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

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LegitBoss4Life said:
The fact that a nurse makes 6 figures of any kind is totally ridiculous. These people don't know any medicine and don't have the ability to solve problems. They are technicians that are glorified baby sitters for the patients. Why anyone would pay them more than 50-75k blows my mind. The fact that people really believe these clowns will replace board certified anesthesiologists is even funnier. Do you people love the drama of creating a crisis where there isn't one?
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No crisis? Try to get a rural job in a CRNA shop.
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dr doze said:
Do not agree. AANA has a simple, clean, easy to understand message that the overwhelming majority of CRNAs can get behind.
ASA has factions: academic v. private practice, MD only v. ACT supporters, Exploitive practices where the super partners are active in ASA and big donors because they have the time and the money, thus pissing off a large number of younger docs. Those that are pro AA's and those that are not. The people that I have personally known at the highest levels of ASA have been amazingly competent and interested, they are just dealing with competing agendas within the organization. AANA does not have this issue to nearly the same extent.
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Interesting point. Question: why would any MD/DO be anti-AA? Even if they want MD-only practices for themselves, why be against the field thats the best buffer against CRNA creep?
 
freemontie said:
Interesting point. Question: why would any MD/DO be anti-AA? Even if they want MD-only practices for themselves, why be against the field thats the best buffer against CRNA creep?
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I am an AA supporter. But I have also heard the sentiment expressed, "do we really want to create a whole new group of people who can do a chunk of our job who may one day become disenfranchised and seek to expand their own scope at our expense?". I don't agree with the above, but I don't dismiss it completely either. Note that some PAs prefer the term "Physician Associate" to Physician Assistant".
 
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LegitBoss4Life said:
1. The average is well within a bell curve distribution
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That's the most mathematically non-profound non-statement I think I've ever read.

Absent special cases like curved spacetime in close proximity of a black hole's event horizon, where the laws of physics are fluid, where else would the average be, if not within the bell curve's distribution?

:)
 
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PianoMedic said:
I believe AAs are the anesthesia equivalent of PAs. Can't remember where I heard/read that though.
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Back in the day, there were multiple models of PA training when the movement was first getting started: generalists and specialists. The only experimental specialist track to survive was the AA, while the surgical PA was folded into the existing generalist PA model.
 
LegitBoss4Life said:
It was my understanding that within the AA bylaws it states they will always be subordinate to an anesthesiologist and never practice independently. We all know there will be mid level providers in every field so you might else well support the AAs. If you try to get too idealistic like supporting MD only practices you will end up getting burned in the end. Listen, I would love to repeal the federal income tax and end the federal reserve, but we all know the chances of that happening are slim to none.
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Not sure. But laws and bylaws can be changed by the stroke of a legislative pen.
 
It may be something like this:
Physician's Assistant -> Physician's Associate -> Physician Assistant -> Physician Associate -> Assistant Physician -> Associate Physician .... or "Physician" for short.

From Duke, c. 1972:
upload_2015-4-29_14-25-33.png
 
qwerty89 said:
Rad Onc has a bad job market. Not to mention their % increase in residency spots make rads and gas look like nothing. That does not bode well for the future.

PGY-2 spots
2001: 81
2005: 128
2010: 142
2015: 176
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Nothing really bodes well for rad onc. Always be wary when the entire specialty is ONE treatment modality. If there's anything you can count on, it's change - whether it's reimbursement rates, models, therapies, etc. There's a reason heme/onc would never want to be called Chemotherapy Oncology.

The only thing making it "competitive" are salary surveys that pre-meds and med students idolize as the Bible. But, chasing salary surveys is like driving forward while looking at the rear view mirror.
 
