade, I think that is still pretty good for non-surgical specialties nowadays. Cards /GI/Onc start around 180K for new grads in big cities.
 
you shouldn't be when some suit is stealing half of your earnings and then the government takes half of what's left while they both tell you what to do
I'm pissed, but you can only b*tch about it for so long. You eventually have no choice but to sack up, pick up the broom, and go to work.
 
Uh... Both fields are entirely visual! That's all they f ucking do is look at stuff and make diagnoses based on what it looks like.

Market be damned, those are your only options unless you suck it up and do something you said you don't like.
Exactly, I meant those fields are not for people who are not strong visual learners. I dislike memorizing path and rad pics.
 
I thought the same thing as a Med Student until I earned $300K then got to earn $600K. Your take home pay will be eaten up by taxes, FICA, 401K, etc so don't expect to live lavishly on $300K. Sure, you will be comfortable on $300K but you won't feel wealthy with a W-2 of $300K.

Taxes
Disability
FICA/SS
Health Insurance
401K (max out)
Student Loans
F.U. Account
After Tax Investments/Savings

Don't respond with the usual B.S. about comparing Physicians to Janitors as I'm comparing Physician Anesthesiologists to Physician Ortho/ENT/etc.
What would you say is the net take home pay for a 300K W-2 after the above expenses?
 
I've posted many times that Anesthesiologists are needed in the USA and that the pay scale is likely to be in the $250-$350 range for a graduate circa 2019.

That is very, very optimistic.
 
MS3 here, long time lurker, trying to decide what I want to be when I grow up.

I'm really interested in anesthesia but kind of weary about joining what is portrayed as a dying field here.

There is a ton of doom and gloom all over this board but I'm a little confused by it. What am I missing here? Are working conditions getting that abusive with CRNAs? Yea PP groups are selling out, but that is hitting every specialty so how can a new grad really avoid that?

When I look at the compensation data I see anesthesia being in the mid to high 300s with surveys showing first job placement for graduating residents averaging 275 or so. So maybe this isn't the massive incomes some older attendings are used to, but in today's market there are really only a few specialties where you can net 500+ without working like a dog. And these are all much more competitive.

So what is a medical student who is otherwise competitive for any specialty and doesnt have a taste for chronic management or surgery supposed to go into?

There is EM, that's hot these days. They work less hours sure, but pulling nights/weekends/holidays when I'm 60 isn't super appealing. Not to mention they're average compensation is less than anesthesia.

So what's the scoop here because competitive medical students are avoiding anesthesia pretty intensely. There has to be a reason that a field with higher relative compensation than most, decent hours, lots of cool procedures, and complex management is having this free fall with medical students and I'm just not understanding what it is.
 
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