Supervision of CRNAs

[BLADEMDA]

The US is moving to a socialized system and this seems to be the end of anesthesiology as we know it. Question, how does anesthesia survive in other socialized healthcare systems in Europe?

In Germany the Average Anesthesiologist earns around 60,000 Euros. Some European nations pay squat to Physicians and the result is migration to those nations paying a decent salary.

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[deleted171991]

In Germany the Average Anesthesiologist earns around 60,000 Euros. Some European nations pay squat to Physicians and the result is migration to those nations paying a decent salary.

What are their average work hours? And let's not forget all the things they don't have to spend money on, because it's included in their taxes. Germany has a fantastic social support system. We are not comparing apples vs. apples.

I am not saying American anesthesiologists don't make more than their European counterparts, even on an hourly basis; I am just saying the social system, work hours and malpractice atmosphere are light years ahead in Europe. Just one example for the latter: they do certain laparoscopies with LMAs.

 

[BLADEMDA]

What are their average work hours? And let's not forget all the things they don't have to spend money on, because it's included in their taxes. Germany has a fantastic social support system. We are not comparing apples vs. apples.

I am not saying American anesthesiologists don't make more than their European counterparts, even on an hourly basis; I am just saying the work hours and malpractice atmosphere are light years ahead in Europe.

Of course, our German counterparts work a lot less than us, around 35 hours per week. As far as taxes and social structure Germany is a socialistic nation. Still, $60,000 Euros is a paltry salary for a city like Berlin where housing is expensive.

 

[deleted171991]

Of course, our German counterparts work a lot less than us, around 35 hours per week. As far as taxes and social structure Germany is a socialistic nation. Still, $60,000 Euros is a paltry salary for a city like Berlin where housing is expensive.

And that's why the best students don't choose anesthesia there either.

Thirty-five hours of less stressful work instead of 60-70, with almost no malpractice concerns, for half the hourly income and better social support? Tough choice. Btw, I think the Europe -> US physician influx has decreased considerably in the last 10 years, especially from new EU member countries. As "bad" as Europe is, it's a much easier track than the USMLE plus American immigration, for EU citizens.

 

[Mman]

Just one example for the latter: they do certain laparoscopies with LMAs.

I wouldn't use that as an example of them being "ahead" of us, just different. Their patients aren't obese, diabetic, and/or on chronic narcotics that can delay their gastric motility. And even in a healthy skinny ASA 1 patient, I've never once wished I could do their lap chole with an LMA instead of an ETT if it wasn't for those pesky lawyers.

 

[deleted171991]

I wouldn't use that as an example of them being "ahead" of us, just different. Their patients aren't obese, diabetic, and/or on chronic narcotics that can delay their gastric motility. And even in a healthy skinny ASA 1 patient, I've never once wished I could do their lap chole with an LMA instead of an ETT if it wasn't for those pesky lawyers.

European patients are also getting obese and diabetic, just slightly less than ours. And one of my former colleagues here used to do all his lap choles with a great surgeon with LMAs, so there is clearly an advantage.

The point was not about LMAs, though. The point was about not getting sued for almost every, single, bad, outcome, even when one did nothing wrong. That's why Europeans can afford using LMAs for laparoscopy and we can't, they can skip CTs and we can't, they can send the patient home and we keep them for observation, they don't write long notes just for CYA etc. The list is long, and includes everything we call defensive medicine. They just don't even think about it, they don't have to; and that changes radically the pleasure of practicing medicine. How do I know? I was one of them.

 

[Mman]

European patients are also getting obese and diabetic, just slightly less than ours. And one of my former colleagues here used to do all his lap choles with a great surgeon with LMAs, so there is clearly an advantage.

In my opinion there is no advantage, let alone clearly.

 

[deleted171991]

In my opinion there is no advantage, let alone clearly.

All those people must be using LMAs just because they are lazy.

Let's agree to differ.

 

[Mman]

All those people must be using LMAs just because they are lazy.

Let's agree to differ.

They aren't all using LMAs. There is no evidence to show a better outcome with an LMA in those situations. Pretty much the end of the story as far as I'm concerned.

 

[Mad Jack]

The US is moving to a socialized system and this seems to be the end of anesthesiology as we know it. Question, how does anesthesia survive in other socialized healthcare systems in Europe?

http://usatoday30.usatoday.com/news/health/2006-06-23-germandoctors_x.htm

If Germany is any indication, not good...