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LegitBoss4Life said:
It was my understanding that within the AA bylaws it states they will always be subordinate to an anesthesiologist and never practice independently. We all know there will be mid level providers in every field so you might else well support the AAs. If you try to get too idealistic like supporting MD only practices you will end up getting burned in the end. Listen, I would love to repeal the federal income tax and end the federal reserve, but we all know the chances of that happening are slim to none.
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AA LAWS (not bylaws) are written such that AA's function under the direction and supervision of an anesthesiologist. Not a surgeon. Not any MD. An anesthesiologist. AA's, like most PA's, have a job description on file with the state medical board, and those job descriptions are very specific about working with an anesthesiologist, as well as provisions that AA's can "fly solo" in extreme emergencies. In their 45 year history, AA's have never sought independent practice. That's simply not the nature of the profession.
 
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LegitBoss4Life said:
Well it looks like anesthesiologists will suffer the same fate as the Native Americans if nothing changes.
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I know there is a lot of thoughts the ASA is not doing enough (which is true). However, a ray of hope just appeared at my hospital. Every anesthesiologist wears a badge that says "physician." Even the most underprivileged and uneducated patients have taken notice. They demand to know where their physician anesthesiologist is, and why they "just have a nurse."

Obvs the attending tells them about the care team model, but it definitely is setting up in the lay publics mind a difference btwn the two.
 
criticalelement said:
that is presuming one can find a part time job. Part time jobs are hard to come by. It is either full time with call or bust
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That statement isn't true. CRNAs do a lot of solo day work at surgery centers for $110-$120 per hour. My bet is a senior, experienced Anesthesiologist would have little trouble getting $140-$150 per hour at these same types of gigs. In addition, there are many surgi-centers out there looking for Anesthesiologists to staff them. Remember, it's all about the money and a semi-retired Anesthesiologist looking to work 30 hours per week will likely have a lot of offers if his/her hourly rate is low enough.


http://www.gaswork.com/post/174749


http://www.gaswork.com/post/174967
 
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LegitBoss4Life said:
I'm ready to do whatever it takes to succeed and create a good life for myself. I'm not going to let anyone take that away from me. There's no HCA, group of CRNAs, etc that will stop me from getting exactly what I want. I will start my own super PAC if I have to and lobby in Washington myself with my own money to influence policy. I will start my own Sheridan type group and negotiate the best reimbursement rates, have a no CRNA policy, expand influence, etc. Seriously... I'm ready and willing to do whatever it takes. I worked too hard to get to this point for someone or a group of non doctors to take everything away from me.
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You guys need to vote this kid into the ASA leadership. If you ever change your mind about anesthesia, we would love to have you in IM.
 
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LegitBoss4Life said:
I'm ready to do whatever it takes to succeed and create a good life for myself. I'm not going to let anyone take that away from me. There's no HCA, group of CRNAs, etc that will stop me from getting exactly what I want. I will start my own super PAC if I have to and lobby in Washington myself with my own money to influence policy. I will start my own Sheridan type group and negotiate the best reimbursement rates, have a no CRNA policy, expand influence, etc. Seriously... I'm ready and willing to do whatever it takes. I worked too hard to get to this point for someone or a group of non doctors to take everything away from me.
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Amen brother!
 
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The current system does not produce nearly enough physician anesthesiologists to meet demand around the country. Unlike cosmetic dermatology, anesthesia is an essential service, and so the demand must be adequately met. Thus, there are 5 options:

1. Increase residency spots for Anesthesiology.
2. Cut down on the number of elective surgeries.
3. ACT model with CRNAs.
4. ACT model with AAs.
5. Exponentially increase the number of CRNA mills and allow for independent CRNA practice.

Of all the above options, #4 sounds like the best option for the specialty and the health of our nation moving forward IMO.
 
LegitBoss4Life said:
I agree completely. I think the first order of business is to get AAs in every state in the country. Once that happens, we can start huge groups with only MDs and AAs and put them everywhere. I would use whatever power and monetary influence I had to enforce ACT supervision and make that the standard of care in every state. I would then make sure that the salaries/reimbursement were adjusted accordingly with inflation and prevent any cuts that were intended under Obamacare. If that were to happen, CRNAs would be done. We would have 100% job and income security.
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You don't need to get rid of crnas. You just need enough AA's to create competition and push crnas to tone down the rhetoric. We need to all be on board with ACT model and present a united front with the nurses for a reasonable piece of the pie for anesthesia as a whole. Independent crna practice would be the worst thing that ever happened to crna income and quality of life. It's amazing that they support the aana kamikaze mission. To think that facilities and surgeons will get rid of anesthesiologists and let crnas keep the md money is ludicrous. Crnas would not make more money through independance. They would be employed in a kickback scheme where surgeon or facility employers take the money. If anything they'll make less due to increased competition. Which might sound good to hospitals but should sound terrible to crnas.
 
