The Surgical Home

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
How do you measure quality in anesthesia?
A quality anesthetic is one for which a normal temperature is documented in the 30 minutes prior to anesthesia end time or the first 15 minutes of PACU time.

Members don't see this ad.
 
A quality anesthetic is one for which a normal temperature is documented in the 30 minutes prior to anesthesia end time or the first 15 minutes of PACU time.
Yes and antibiotics are given on time and lines are inserted under sterile conditions... these are all the metrics that determine if an anesthetic was of good quality in the eyes of those who invent metrics!
 
Yes and antibiotics are given on time and lines are inserted under sterile conditions... these are all the metrics that determine if an anesthetic was of good quality in the eyes of those who invent metrics!

Technically, it doesn't matter whether antibiotics are given as ordered or whether sterility is maintained. It matters that these metrics are documented! A sterile procedure not documented as msbt is a fail. A contaminated procedure documented as msbt is quality care! Outcomes don't matter. Documentation matters.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
How do you measure quality in anesthesia? Does experience count? what will the market pay for that experience?

You measure quality by how much the provider costs you, whether or not the patient survived the procedure, and how quickly you can turn over the room. Nothing else matters now. Hence, why the profession is in trouble.
 
I think this is a great idea, if we get paid for it....

No, the premise is to attempt to stabilize your salary by giving you different responsibilities because the OR battle is over. However, I think the PSH proposal will result in other providers (hospitalists/mid level providers) doing it instead also because they are cheaper. That is why I said the field will cease to exist in 10 years unless you're willing to do it for 150-200k tops.
 
How is the OR fight over? Simple cases on healthy patients will be done solely by mid-levels, intermediate risk cases will be done with an ACT, and the complicated, risky cases will be done solo by physicians. Life is not black and white. PSH will make the Anesthesiologist the attending of record outside the OR in pre-op and post-op, and a consultant intra-op.
 
How is the OR fight over? Simple cases on healthy patients will be done solely by mid-levels, intermediate risk cases will be done with an ACT, and the complicated, risky cases will be done solo by physicians. Life is not black and white. PSH will make the Anesthesiologist the attending of record outside the OR in pre-op and post-op, and a consultant intra-op.
You do know that those "simple cases" are about 80% of the daily practice of anesthesia... don't you?
So, if 80% of billable work will be done by nurses then how are you going to produce enough revenue to pay the anesthesiologists?
See, the amount of money insurance will pay for surgery and perioperative care is not going to increase in the future under any conceivable circumstances, so if you give a bigger slice of the pie to someone, then by default someone else is going to get less , think about it.
 
  • Like
Reactions: 1 user
Technically, it doesn't matter whether antibiotics are given as ordered or whether sterility is maintained. It matters that these metrics are documented! A sterile procedure not documented as msbt is a fail. A contaminated procedure documented as msbt is quality care! Outcomes don't matter. Documentation matters.
Correct! this where the expression "buff the chart" confirms it's value one more time!
 
You do know that those "simple cases" are about 80% of the daily practice of anesthesia... don't you?
So, if 80% of billable work will be done by nurses then how are you going to produce enough revenue to pay the anesthesiologists?
See, the amount of money insurance will pay for surgery and perioperative care is not going to increase in the future under any conceivable circumstances, so if you give a bigger slice of the pie to someone, then by default someone else is going to get less , think about it.
Plank, do you not recommend this field to current medical students? From reading older threads, you seemed way more optimistic about anesthesiology back then than now. Many of us are just looking for a non-surgical specialty where we don't have to talk all day, but rather take pride in being good at what we do. Rad/path is too isolating. What else is there?
 
Plank, do you not recommend this field to current medical students? From reading older threads, you seemed way more optimistic about anesthesiology back then than now. Many of us are just looking for a non-surgical specialty where we don't have to talk all day, but rather take pride in being good at what we do. Rad/path is too isolating. What else is there?

ibanking
 
  • Like
Reactions: 1 user
Members don't see this ad :)
Plank, do you not recommend this field to current medical students? From reading older threads, you seemed way more optimistic about anesthesiology back then than now. Many of us are just looking for a non-surgical specialty where we don't have to talk all day, but rather take pride in being good at what we do. Rad/path is too isolating. What else is there?

Health care management
 
That is why I said the field will cease to exist in 10 years unless you're willing to do it for 150-200k tops.
The military pays better than that, not even counting the healthcare/tax benefits and pension. Even at my most pessimistic, I can't really see pay for anesthesiologists dropping below that.
 
