The doom and gloom worked at my school

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BLADEMDA said:
The Democrats want Anesthesiology and Radiology to pay less than Family practice.
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I don't think this is what patients want. Totally different training pathway too. Actually patients expect that a doctor will be in charge of their anesthesia. A lot of the AANA propaganda is aimed at trying to convince patients that they are involved and an anesthesiologist isn't even needed. Even the CRNAs know this is bull****... especially when the **** hits the fan, that is. They're not going to call an FP doctor into the OR, are they? We do critical care every day. I shudder to think what your average FP would do in that situation, no offense to the dignity and expertise of their particular chosen profession intended.
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It sad b/c sometimes I feel like other medical professionals dont really view anesthesiologists w/ the respect I feel like they deserve. I hope this doesn't happen much in practice. These days when I tell my classmates i want to be anesthesiologist, they say stuff like, "wow you are going to be so rich and your life will be so easy! They pretty much spend most of their time on the phone or reading".
 
BuzzPhreed said:
I don't think this is what patients want. Totally different training pathway too. Actually patients expect that a doctor will be in charge of their anesthesia. A lot of the AANA propaganda is aimed at trying to convince patients that they are involved and an anesthesiologist isn't even needed. Even the CRNAs know this is bull****... especially when the **** hits the fan, that is. They're not going to call an FP doctor into the OR, are they? We do critical care every day. I shudder to think what your average FP would do in that situation, no offense to the dignity and expertise of their particular chosen profession intended.
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Quite a few anesthesiologists introduce themselves as the patient's physician and at some point the question is asked if they would be involved continuously in their care. Those supervising inevitably say "no, but I am available for.... etc etc" - the public knows and do not care.

That last part of your post is kinda unfair and not the point of any of this. Ezekiel nor the dems are planning on putting in non-anesthesiology physicians in the OR for consultation when **** hits the fan. Do you really expect any non-anesthesiologist to really be able to manage an acute situation in the OR? You're telling me an EM or surgery or IM trained physician is going to know a lick or two about the anesthetic machine and troubleshooting issues, or be able to run a differential given a certain situation? No, that's what comes with training and time in practice.
 
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anbuitachi said:
It sad b/c sometimes I feel like other medical professionals dont really view anesthesiologists w/ the respect I feel like they deserve. I hope this doesn't happen much in practice. These days when I tell my classmates i want to be anesthesiologist, they say stuff like, "wow you are going to be so rich and your life will be so easy! They pretty much spend most of their time on the phone or reading".
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lol, I had cardiologists and other specialists tell me the same... all the while the interventional cardiologist was breezing through her 10th cath by noon and seeing consults with me as a med student. they dont have it easy either but they make more than the avg anesthesiologist.

out in priv practice it really depends on the person and the environment. i've seen it both ways.
 
BuzzPhreed said:
I don't think this is what patients want. Totally different training pathway too. Actually patients expect that a doctor will be in charge of their anesthesia. A lot of the AANA propaganda is aimed at trying to convince patients that they are involved and an anesthesiologist isn't even needed. Even the CRNAs know this is bull****... especially when the **** hits the fan, that is. They're not going to call an FP doctor into the OR, are they? We do critical care every day. I shudder to think what your average FP would do in that situation, no offense to the dignity and expertise of their particular chosen profession intended.
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What does that have to do with anything? An anesthesiologist doing primary care would be equally disastrous, though not quite as obvious in the immediate term. Therein lies the crux of specialization. I would sooner trust a newly minted CRNA to perform anesthesia than I would the best neurosurgeon in the world.
 
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My wife is an FM doc. Received many offers over $200k in a major east coast city that many specialists would cut their left nut to enter. She has a difficult job though, much under-appreciated by other physicians in medicine (especially by the ones who don't carry patient panels), but there is a lot of satisfaction with having patients and that continuity; it's kind of the reason many of us went into medicine in the first place.