 

[deleted171991]

http://usatoday30.usatoday.com/news/health/2006-06-23-germandoctors_x.htm

If Germany is any indication, not good...

That's what will happen to the US, too, once salaries reach a threshold.

 

[Sirach38]

That's what will happen to the US, too, once salaries reach a threshold.

So we will all be going to Australia, Canada, UK, etc.? I don't know how welcoming these places will be to all the influx of US physicians...

 

[LAtoDavis]

I'm a US citizen and finishing MS in pharmacology (writing a paper on the ryanodine receptor under a Brigham and Woman's Hospital anesthesiology honcho) before starting med school; I'm applying to medical schools in Australia with the intention of staying in Australia for internship, residency, and practice. I have/had 3 MD interviews in the US. If I can't stay in Australia, I'll do my residency in the US and then move to the UK. Practicing in the UK may be more straightforward for anesthesiologists than other specialist attendings from the US; please feel free to interpret info on this link detailing this
http://www.gmc-uk.org/doctors/registration_applications/acceptable_postgraduate_qualifications.asp

By the way, I dropped out of nursing school -- with the long term goal of becoming a CRNA -- due to feeling like my science background was inadequate to do the job. That, and nurses I met struck me as greedy, unaccountable, resentful scumbags. I hear that Victoria is nice.

 

[deleted171991]

Practicing in the UK is easy for attending anesthesiologists from the US; see this link for details:
http://www.gmc-uk.org/doctors/registration_applications/acceptable_postgraduate_qualifications.asp

The overseas qualifications listed meet the same standards as UK postgraduate qualifications. But this does not mean they are the same as UK qualifications in every way. It is important to note that they do not guarantee entry to UK specialty training.

 

[Mad Jack]

I believe for Australia you need at a minimum to be a permanent resident (equivalent to a US green card) to even be eligible to get a job in a hospital. You have to set that up before you come. Australia is a welcoming country, but it's not necessarily easy to get PR. Maybe if you marry an Aussie. Otherwise locals will get jobs. Maybe you can go to undesirable areas.

In the UK I believe you also compete not only with UK citizens but also EU citizens for jobs.

You can do locums in Australia fairly easily as a US-trained physician without PR. But working as you please, that's a whole 'nother process...

 

[LAtoDavis]

I believe for Australia you need at a minimum to be a permanent resident (equivalent to a US green card) to even be eligible to get a job in a hospital. You have to set that up before you come. Australia is a welcoming country, but it's not necessarily easy to get PR. Maybe if you marry an Aussie. Otherwise locals will get jobs. Maybe you can go to undesirable areas.

In the UK I believe you also compete not only with UK citizens but also EU citizens for jobs.

Interesting. Thanks for the bit of knowledge. I'm applying for dual EU-US citizenship through the Lithuanian Embassy in the US, now; this would be to establish residency for undertaking an Irish medical internship or UK foundation programme in the case that I attend an Irish medical school (applied to a few).

I'm going to start researching how to start lining up permanent residency in Australia, now. I've seen you on the international forums, too. I like your posts. If you're following along with what it is that I'm up to, I'm applying to Australian medical schools that accept US financial aid that also have decent internship priority schemes in their respective states (see attached PDF). If you don't think that getting permanent residency through legitimate means is possible, please rate the attached picture of an Australian girl from 0-10 for marriage-likelihood purposes. Thanks again.

 

[LAtoDavis]

Hey LAtoDavis! Sorry I haven't followed what you're up to. But I'm happy to help if I can. SDN including a few regular people here have more than helped me so I just try to return the favor.

I don't know the UK/EU situation as well. But anecdotally lots (and I mean lots!) of Irish doctors here in Australia who tell me things are pretty dire in the UK and Ireland. Pay and work-life balance generally much better in Australia than UK or Ireland. But all this is from UK and Irish doctors here in Australia so maybe they're biased since they did leave after all. Since Australian/NZ training is probably more similar to UK and Irish training than it is to American training, I believe it's 'easier' for UK/Irish training to be recognised in Australia/NZ than American training. Unless you like cold weather, the weather is far better Down Under.