The military pays better than that, not even counting the healthcare/tax benefits and pension. Even at my most pessimistic, I can't really see pay for anesthesiologists dropping below that.
IIRC, you said the military pays 250K plus benefits for Anesthesiology? Do you know if there is much of a difference in pay between other specialties in the military?
 
Plank, do you not recommend this field to current medical students? From reading older threads, you seemed way more optimistic about anesthesiology back then than now. Many of us are just looking for a non-surgical specialty where we don't have to talk all day, but rather take pride in being good at what we do. Rad/path is too isolating. What else is there?

Censeo Health
 
  • Like
Reactions: 1 user
People on this board are either delusional or way too optimistic. Seriously, think about this... if I was a corporate executive running an AMC why on Earth would I pay for an anesthesiologist? If I put a CRNA back there, the job will get done for 1/3 of the price. Do I care that you did your residency at the Mayo Clinic? No. Do I care that you did a fellowship? No. If anything that will deter me even more from hiring you because I know you will want to command 400k and I'm looking to cut overhead here. Trust me, I will find a CRNA willing to do that heart case. Do I care that they are not board certified in TEE? No, I don't. Once again, as long as it gets done I could care less. Now that medicine has progressed from private practice to corporations employing providers they will take advantage of the situation in any way possible to maximize profits for corporate executives and shareholders. This is happening in virtually every field of medicine so it's not something specifically with anesthesiology. In case you haven't noticed, ARNPs are now big in ERs, ICUs, IM, Pediatrics, Family Medicine, etc. Midwives are huge in OBGYN and psychologists are now prescribing medication in many places. Salaries are going down across the board so get used to it. Paying off those loans will get ever more difficult. I feel bad for Pathologists and Radiologists now because they have to compete on a global marketplace for a job. You have to do something that accepts no insurance or government payment where you are the boss running your own practice as a plastic surgeon, dermatologist, ophthalmologist, etc. in a wealthy unsaturated area. Otherwise, go corporate.
 
  • Like
Reactions: 2 users
I agree. They wanna replace me w two crnas... More workforce for same $. It's not just us... Family med guy in town retired n they replaced him w two nps. I keep asking who is supervising them n no one answers. Probably paying some one a couple bucks to review, what's the rule 10% of their charts, drop in once every ten days and answer the phone if they have a question.
 
  • Like
Reactions: 1 user
The military pays better than that, not even counting the healthcare/tax benefits and pension. Even at my most pessimistic, I can't really see pay for anesthesiologists dropping below that.


There are many VA jobs out there which pay more than Academics and AMCs currently do.
 
  • Like
Reactions: 1 user
IIRC, you said the military pays 250K plus benefits for Anesthesiology? Do you know if there is much of a difference in pay between other specialties in the military?
There are lots of factors that go into it, there are many many different paths that lead to one being a doctor in the military, and the whole pay scheme is complicated. Short version:

A military anesthesiologist that is not repaying a period of obligated service (e.g. in return for the military paying for medical school) will make around $200-250K depending on location and the length of the contract (2-4 years). Add in a few years of seniority and some rank and it'll be $250-275K, roughly. Primary care specialties earn somewhat less. Work hours vary a lot. BS quotient that you have to put up with varies a lot too. Pension vests at 20 years and a reasonable estimate of cash value would be $1.5M, give or take.
 
People on this board are either delusional or way too optimistic. Seriously, think about this... if I was a corporate executive running an AMC why on Earth would I pay for an anesthesiologist? If I put a CRNA back there, the job will get done for 1/3 of the price. Do I care that you did your residency at the Mayo Clinic? No. Do I care that you did a fellowship? No. If anything that will deter me even more from hiring you because I know you will want to command 400k and I'm looking to cut overhead here. Trust me, I will find a CRNA willing to do that heart case. Do I care that they are not board certified in TEE? No, I don't. Once again, as long as it gets done I could care less. Now that medicine has progressed from private practice to corporations employing providers they will take advantage of the situation in any way possible to maximize profits for corporate executives and shareholders. This is happening in virtually every field of medicine so it's not something specifically with anesthesiology. In case you haven't noticed, ARNPs are now big in ERs, ICUs, IM, Pediatrics, Family Medicine, etc. Midwives are huge in OBGYN and psychologists are now prescribing medication in many places. Salaries are going down across the board so get used to it. Paying off those loans will get ever more difficult. I feel bad for Pathologists and Radiologists now because they have to compete on a global marketplace for a job. You have to do something that accepts no insurance or government payment where you are the boss running your own practice as a plastic surgeon, dermatologist, ophthalmologist, etc. in a wealthy unsaturated area. Otherwise, go corporate.

