Why—Or Why Not—Go Into Anesthesia, by Karen Sibert, MD

[Carbocation1]

http://in-training.org/why-not-not-go-anesthesia-karen-sibert-md-9276

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[kortneeluv]

Great read! I really enjoyed this. Thanks for posting!

 

[gasdoc77]

I particularly like the nod she gave to investment banking.

 

[RK.md]

Wonderful post!

 

[Urzuz]

If only I got into Wharton...

The grass is always greener. My brother actually went to Wharton and did investment banking on Wall Street and hated his life for that short period. For him, there was no use in earning a ton of money if he didn't have time to spend it and didn't see his family for days on end.

It's all about an individual's personality; some people will be miserable regardless of what they do, how much money they have, and how great they have it in the grand scheme of things (look no further than this message board). Adjust your psychology and learn to appreciate what really matters in life and you'll be happy.

 

[deleted171991]

Investment bankers hate investment banking (because of the hours and amount of work, very much like medicine)... until they get a bit of experience and start out on their own.

Great article, by the way.

 

[BLADEMDA]

But, sometimes the grass really is greener. Why go into a field where 75% of the graduates will be an employee of some sort when there are better options? Why enter a field where greedy middlemen suck out the money while you do all the work? Or, a field where Nurses are reimbursed at exactly the same level as Physicians who are Board Certified in their field?

If there is NOTHING else which floats your boat or your Step 1 scores are not competitive for a better specialty then by all means choose Anesthesiology. But, the fact of the matter is most Med Students could be just as happy in Specialty "y" vs Specialty "X" if only they could see the outcome of that choice 10 years post residency. Unfortunately, this type of myopia isn't easily corrected with glasses.

 

[bashwell]

Currently, and as Siebert mentioned she was also interested in in her article, pulm/cc is similar-ish to anesthesiology and has a better future.

 

[WastedTime]

But, sometimes the grass really is greener. Why go into a field where 75% of the graduates will be an employee of some sort when there are better options? Why enter a field where greedy middlemen suck out the money while you do all the work? Or, a field where Nurses are reimbursed at exactly the same level as Physicians who are Board Certified in their field?

If there is NOTHING else which floats your boat or your Step 1 scores are not competitive for a better specialty then by all means choose Anesthesiology. But, the fact of the matter is most Med Students could be just as happy in Specialty "y" vs Specialty "X" if only they could see the outcome of that choice 10 years post residency. Unfortunately, this type of myopia isn't easily corrected with glasses.

what specialty do u suggest?

 

[bashwell]

If you are a top student I believe Blade has recommended surgical specialties.

If you are an average student I believe Blade has recommended IM then subspecialty like cards, GI, or heme/onc, or anesthesiology with fellowship in peds, pain, cardiothoracic, or critical care.

But that was maybe over a year ago, not sure if Blade would still recommend the same today.

http://forums.studentdoctor.net/threads/question-for-blade.997886/

 

[kkinase]

EM is hot, PMR and Psych are lifestyle oriented and gaining popularity with salaries rising yearly

 

[imfrankie]

That's really the part I don't think I will ever understand. Why allow these people to dictate to you how things will run when you are the board certified physician? Without you, there is no party. They can't survive without you and are the definition of parasites. Why not just take the heavy dose Amphotericin B already? Also, why are nurses reimbursed the same? I don't understand how that happens or how they get away with that. Is there even an argument to support that?

The argument is you don't own the patients--the insurance provider does.

 

[Carbocation1]

@BLADEMDA
Wouldn't anesthesiologists/perioperative medicine specialists be valued providers under a single payer system which emphasizes cutting cost? Much of the premise of the PSH is to cut cost and reduce waste.

 

[NOsaintsfan]

I don't care who owns the patient. The fact remains that a board certified anesthesiologist is needed and without you the insurance company might as well not exist. If every anesthesiologist decided that enough was enough, the insurance company would have to comply with your new demands because they need you. If the patient cannot receive medical services, they will not pay for health insurance and the provider will go out of business. I don't think physicians realize how important they truly are in this whole equation. These hospitals and insurance companies will do everything in their power to make you believe you are powerless, but that is far from the truth.

The bolded is the hard part. You are correct in principal but actually making that happen is a different story all together. Physicians as a whole are adverse to controversy. What you are suggesting is basically a strike or collective bargaining with hospitals/insurance companies. It would be extremely difficult to get docs to organize and collectively negotiate like you suggest. Not impossible but very difficult. I would like to see it happen.

 

[Carbocation1]

In a recent editorial in the British Journal of Anaesthesia entitled Anaesthesiology and Perioperative Medicine around the World: Different Names, Same Goals, some of us argue that “regardless of what the model is called around the globe, we have to embrace our expanded role as perioperative physicians as our main value proposition.”2

Possible changes in the structure of anesthesiology training that would be required to realize our enhanced role in perioperative medicine range from (1) increasing the number of out–of–operating room rotations while keeping the current length of the residency training duration (base year plus 3 yr) to (2) lengthening the residency training (base year plus 4 yr).

Will gas become a 5 year residency like most other countries? If it does, will older graduates require additional training or will they be grandfathered in?

 

[deleted162650]

EM is hot

I'm not sure why EM is viewed as a better alternative to Anesthesia with regards to the future of the specialty/AMC's, pay, security, etc. EM pretty much wrote the book (literally, see The Rape of Emergency Medicine) on managment company take-overs/sell-outs, etc. Where do you think EmCare got its name. Mid-levels are enjoying increasingly independent roles in ED's across the county as well.

On the bright side, if it's still viewed as a viable specialty today, even after years of the above happening (long before it started in Anesthesia) then maybe we've got a fighting chance as well.