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LegitBoss4Life said:
I agree completely. I think the first order of business is to get AAs in every state in the country. Once that happens, we can start huge groups with only MDs and AAs and put them everywhere. I would use whatever power and monetary influence I had to enforce ACT supervision and make that the standard of care in every state. I would then make sure that the salaries/reimbursement were adjusted accordingly with inflation and prevent any cuts that were intended under Obamacare. If that were to happen, CRNAs would be done. We would have 100% job and income security.
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This definitely sounds good theoretically, on paper. But the CRNAs and AANA are an established force, and I don't think you can completely get rid of them. We just need enough AAs in every state to force the CRNAs to shut the hell up with their BS agenda.
 
New article in A&A: "The Perioperative Surgical Home: A Response to a Presumed Burning Platform or a Thoughtful Expansion of Anesthesiology?" Mark A. Warner, MD,* and Jeffrey L. Apfelbaum, MD†
 
Carbocation1 said:
The current system does not produce nearly enough physician anesthesiologists to meet demand around the country.
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That is absolutely false. Hence the crappy jobs, the decreasing pay, and the feeling among graduates that they must waste another year, for a fellowship (or "fellowship"), just to have some kind of job security.

The reason anesthesiologists don't work in the rural areas is not the lack of the former, but the politically-motivated federal financing of CRNAs. Rural hospitals get a special incentive for hiring CRNAs, so they just avoid hiring anesthesiologists (which would be more expensive than a CRNA even at the same salary+benefits). That was one of the genius strikes of the AANA.
 
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LegitBoss4Life said:
I agree completely. I think the first order of business is to get AAs in every state in the country. Once that happens, we can start huge groups with only MDs and AAs and put them everywhere. I would use whatever power and monetary influence I had to enforce ACT supervision and make that the standard of care in every state. I would then make sure that the salaries/reimbursement were adjusted accordingly with inflation and prevent any cuts that were intended under Obamacare. If that were to happen, CRNAs would be done. We would have 100% job and income security.
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I think the first order of business is to get into a good anesthesia residency. Then get into an even better fellowship. Then work at least 3-5 years as an attending to better understand the business of anesthesia. Then talk.
 
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Carbocation1 said:
New article in A&A: "The Perioperative Surgical Home: A Response to a Presumed Burning Platform or a Thoughtful Expansion of Anesthesiology?" Mark A. Warner, MD,* and Jeffrey L. Apfelbaum, MD†
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Another 5 minutes of my life wasted.
 
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LegitBoss4Life said:
You are right. As a medical student I'm not in a position to tell an attending anything about the business of anesthesia. However, I will say a good majority of the middle men dinguses that are raping doctors and patients only have a bachelors degree. I think my clinical proficiency as a future anesthesiologist has little to do with my business skills. I respect your point though. I just thought it would be good idea to be thinking ahead. I would hope that you and others would be encouraged if more of the younger grads were like me.
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Delusional? Yeah, very encouraging.
 
LegitBoss4Life said:
You are right. As a medical student I'm not in a position to tell an attending anything about the business of anesthesia. However, I will say a good majority of the middle men dinguses that are raping doctors and patients only have a bachelors degree. I think my clinical proficiency as a future anesthesiologist has little to do with my business skills. I respect your point though. I just thought it would be good idea to be thinking ahead. I would hope that you and others would be encouraged if more of the younger grads were like me.
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I like your passion and your ideas. But you do need to learn more before you can go on this crusade.
 