The AMCs still have to get contracts from the hospital execs. Why would a hospital keep an AMC using all crnas when they could have another AMC provide the same coverage with a care team model? The patients won't save money. The surgeons won't have an easier time booking cases. There's no reason to go with an AMC of crnas from the hospitals point of view, so it makes no sense from the AMCs point of view.

If the hospital employs crnas directly then at least you could argue that they benefit financially from hiring crnas only, but not if they use an AMC. If they hire crnas directly, then surgeons have to be willing to accept inferior care for their patients with no benefit in return. That's why you see crnas employed by facilities owned by the surgeons/where they get a kickback from the anesthesia or in remote areas with rural pass-through.

No one anywhere ever choses crna-only care unless they are getting paid to do so or have no other options.
 
Plank, do you not recommend this field to current medical students? From reading older threads, you seemed way more optimistic about anesthesiology back then than now. Many of us are just looking for a non-surgical specialty where we don't have to talk all day, but rather take pride in being good at what we do. Rad/path is too isolating. What else is there?
Unfortunately anesthesiology is no longer what it used to be, and the future of this specialty is very questionable.
If you like procedures and little talk I would recommend interventional radiology.
 
  • Like
Reactions: 1 user
Unfortunately anesthesiology is no longer what it used to be, and the future of this specialty is very questionable.
If you like procedures and little talk I would recommend interventional radiology.
Turf wars aplenty, have to get trained in diagnostic radiology (deal-breaker), excessive radiation exposure, wearing 20 lb lead vest all day every day causing back problems, constantly evolving specialty (you are always behind on the latest procedures).
 
  • Like
Reactions: 1 user
Unfortunately anesthesiology is no longer what it used to be, and the future of this specialty is very questionable.
If you like procedures and little talk I would recommend interventional radiology.

It's interesting you mention that because I was thinking anesthesiologists should've attempted to encroach on IR instead of trying to pursue salvation through the PSH. Cardiologists, Vascular Surgeons, Neurologists, etc. have all encroached to take the money making IR procedures. Why not anesthesiologists? I think the future of everything procedural/surgical will eventually be done by interventional procedures. Most of the pain fellowships are centered around IR procedures at this point anyway.
 
Wow the doom and gloom on this thread is amazing. It's not currently as bad as many describe and it most likely won't be as bad as most think.
We will more than likely not continue to make the kind of income we have been but we will still make a good living and will continue to be a big part of anesthesia services in most hospitals for the foreseeable future.
It's is possible that the PSH will funnel more money away from the surgeons and into the hands of the ones taking care of the pts pre and post op.
It's possible that hospitals will just hire these folks and pay them a salary.
Nobody really knows and to sit here and claim the sky is falling just isn't my M.O.
 
  • Like
Reactions: 1 user
Turf wars aplenty, have to get trained in diagnostic radiology (deal-breaker), excessive radiation exposure, wearing 20 lb lead vest all day every day causing back problems, constantly evolving specialty (you are always behind on the latest procedures).

They've started exclusive IR residencies now, but I'm sure they are extremely competitive to get into. I agree with everything else you said though.
 
The AMCs still have to get contracts from the hospital execs. Why would a hospital keep an AMC using all crnas when they could have another AMC provide the same coverage with a care team model? The patients won't save money. The surgeons won't have an easier time booking cases. There's no reason to go with an AMC of crnas from the hospitals point of view, so it makes no sense from the AMCs point of view.

If the hospital employs crnas directly then at least you could argue that they benefit financially from hiring crnas only, but not if they use an AMC. If they hire crnas directly, then surgeons have to be willing to accept inferior care for their patients with no benefit in return. That's why you see crnas employed by facilities owned by the surgeons/where they get a kickback from the anesthesia or in remote areas with rural pass-through.

No one anywhere ever choses crna-only care unless they are getting paid to do so or have no other options.