Anesthesia is a good gig, no need to put down FM docs though. Money is important, but it's not everything. Plenty of people don't want to work with egomaniac surgeons either ("anesthesia, raise the table!", "hey he's bucking!"). Many of us physicians also marry other docs or other high earning professionals. Does it really matter that your combined income is going to be $500k versus $600k? Oh the horror! I think for many, being able to find a job ANYWHERE and have a plethora of practice arrangements to choose from (clinic, urgent care, in-patient, med school clinical teaching, concierge, public health) is also a worthwhile perk.
 
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BLADEMDA said:
They won't trade a 20+ year experienced CRNA for a newly minted Anesthesiologist. Instead, the CEO will use the threat of bringing in the MD to drop the salary of the CRNA.
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Not only that, but while rural CRNAs are subsidized by Medicare, rural anesthesiologists are not. That's what happens when you don't have a loyal national lobbying organization. The ASA is a joke; it doesn't care about its members' interests, only its leaders' (see the new headquarters).
 
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FFP said:
Not only that, but while rural CRNAs are subsidized by Medicare, rural anesthesiologists are not. That's what happens when you don't have a loyal national lobbying organization. The ASA is a joke; it doesn't care about its members' interests, only its leaders' (see the new headquarters).
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What that makes no sense at all. WHy is CRNa subsdiized but rural anes not?? That is messed up
 
Yep. That's the law.

One such program is the anesthesia rural "pass-through" program; a program created as an incentive for anesthesia providers to practice in small rural hospitals. Under the “pass-through” program, eligible hospitals may use reasonable-costs based Part A funds in lieu of the conventional Part B fee schedule to induce anesthesia providers such as anesthesiologist assistants (a type of physician assistant) and nurse anesthetists to provide anesthesia services in small rural hospitals and critical access facilities. Under the Centers for Medicare and Medicaid Services (CMS) current interpretation of the statute creating the “pass-through” program, eligible rural hospitals are not permitted to use the “pass-through” funds to employ or contract with anesthesiologists. Low Medicare Part B anesthesia payments and low patient volume in rural areas also make it difficult for rural hospitals to retain anesthesia providers.
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https://www.asahq.org/For-Members/A...ctivities/Rural-Pass-Through-Legislation.aspx
 
Just would like to add since I have an interest in Anesthesiology. I've asked all of the Anesthesiologist in my area and they all highly recommend the field. Their main issue has been becoming so reliant on the hospital subsidies, that being said... with the future of medicine, who isn't? I know many attendings on here have different viewpoints and i take them very seriously as well. Now I'm at a point though where I don't know what to think
 
Whenever there is a reliance on hospital subsidies, it's a recipe for disaster. An AMC can come in any time, ask for much lower or no subsidies and promise the same coverage and quality. Those groups are doomed, they just don't know it yet.
 
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womp said:
My wife is an FM doc.
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Oh, I'm not denigrating FP docs or what they do. They have their own levels of B.S. that they have to deal with that are unfathomable to a lot of us, including encroachment by CRNPs.

I'm just saying that it is a completely different training pathway. I was looking at jobs in the desert SW when I finished my post-training year and was ready to branch out into the "real" world. One of the cities where I was looking at practices was in a region that was heavily dominated by CRNAs. They had to have a medical director in order to meet the hospital by-law requirements for permanent "physician consultant" to the practice. They had an FP doc. The CRNAs essentially functioned autonomously with this rubber-stamping doctor.

What kind of true "consultant" is an FP-trained doc to a bunch of CRNAs? Talk about a complete sham.
 
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BLADEMDA said:
The field has NEVER looked worse; that could change if the AMCs are ruled illegal (anti-trust) or the ACA gets nullified (SCOTUS could still rule 5-4 that each state must have its own health care portal in order for the citizen to receive a subsidy).

Both of those are a long shot so you should honker down for the long run which means a Fellowship (or even 2) with anticipation of a $240K starting salary.