 

[nimbus]

I don't care who owns the patient. The fact remains that a board certified anesthesiologist is needed and without you the insurance company might as well not exist. If every anesthesiologist decided that enough was enough, the insurance company would have to comply with your new demands because they need you. If the patient cannot receive medical services, they will not pay for health insurance and the provider will go out of business. I don't think physicians realize how important they truly are in this whole equation. These hospitals and insurance companies will do everything in their power to make you believe you are powerless, but that is far from the truth.

Ever heard of opt out states? For the vast majority of cases, we are not "needed". I would encourage anyone in training or early in their career to focus on cases where we are indeed "needed".

And how do you propose anesthesiologists say enough is enough? Perhaps all new grads can work at Denny's instead of accepting any offer less than 400k.

Because we created an oversupply of anesthesia providers, our only leverage is to fill difficult niches.

 

[scutdoc]

I appreciate Karen Sibert's writings a lot. She's one of my regular anesthesia reads along with others like the Great Zs.

 

[AnesTiger]

It's important to remember that demand for different specialties changes over time. You aren't going to be able to read in your crystal ball how things will change and what the playing field will look like even 5 years from now.

The financial competition from midlevels will affect everyone except the most uniquely trained specialists. Read about section 2706 in the ACA and you'll see why. PAs are seeing ER patients with minimal physician supervision. Look at what's going on with the proposed changes in the VA Nursing Handbook--they would mandate independent practice for all advanced practice nurses, including NPs, nurse midwives, and nurse anesthetists, eliminating physician supervision altogether.

The ability to be a "rainmaker" is going away for all physicians except the most uniquely trained specialists. In general, patients will enroll in health systems, not seek out individual physicians. Some internists are going to "concierge" medicine, and getting away from all insurers, but if you work for a health care organization or are in a hospital-based specialty, you see all patients that the hospital accepts. Period. The recent passage of HR 2, which repealed the SGR, is instituting payment changes which will escalate the pressure on physicians to join large HCOs, abandoning private practice and fee-for-service payment. (If you don't know what I'm talking about, let me know and I'll be glad to provide links.)

So I would advise you, again, to go into the field which interests you most, and be the best physician you know how to be. It's impossible to predict how technology will evolve, and to predict how workforce needs will change. Who imagined even 20 years ago that so much radiologist expertise could be outsourced overseas?

 

[Psai]

nvm

 

[likeaboss]

It's important to remember that demand for different specialties changes over time. You aren't going to be able to read in your crystal ball how things will change and what the playing field will look like even 5 years from now.

The financial competition from midlevels will affect everyone except the most uniquely trained specialists. Read about section 2706 in the ACA and you'll see why. PAs are seeing ER patients with minimal physician supervision. Look at what's going on with the proposed changes in the VA Nursing Handbook--they would mandate independent practice for all advanced practice nurses, including NPs, nurse midwives, and nurse anesthetists, eliminating physician supervision altogether.

The ability to be a "rainmaker" is going away for all physicians except the most uniquely trained specialists. In general, patients will enroll in health systems, not seek out individual physicians. Some internists are going to "concierge" medicine, and getting away from all insurers, but if you work for a health care organization or are in a hospital-based specialty, you see all patients that the hospital accepts. Period. The recent passage of HR 2, which repealed the SGR, is instituting payment changes which will escalate the pressure on physicians to join large HCOs, abandoning private practice and fee-for-service payment. (If you don't know what I'm talking about, let me know and I'll be glad to provide links.)

So I would advise you, again, to go into the field which interests you most, and be the best physician you know how to be. It's impossible to predict how technology will evolve, and to predict how workforce needs will change. Who imagined even 20 years ago that so much radiologist expertise could be outsourced overseas?

Can you please provide links?

 

[AnesTiger]

http://www.internalmedicinenews.com...are-pay/4a6625d192514e7da3d34a3fc5cecc60.html

See also www.csahq.org, the website of the California Society of Anesthesiologists, and look for article called "Hunger Games of Payment" on the CSA Online First blog.

 

[deleted171991]

http://www.internalmedicinenews.com...are-pay/4a6625d192514e7da3d34a3fc5cecc60.html

See also www.csahq.org, the website of the California Society of Anesthesiologists, and look for article called "Hunger Games of Payment" on the CSA Online First blog.

http://members.csahq.org/blog/2015/06/08/hunger-games-payment-news-csa-house-delegates

 

[urge]

Will gas become a 5 year residency like most other countries? If it does, will older graduates require additional training or will they be grandfathered in?

In other countries you are an intensivist also. If the ABA extends residency without letting them sit for the critical care boards, then there is no point. It's just a wasted year.

I don't see a good reason to extend the residency so that you can do what their surgical PA does. That would be crazy.

Older grads always get grandfathered in. Do you know why? Because they are the ones in charge.

 

[Spinach Dip]

Will gas become a 5 year residency like most other countries?

Horrible idea.

One of the main reasons anesthesia remains a competitive residency (even in the face of mid-level encroachment) is because it remains on the shorter side of residencies. Add a year, and that "benefit" is lost.

And why would a year need to be added anyway? Is it because those being graduated currently are not safe?

 

[deleted171991]

There is no reason to extend anesthesiology residency. Whoever wants to do more periop can do a CCM fellowship.

 

[deleted171991]

One of the main reasons anesthesia remains a competitive residency (even in the face of mid-level encroachment) is because it remains on the shorter side of residencies.

No. It's because we always need another proof that doctors are not street-smart people.

 

[Spinach Dip]

No. It's because we always need another proof that doctors are not street-smart people.

LOL

 

[Consigliere]

Why? $$$ Why not? Everything else.