You are assuming that some AMCs will continue the ACT model, while others go exclusively CRNA. I personally believe once an AMC goes all CRNA, the rest will follow suit. The whole purpose this is happening is because the patients refuse to pay for health care and there are too many middle men between you and the patient that need to take a piece of your pie. Nurses book cases now so I don't know what that has to do with anything. Hospitals will go with AMCs that provide CRNA only care because it may become the status quo in the near future and already is in certain places. If the hospital is hesitant, the AMC will negotiate a deal that they will accept while still making a considerable profit. Surgeons don't know anything about anesthesia and quite frankly most of them don't care. I've noticed only the CT surgeons actually care who's back there. I'm sure the hospital will incentivize them to accept it assuming they aren't already okay with it. When you are cutting 200k in overhead on average per CRNA, there is a lot of extra money to work with to make it attractive for all parties involved. Business follows the basic principles of economics, which haven't changed since the beginning of time. Everything I'm discussing will be 5-10 years from now assuming everything continues as projected. I think it's inevitable barring a miracle (Obamacare gets repealed, laws requiring physician care are passed, groups stop selling out to AMCs, AMCs are held in check, AAs get licensed in every state and become the premier mid level provider, AAs undercut CRNAs and take many of their jobs, etc.)
 
Last edited:
  • Like
Reactions: 1 user
I have just realized today that anesthesiologists are to surgeons what radiologists are to internists. In a corporate environment, an internist couldn't care less who reads the x-Ray, as long as the person is competent. The radiologist is a faceless, nameless corporate entity who helps them do their job.

Believing that we are anything more than this to surgeons (or bean counters) is just denial and a recipe for disaster. We have to start thinking like business people and figure out ways to make ourselves as irreplaceable as possible at our workplaces. If other people could do your job better or cheaper, sooner or later they will. This whole "I did not go into anesthesia/medicine to do X" is a luxury that will soon go away, if one wants to have a job. Start thinking like business people, start befriending your administrators, make yourselves useful for them, especially by figuring out ways to continuously save money, even if it means working more. If you don't, somebody else will. You can't stop change, not while we are as disorganized and easy to rule as today.

Just food for thought.
 
Last edited by a moderator:
  • Like
Reactions: 1 users
I have just realized today that anesthesiologists are to surgeons what radiologists are to internists. In a corporate environment, an internist couldn't care less who reads the x-Ray, as long as the person is competent. The radiologist is a faceless, nameless corporate entity who helps us do our task.

Believing that we are anything more than this to surgeons (or bean counters) is just denial and a recipe for disaster. We have to start thinking like business people and figure out ways to make ourselves as irreplaceable as possible at our workplaces. If other people could do your job better or cheaper, sooner or later they will. This whole "I did not go into anesthesia/medicine to do X" is a luxury that will soon go away, if one wants to have a job. Start thinking like business people, start befriending your administrators, make yourselves useful for them, especially by figuring out ways to continuously save money, even if it means working more. If you don't, somebody else will. You can't stop change, not while we are as disorganized and easy to rule as today.

Just food for thought.

Netflix came on the scene in 2000 and everyone's first thought was Blockbuster is going to go out of business. Sure enough, 10 years later Blockbuster filed for bankruptcy. It's not difficult to see obvious trends or make insightful inferences based on what is currently going on. I see a similar situation here unless something drastically changes.
 
  • Like
Reactions: 1 user
Netflix came on the scene in 2000 and everyone's first thought was Blockbuster is going to go out of business. Sure enough, 10 years later Blockbuster filed for bankruptcy. It's not difficult to see obvious trends or make insightful inferences based on what is currently going on. I see a similar situation here unless something drastically changes.
You really want to beat me at unpopularity.
 
  • Like
Reactions: 1 users
Mobile primary care? Earning $750 per day on avg? Primary Care??? Are you kidding me?

No. $750 x 5day/week x 48 weeks/year = $180k. There are family practitioners and pediatricians that would KILL for a salary like that.
 
They've started exclusive IR residencies now, but I'm sure they are extremely competitive to get into. I agree with everything else you said though.
I'm fairly certain that the direct IR pathway is basically the same thing except you cut one diagnostic rad year for an IR year...
 
No. $750 x 5day/week x 48 weeks/year = $180k. There are family practitioners and pediatricians that would KILL for a salary like that.
How is that a better alternative to Anesthesiology? CRNAs can even make that much as per gaswork.
 
I'm fairly certain that the direct IR pathway is basically the same thing except you cut one diagnostic rad year for an IR year...

just a little different..typically they are 6 years total, three and three. Instead of 5 and 1.

I have/had the inside track to IR. My longtime mentor is probably the biggest name in IR and I was on that pathway until I started an anesthesia rotation and then changed gears. Ive already matched and am starting an anesthesia categorical residency but threads like this and probably 40% of the others on the main page make me second guess my decision.