The Democrats want Anesthesiology and Radiology to pay less than Family practice. While this may take time (7-10 years) they may ultimately get their way. Unlike many on this Board I wouldn't choose Anesthesiology over a far easier specialty with a better lifestyle if the pay was equal. While I rarely agree with the liberal Dr. Emanuel on anything he is correct in his assumption that income/salary is the largest deterrent to primary care in the USA.
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Hey you're exactly right!! at 30:43
 
If the key to doing the right thing is being happy, what happens if you do a rotation in anesthesia and love it, but you can't imagine being happy in it because of the overwhelming butt hurtage caused by politics?
 
Isn't it funny how liberals( the fiscal libs) hate corporations, but they sort of encourage the proliferation of large money hoarding hospital systems and AMC's? Isn't it also funny how they are usually the ones with the feelings and "care" more about their fellow man, but would love to see CRNA's get the same rights as doctors, rendering patient care quality to be inevitably lower?

Seems a bit contradictory
 
wjs010 said:
Isn't it funny how liberals( the fiscal libs) hate corporations, but they sort of encourage the proliferation of large money hoarding hospital systems and AMC's? Isn't it also funny how they are usually the ones with the feelings and "care" more about their fellow man, but would love to see CRNA's get the same rights as doctors, rendering patient care quality to be inevitably lower?

Seems a bit contradictory
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Not at all. Smart players in this political system realize that they need to play both sides. So, what makes an insurance company more money? More premiums and lower payments to providers. The (R) side wants to give them the former, the (D) side the latter. Simple. Neither the (D) nor the (R) have their constituents' best interests at heart. They just go about serving their masters in slightly different ways.

It distresses me that my colleagues don't understand what the true game is. It's not (D) vs (R). It's concentrated power vs not. Guess what? We aren't on the side of concentrated power. And the people who possess it use it to their advantage without exception and without remorse. Once you understand that, follow the money, everything that follows becomes crystal clear. What to do about it? Well... that's a lot harder, isn't it?

http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations

We physicians aren't the problem in the ballooning cost of healthcare in the U.S. And I'm sick of us being made the scapegoat.
 
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wjs010 said:
If the key to doing the right thing is being happy, what happens if you do a rotation in anesthesia and love it, but you can't imagine being happy in it because of the overwhelming butt hurtage caused by politics?
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You find something else that makes you happy. There is usually more than one specialty that fits a person well.
 
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FFP said:
Not only that, but while rural CRNAs are subsidized by Medicare, rural anesthesiologists are not. That's what happens when you don't have a loyal national lobbying organization. The ASA is a joke; it doesn't care about its members' interests, only its leaders' (see the new headquarters).
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I just love our government. /sarcasm
 
How is monitoring/watching cRNA's that much worse than the current job. If anything it's kinda better!
 
Longhorn91 said:
How is monitoring/watching cRNA's that much worse than the current job. If anything it's kinda better!
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Because the person you're monitoring is absolutely resentful of the fact that she needs to be monitored and is fully convinced she can do a better job than you with 1/4th the training and selectivity. Makes for a great working environment, right? It's different from surgeons and PAs where the surgeon is the main revenue generator and the front man; and patients tend to think that surgery needs to involve a real and seasoned doctor while underestimating the degree of medical expertise needed to do other things like anesthesia or blood pressure management.
 
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correct me if im wrong but didnt the avg usmle for anes. go up from a 226 to 227 this past yr?
every specialty out there is bashable, doom and gloom is sdn. do what u want with your life
 
donkeykong1 said:
correct me if im wrong but didnt the avg usmle for anes. go up from a 226 to 227 this past yr?
every specialty out there is bashable, doom and gloom is sdn. do what u want with your life
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Yes. If you want to work for someone else your entire career then Anesthesiology is a fine choice. Limited income and autonomy with a decent but not great income. If, on the other hand, you want to have your own practice and be in charge of your own schedule then look elsewhere. Income potential in other specialties will be 2-3 times that of being an employed Anesthesiologist.