What are everyone's thoughts about bundled payments & how they will affect anesthesia, and other medical fields that have little to no ownership of patients? (i.e., radiology, pathology)
 
aneftp said:
Agree.

AANA is playing the underdog role with nothing to lose. Their position is easier to promote than the ASA.

Nurses and other non physician providers are always trying to "practice to the fullest extent of their abilities" whatever the heck that means.

Docs are always defending their practices.

Good point always on MDs in anesthesia who are anti AA. We know who those folks are. They have different agenda. Aka. They support crnas so they can bill and collect revenue when crnas are on call themselves so those same MDs sleep at home.

If AA were on call they would physically have to get out of their bed from home and go to the hospital for the case.
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Not always the case for being Anti AA. If one lives in a state where most of anesthesia care is provided by physicians, as I do, we don't necessarily want to supervise. Be it CRNA/AA. We just had a bill come to our state to allow A As to practice. Many of us are against it, because we don't want to supervise period. Now were I in Texas my home state that I dearly miss, where there is a bill currently to let AAs practice, then heck yes. Because most of Texas is run in an ACT or pseudo independent CRNA model. I would support it all the way all the way because I prefer A As any day of the week over CRNAs. But since I live in a state that Docs do overwhelmingly their own anesthesia, then I don't want to tempt fate. I love doing my own cases and so do most of us here.

Now eventually when things in my state start shifting to mostly ACT model, then Heck yes. Bring in the AAs. I know that is who I would be looking to hire. They tend not to come with superior complexes, bad habits and a chip on their shoulder for being supervised.

That being said, there are a few CRNAs in my state and they are allowed to practice independently. There are a few in my city, and I even saw a letter of opposition from a CRNA at the hearing, opposing AAs and that made me want to say yes, to the bill. I am sort of neutral only because I don't like CRNA's touting that they are better trained and can work independently, blah, blah, blah.

This just to say that those of us who oppose AAs in our state are not in bed with the CRNAs. The same ones who want to hire CRNA's here also want to hire AA's because they are viewed as "cheap labor" and they make money off them. I am interested in neither at this point in my life.
 
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"chocomorsel, post: 16443536, member: 101189" We just had a bill come to our state to allow A As to practice. Many of us are against it,.
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If I were you I would support it 100 percent, if you knew what was good for our future. Supporting AA legislation doesn t mean you have to supervise them. It means you prefer them over CRNAs. BTW meet your new bosses that you will be helping to enrich in the future. All of them have multi million dollar homes, multiple cars, vacation homes . And you will be making money for them. HOw do you like that?

Here they are:
http://tinyurl.com/qd2rzk4
 
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Sorry critical, but will NOT be working for these folks. Not now, not ever. We do have choices outside of the East Coast and Southeast.
As I said, I do prefer them over CRNAs. More neutral about it than anything else really. Currently what is good for me, is practicing alone. Don't know what the future holds. If it goes to all midlevel supervision, then yes. All about the AA's.
 
chocomorsel said:
. If it goes to all midlevel supervision, then yes. All about the AA's.
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What do you mean if? Are you sirius? You think someone is going to hand you a 500K per year job for sitting in the room with your thumb in your rear playing solitaire?
 
Take a look at this job. basically its a crna job doing endo cases at a center similar to where Joan Rivers sustained her neuronal injury. Here is the catch..... The gi doctor is supervising the CRNA. And guess what the salary is.... 1100... thats what anesthesiologists are making roughly.. Now you tell me what the future is? Granted if things went south..... no more carreer for the gastroenterologist but i guess they dont care.


http://www.gaswork.com/post/167019
 
Yes, I am serious, and I do mean "if" criticalelement. "If" in my career. I don't need anyone to hand me a 500k job to sit in a room with a thumb up my ass either. Sorry your world involves supervision, but mine does not. I DON'T NEED 500k, although I would like it. However, I won't take it if it means being a paper pusher, preop monkey supervising four rooms. That's where a lot of our problems arose. Greedy folk who wanted to sign off on charts and make money off midlevels. And the many who continue to do it today. Heck you maybe one of them. There's more to life than money. I don't care about the CRNA being paid 1100 a day to push propofol at a GI center. I care about what I went to school and residency for, and it wasn't to sign charts and run around like a chicken with my head cut off trying to keep track of what is going on in multiple rooms.