One problem with IR is that 100% IR jobs are hard to get. Most likely will have some large % of just reading images which might be good to some, but to me it was the image reading that I am just not as fond of.
 
I personally believe that IF an AMC goes all crna they will lose contracts because they are not competitive with ACT AMCs. There is no benefit to the hospital but there IS, I believe, harm, so there's no reason for hospitals to accept it.

You are assuming that some AMCs will continue the ACT model, while others go exclusively CRNA. I personally believe once an AMC goes all CRNA, the rest will follow suit. The whole purpose this is happening is because the patients refuse to pay for health care and there are too many middle men between you and the patient that need to take a piece of your pie. Nurses book cases now so I don't know what that has to do with anything. Hospitals will go with AMCs that provide CRNA only care because it may become the status quo in the near future and already is in certain places. If the hospital is hesitant, the AMC will negotiate a deal that they will accept while still making a considerable profit. Surgeons don't know anything about anesthesia and quite frankly most of them don't care. I've noticed only the CT surgeons actually care who's back there. I'm sure the hospital will incentivize them to accept it assuming they aren't already okay with it. When you are cutting 200k in overhead on average per CRNA, there is a lot of extra money to work with to make it attractive for all parties involved. Business follows the basic principles of economics, which haven't changed since the beginning of time. Everything I'm discussing will be 5-10 years from now assuming everything continues as projected. I think it's inevitable barring a miracle (Obamacare gets repealed, laws requiring physician care are passed, groups stop selling out to AMCs, AMCs are held in check, AAs get licensed in every state and become the premier mid level provider, AAs undercut CRNAs and take many of their jobs, etc.)
 
They will get a sucker MDA as firefighter, and problem solved. Best of both worlds: "ACT" and 1:8 coverage. ;)

I think that's what some gasworks jobs are about.
 
just a little different..typically they are 6 years total, three and three. Instead of 5 and 1.

I have/had the inside track to IR. My longtime mentor is probably the biggest name in IR and I was on that pathway until I started an anesthesia rotation and then changed gears. Ive already matched and am starting an anesthesia categorical residency but threads like this and probably 40% of the others on the main page make me second guess my decision.

One problem with IR is that 100% IR jobs are hard to get. Most likely will have some large % of just reading images which might be good to some, but to me it was the image reading that I am just not as fond of.

Yes, IR does have some level of job security, but that field has a whole set of problems too. They are finding higher incidences of cancer in IR specialists, wearing all that lead will eventually take a toll on you, IR is losing a turf war to all of the other fields that have their own patients and that trend will continue as many IM subspecialties and surgeons continue to encroach, and IR specialists live in the hospital and have a poor quality of life working 24/7. Like I said before, nearly every field has some serious problems.
 
They will get a sucker MDA as firefighter, and problem solved. Best of both worlds: "ACT" and 1:8 coverage. ;)

I think that's what some gasworks jobs are about.

I really loved that one posting where the CRNA was one running the group LMFAO!!! There is some serious comedy on there.
 
I really loved that one posting where the CRNA was one running the group LMFAO!!! There is some serious comedy on there.
Welcome to the desert of the real, Neo!

Groups are businesses, and there are all kinds of individuals owning or running them. I mean, just look at @Consigliere. :D
 
Last edited by a moderator:
  • Like
Reactions: 1 user
How is that a better alternative to Anesthesiology? CRNAs can even make that much as per gaswork.

Didn't say it was better, just that it's an alternative. And I pay our CRNAs more than that.
 
I really loved that one posting where the CRNA was one running the group LMFAO!!! There is some serious comedy on there.
I don't think there's anything funny whatsoever about CRNAs diplacing physician anesthesiologists and taking their jobs.
 
  • Like
Reactions: 1 user
I don't think there's anything funny whatsoever about CRNAs diplacing physician anesthesiologists and taking their jobs.

That's not what I was laughing about. I found the idea of a CRNA running a group to be so ludicrous and ridiculous that the thought of it actually coming to fruition in the real world is unfathomable to me. I would put it in the same category as Bernie Sanders becoming president and implementing a 90% tax rate and pigs flying.
 
Last edited:
Welcome to the desert of the real, Neo!

Groups are businesses, and there are all kinds of individuals owning or running them. I mean, just look at @Consigliere. :D

But seriously, Consigliere is probably busting his ass running that group. I just hope he doesn't sell out to an AMC. FFP aren't you at an academic institution?
 
Top