Med students aren't the most informed individuals when it comes time to match into a specialty.
 
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BLADEMDA said:
Yes. If you want to work for someone else your entire career then Anesthesiology is a fine choice. Limited income and autonomy with a decent but not great income. If, on the other hand, you want to have your own practice and be in charge of your own schedule then look elsewhere. Income potential in other specialties will be 2-3 times that of being an employed Anesthesiologist.

Med students aren't the most informed individuals when it comes time to match into a specialty.
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from the little i know as a ms3, the high paying specialties aka 500k+ are mostly surgical i.e ortho, uro, ent, plastics. if one is surgically oriented and has the board score then yah be my guest, make bank. at the end of the day i'd much rather do anesthesiology, still make 300k+, with arguably depending on the specilaty a better lifestyle and less responsibility, and come home everyday feeling satisfied and happy.

also, with all due respect seeing as you're the guy with the knowledge around here, how sure are we that private group practice anesthesia is dead? sure being solo in almost any specialty is getting to be a rarity, but what about those days of buying into a group and making partner after x yrs is that going to be around in the future?
 
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also with regards to high paying specialties like GI, cards, heme/onc, as a med student there is still the risk of going IM and after 3 yrs not matching into these competitive spots. this is why a lot of my friends who have competitive stats and are between going im or anes are choosing the latter..just the way the kids think these days
 
donkeykong1 said:
from the little i know as a ms3, the high paying specialties aka 500k+ are mostly surgical i.e ortho, uro, ent, plastics. if one is surgically oriented and has the board score then yah be my guest, make bank. at the end of the day i'd much rather do anesthesiology, still make 300k+, with arguably depending on the specilaty a better lifestyle and less responsibility, and come home everyday feeling satisfied and happy.

also, with all due respect seeing as you're the guy with the knowledge around here, how sure are we that private group practice anesthesia is dead? sure being solo in almost any specialty is getting to be a rarity, but what about those days of buying into a group and making partner after x yrs is that going to be around in the future?
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By the time you finish residency 85-90 percent of all jobs will be employee based. This means an employee of an AMC, hospital or an academic center. As an employee your income potential will be capped unlike some of the other specialties. Will you make $300k? Probably. But in my world that isn't a lot of money ( please refrain from the liberal b.s. About the top 1 percent... It's all lies)

This means that 10 percent of job openings will offer true partnership. If you know the right person or have the right fellowship or simply get luck you may end up making double your colleagues from residency.

Pain medicine still offers the opportunity for private practice and go it alone. That is something a street smart med student should keep in mind. As for the medical sub specialties they will do better than general Anesthesiology over your career.
 
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BLADEMDA said:
By the time you finish residency 85-90 percent of all jobs will be employee based. This means an employee of an AMC, hospital or an academic center. As an employee your income potential will be capped unlike some of the other specialties. Will you make $300k? Probably. But in my world that isn't a lot of money ( please refrain from the liberal b.s. About the top 1 percent... It's all lies)

This means that 10 percent of job openings will offer true partnership. If you know the right person or have the right fellowship or simply get luck you may end up making double your colleagues from residency.

Pain medicine still offers the opportunity for private practice and go it alone. That is something a street smart med student should keep in mind. As for the medical sub specialties they will do better than general Anesthesiology over your career.
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i hear you, but again matching into IM sub-specialties like gi, card, heme, or ent, ortho is very very cutthroat these days. theres this risk, and the fact that as an attending you'll prob have much more call, responsibility than an employed anesthesiologist etc. sure they will be making 500k by the time they're in late 30s, it honestly just depends on the person.
 
donkeykong1 said:
i hear you, but again matching into IM sub-specialties like gi, card, heme, or ent, ortho is very very cutthroat these days. theres this risk, and the fact that as an attending you'll prob have much more call, responsibility than an employed anesthesiologist etc. sure they will be making 500k by the time they're in late 30s, it honestly just depends on the person.
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what call?

have you seen hospitalist schedules?? 7 on 7 off. depending on where you are, ranges from 200-300K. pretty damn similar to anesthesia pay depending on area if you ask me. once you leave, you turn off your pager. when you work, yeah you're working your ass off but you have PAs too.
 
although having to deal with the ER's special brand of lunacy is its own hell. then again, the hospitalists i know say it's all worth it when they have that week off to enjoy their lives and travel.
 