Currently it's still possible for international students graduating from Aussie med schools to get an internship/RMO. But things are getting more difficult. I do have several international friends who have gone through the ordeal however and gotten internships. But you may not get the most desirable hospitals, or be somewhere where you don't want to be. But after 2 years (it's usually a 2 year contract - internship and residency) you can try to move around. You most likely won't get a hospital like RPA, St Vincent's or Royal North Shore in Sydney, or the Royal Melbourne in Melbourne, or any of the other big hospitals with tons of specialties and great networking opportunities, but currently you'll likely get something. However, if you're a PR before you graduate med school, you're just as good as any local insofar as getting an internship/RMO contract. No worries at all. Melbourne and in fact the whole of Victoria is different than most the rest of Australia because they don't use a random ballot system for internships. Rather they use a merit-based one. So essentially the best students (in-state) have the best chances at getting the hospital of their choice. I love Melbourne though. Great city, great people.

Marriage is a legitimate means to PR/citizenship though! I prefer brunettes, but beauty is in the eye of the beholder.

By the way if you're from California (LA, Davis) I know both very well.

Thanks for the FYI. Australia is looking better and better, to me. Aside from matching anesthesiology in Australia, what concerns me most is the amount of time training takes in Australia. It looks like post-medical school training follows this pathway:

From the ANZCA website:
http://www.anzca.edu.au/training/2013-training-program/program-overview

... there are 364 weeks (7 years) of specialty training following 2 years of internship/residency.

Just so I have my facts right, it looks like this is the pathway you take to becoming an anesthetist in Australia:

1. Medical school: 4 years
2. Internship: 1 year
3. Residency: 1 year
4. Specialist training: 7 years
5. Consultant
Total time to reach 5. = 13 years
$300,000 principal loan unpaid over 13 years = $745,296.76 USD

versus the pathway in the United States:
1. Medical school: 4 years
2. Preliminary/Rotating: 1 year
3. Residency: 3 years
4. Attending
Total time to reach 4. = 8 years
$300,000 principal loan unpaid over 8 years = $525,201.75 USD

I posted in the Australian/International forum a question about the financial feasibility of moving to Australia for med school, residency, and practice, and only had 1 response. See that post ("US Citizen --> Australian Medical School --> Australian Practice = Financially Feasible?") here:
http://forums.studentdoctor.net/thr...ralian-practice-financially-feasible.1112788/

And, thanks for posting how Melbourne/Victoria internship spaces are ranked. As it stands, the University of Melbourne Medical School is my first choice. After that is Australian National University (doesn't accept US financial aid but has guaranteed internships for international student grads of its program in the Australian Capitol Territory, or "ACT" is what you guys call it) and Flinders University of South Australia (does accept US financial aid, good track record of placing all its international grads into internships in South Australia).

I'm not applying to the University of Sydney, University of Queensland, or any other Australian University, for that matter. The risk vs reward for attending one of those and getting an internship is too high.

If you're curious, they've raised tuition at the Irish medical schools to around 63 thousand US dollars per year; I'm not sure that's worth it in the grand scheme of things due to how well their grads match (mostly IM and primary care).

I'm a Californian, too, good catch. I like it, here, but things are changing for the worse, and I only see bad things ahead if you're not in a well-insulated job. Don't worry about not following me, either. I have a habit of plopping down long research-based posts like this one around here; I did a workup on Irish medical school matching a bit ago, and some others that I can't remember off the top of my head. Thanks for bearing with me as I hijack this thread and ask lots of questions

 

[BuzzPhreed]

I completely disagree that things haven't changed much since 2007.

Well I was more referencing the sentiment regarding know-it-all CRNAs, but I guess it's okay that you moved the goalposts because I agree with most of what you said.

 

[dhb]

Question, how does anesthesia survive in other socialized healthcare systems in Europe?

Not too bad, i would guess the average annual gross income for non academic positions is between 150 and 200k for north western Europe (France and up) with no med school debt.
And many countries do have CRNAs

 

[deleted171991]

Which European countries have crnas?

 

[dhb]

Austria, Croatia, Denmark , Finland , Germany, Greece, Hungary , Iceland, Ireland , Luxembourg, Norway , Netherlands , Poland, Czech Republic , United Kingdom, Slovenia, Sweden, Switzerland

 

[deleted171991]

Austria, Croatia, Denmark , Finland , Germany, Greece, Hungary , Iceland, Ireland , Luxembourg, Norway , Netherlands , Poland, Czech Republic , United Kingdom, Slovenia, Sweden, Switzerland

Crnas, or nurses assisting the anesthesiologist? Because anesthesiologists have their own nurse in some countries. But they are nothing like American crnas, neither in education nor in scope of practice, AFAIK.

I'll look it up in the weekend. You made me curious m