If and when that starts becoming the norm where I am, then I will fight for the AAs. As of now, I will enjoy my independent world free of midlevels. Don't hate. You can move here if you want.

And BTW, there are plenty of anesthesiologist here in town making more than some who supervise. I know, as I have done both.
 
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Market forces, politics and CRNAs and are desperately trying to eliminate our presence. And its working. I am not 100 percent certain it will work completely. Catastrophes are rare and life changing complications are not common but they still exist. As dumb and short sighted as hospital execs are they do not want to be answering questions when another joan rivers happens. I still believe our training matters. We'll see in the future if that holds true.
 
chocomorsel said:
Yes, I am serious, and I do mean "if" criticalelement. "If" in my career. I don't need anyone to hand me a 500k job to sit in a room with a thumb up my ass either. Sorry your world involves supervision, but mine does not. I DON'T NEED 500k, although I would like it. However, I won't take it if it means being a paper pusher, preop monkey supervising four rooms. That's where a lot of our problems arose. Greedy folk who wanted to sign off on charts and make money off midlevels. And the many who continue to do it today. Heck you maybe one of them. There's more to life than money. I don't care about the CRNA being paid 1100 a day to push propofol at a GI center. I care about what I went to school and residency for, and it wasn't to sign charts and run around like a chicken with my head cut off trying to keep track of what is going on in multiple rooms.

If and when that starts becoming the norm where I am, then I will fight for the AAs. As of now, I will enjoy my independent world free of midlevels. Don't hate. You can move here if you want.
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You need to stop taking the forane home with you. Just support AAs. It will do a lot to deflate the CRNA push for independence.
 
Guess I will keep sniffing the forane then. Ahh, I like the high. Clearly, you are only piking and choosing to read what parts you don't like in my posts. As I said, I am somewhat neutral on the subject in regards to my state legislature as MD/DO's rule where I am. As it starts changing, I will support the AAs. But as of now, we are doing fine. I am not against AA's, just against supervision in general. Don't want to do it.
Thanks.

To be honest, I do feel it is completely hypocritical to let CRNAs practice independently but block AAs who don't want to practice independently. At least not yet. However, I don't also want to introduce my competition in the mix. The supervision of 3:1 or 4:1 that bothers me. Are the surgeons supervising more than one PA in the OR? Its ok for us to supervise that many nurses why? I can see 2:1 but anything above that doesn't sit well with me. I have walked in on disasters before because I was busy tied up in another room and the CRNA didn't bother calling me.
 
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Assuming equal interest in both fields, would any attendings recommend Hospitalist medicine over General Anesthesiology as a career? Anesthesia seems more lucrative right now but Hospitalists seem to enjoy a decent combination of lifestyle, salary, and future job security.
 
The nps are independent but have to collaborate with a doc on tough cases. The docs hate it. Too many screw ups and near misses.

Oh yeah, but they do love walking around in that white coat and the stethoscope around their neck!!
 
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Wiscoblue said:
The nps are independent but have to collaborate with a doc on tough cases. The docs hate it. Too many screw ups and near misses.

Oh yeah, but they do love walking around in that white coat and the stethoscope around their neck!!
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Well, would you recommend it over gas?
 
May be I can rest my mind and soul. While the CRNA and AA can work as hard as they want. I really don't care. The fiat currency, ie, the currency that has diminishing value, meaning, no ability to store value is not worth fighting for.

The solution for this insane work conditions is to cut down expenses / lifestyle and not take any debt.
 
Carbocation1 said:
Well, would you recommend it over gas?
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I've been doing 'gas' for 30 years. If you choose to be a hospitalist you do not have the option of independent practice. You're an employee from day one. As an anesthesiologist you might still have the option to work independently or as a partner in a practice. I can't imagine ever working for someone else.
 
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