Doctor4Life1769 said:
what call?

have you seen hospitalist schedules?? 7 on 7 off. depending on where you are, ranges from 200-300K. pretty damn similar to anesthesia pay depending on area if you ask me. once you leave, you turn off your pager. when you work, yeah you're working your ass off but you have PAs too.
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i was talking about taking call as a gi, cards, or heme/onc doc
 
donkeykong1 said:
i was talking about taking call as a gi, cards, or heme/onc doc
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and you think anesthesia call is somehow easier? lol

i've never seen an emergent heme/onc case. rarely do I see GI come in in the middle of the night. Cards is a beast as is nephrology.
 
Doctor4Life1769 said:
and you think anesthesia call is somehow easier? lol

i've never seen an emergent heme/onc case. rarely do I see GI come in in the middle of the night. Cards is a beast as is nephrology.
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maybe not heme/onc, but gi call is tough depending on where u are
 
donkeykong1 said:
maybe not heme/onc, but gi call is tough depending on where u are
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also take a look at the heme/onc forum..looming cuts to chemo. yah, doom and gloom yet again. point is every specialty has its own dirty laundry.
 
the downside to anesthesia isn't simply the falling reimbursements/pay. it's the entire specialty that is in flux. but, you can go into it if you want. at the end of the day, you're the one who'll make the choices that'll lead to the path you will be following in 5, 10, 15 and more years.
 
donkeykong1 said:
also take a look at the heme/onc forum..looming cuts to chemo. yah, doom and gloom yet again. point is every specialty has its own dirty laundry.
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Except derm, ortho, rad onc, etc.
 
Doctor4Life1769 said:
the downside to anesthesia isn't simply the falling reimbursements/pay. it's the entire specialty that is in flux. but, you can go into it if you want. at the end of the day, you're the one who'll make the choices that'll lead to the path you will be following in 5, 10, 15 and more years.
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all of medicine is in flux these days. who knows maybe NP will dominate primary care, perhaps you will be seeing a DNP derm specialist for those moles, or some guy in singapore will be reading those CTs u order on the floors etc...
 
The employed specialties in the hospital system in which I work are: orthopedic surgeons, cardiologist, CT surgeons, IM, FPS
The only group of physicians that work for an AMC are the ER docs.
My group is still currently private…will that change in the future…maybe but doesn't look that way at this time
The point I am trying to make is that there is pressure on nearly every single field of medicine…not just anesthesiology
 
Stank811 said:
The employed specialties in the hospital system in which I work are: orthopedic surgeons, cardiologist, CT surgeons, IM, FPS
The only group of physicians that work for an AMC are the ER docs.
My group is still currently private…will that change in the future…maybe but doesn't look that way at this time
The point I am trying to make is that there is pressure on nearly every single field of medicine…not just anesthesiology
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Bravo. hopefully y'all will be hiring when im done with residency
 
BLADEMDA said:
Yes. If you want to work for someone else your entire career then Anesthesiology is a fine choice. Limited income and autonomy with a decent but not great income. If, on the other hand, you want to have your own practice and be in charge of your own schedule then look elsewhere. Income potential in other specialties will be 2-3 times that of being an employed Anesthesiologist.

Med students aren't the most informed individuals when it comes time to match into a specialty.
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I don't post much but try to stay very informed and read this forum quite a bit. I thank Blade and everyone else who contributes to these forums and will start posting more. I will need to make a decision soon but I really like gas. While I am not disagreeing with the bold statement of Blade I just don't see a higher income potential for an average medical student other than gas.

Some IM sub specialties can compete with the surgical sub specialties along with rad onc and derm but other than that, gas I feel is a great option. Here is my list for best options for the average med student. In order. (say 225 step 1, average extras). Opinions?

1. IM- Cards, GI,
2. IM- Heme/onc, Pulm/cc
2. Anes- Pain
3. Anes- Peds, cards
4. Radiology
5. Anes-general
6. Anes- CC
7. EM
8. OB/Gyn
9. Gen Surg- (certain fellowships like hand could move this way up if you can bear the residency)
10. PM &R - pain
 
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DallasCowboys22 said:
I don't post much but try to stay very informed and read this forum quite a bit. I thank Blade and everyone else who contributes to these forums and will start posting more. I will need to make a decision soon but I really like gas. While I am not disagreeing with the bold statement of Blade I just don't see a higher income potential for an average medical student other than gas.

Some IM sub specialties can compete with the surgical sub specialties along with rad onc and derm but other than that, gas I feel is a great option. Here is my list for best options for the average med student. In order. (say 225 step 1, average extras). Opinions?

1. IM- Cards, GI,
2. IM- Heme/onc, Pulm/cc
2. Anes- Pain
3. Anes- Peds, cards
4. Radiology
5. Anes-general
6. Anes- CC
7. EM
8. OB/Gyn
9. Gen Surg- (certain fellowships like hand could move this way up if you can bear the residency)
10. PM &R - pain
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What is this list?? Best options? In terms of what..? Dont focus TOO much on money i think. That's why im going for anesthesia even though i know they are broke.. i feel like its more interesting than some of the other fields. you dont know what cuts are coming for other fields in the next 10 years
 
DallasCowboys22 said:
I don't post much but try to stay very informed and read this forum quite a bit. I thank Blade and everyone else who contributes to these forums and will start posting more. I will need to make a decision soon but I really like gas. While I am not disagreeing with the bold statement of Blade I just don't see a higher income potential for an average medical student other than gas.

Some IM sub specialties can compete with the surgical sub specialties along with rad onc and derm but other than that, gas I feel is a great option. Here is my list for best options for the average med student. In order. (say 225 step 1, average extras). Opinions?

1. IM- Cards, GI,
2. IM- Heme/onc, Pulm/cc
2. Anes- Pain
3. Anes- Peds, cards
4. Radiology
5. Anes-general
6. Anes- CC
7. EM
8. OB/Gyn
9. Gen Surg- (certain fellowships like hand could move this way up if you can bear the residency)
10. PM &R - pain
Click to expand...

Going into a specialty just because it's relatively highly reimbursed RIGHT NOW is like shooting at a moving target while aiming at its current location. Unless you're already in the specialty, you won't reap the benefits of its income potential.
 
DallasCowboys22 said:
I don't post much but try to stay very informed and read this forum quite a bit. I thank Blade and everyone else who contributes to these forums and will start posting more. I will need to make a decision soon but I really like gas. While I am not disagreeing with the bold statement of Blade I just don't see a higher income potential for an average medical student other than gas.

Some IM sub specialties can compete with the surgical sub specialties along with rad onc and derm but other than that, gas I feel is a great option. Here is my list for best options for the average med student. In order. (say 225 step 1, average extras). Opinions?

1. IM- Cards, GI,
2. IM- Heme/onc, Pulm/cc
2. Anes- Pain
3. Anes- Peds, cards
4. Radiology
5. Anes-general
6. Anes- CC
7. EM
8. OB/Gyn
9. Gen Surg- (certain fellowships like hand could move this way up if you can bear the residency)
10. PM &R - pain
Click to expand...

Solid list but radiology at number 4? I assume you mean interventional radiology

Except for that one specialty I like your list.
 
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