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Why do Anesthesiologists get paid so much?

Discussion in 'Anesthesiology' started by CowsLoveJourney, Mar 23, 2009.

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    This is not about me being against the higher pay, but simply not knowing why. Most of this is speculation, but it seems a lot of the lesser traditional positions make the more money. Kind of like Radiology, or Dermatology. By less traditional, I mean not your typical stressful examine, diagnose, prescribe/treat doctor. I know Derm is, but stereotype is, it has better hours, no emergencies, less tress. I hope you get what I'm saying lol.

    Pretty much, what does Anesthesiology do that brings in such great money?
  2. RxBoy

    RxBoy

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    High liability job, always doing stuff (blocks, pumps, intubations, pain, ect.), very fast and efficient, keep the OR turnover as short as possible.

    When an anesthesiologist puts in 12 hour shift, they usually work the entire 12 hours. Very little down time, many times don't even eat lunch.

    Refer to this thread as well:
    http://forums.studentdoctor.net/showthread.php?t=534873
  3. asmallchild

    asmallchild Moderator Lifetime Donor

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    procedure based fields reimburse better

    for now
  4. Well that leaves me with a more detailed question. My step recently had spine surgery. I looked at his bill, and the surgeon works apart from the hospital but uses the hospitals OR. It was a 3 1/2 operation where they fix some nerve damage around some disks. Well the Surgeon got about 9.5K, the Anesth got about 2K and the hospital got 20K. Did the surgeon really just make 3K an hour, or does he lose a great bit of that? And other then paying for staff compensation, why did the hospital charge so much to rent a room for so much? Is it simply cause they can? There entire budget requires it? The equipment is so ridiculous?

    I really don't understand how the money part of medicine works.
  5. asmallchild

    asmallchild Moderator Lifetime Donor

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    sadly, most medical students don't either
  6. Bertelman

    Bertelman Maverick!

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    Your step, who appears to have good insurance, just subsidized the same surgery for two other people with Medicare.
  7. panetrain

    panetrain

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    The surgeon/hospital/anesthesiologist gets paid an amount that was determined in a contractual agreement with the insurance company. The dollar amounts you have listed where the billed amounts for the procedure. The actual paid amounts will be a fraction of the billed amounts. :eek: The size of that fraction was pre-determined in the contract. Billed amounts and collected amounts are very different.
    It is my estimate that the actual amounts collected for this procedure are 2-3K to the surgeon/ 3-5K to the hospital/ 400-800$ anesthesia. And remember, the surgeon's office overhead is about 50% so they will only net 1-1.5K and be taxed 50% of that thus netting only 500-750$ to take home.:scared: One more thing to keep in mind. This is a well insured patient. Poorly insured patients will yield only a fraction of this amount :eek::eek::eek::eek:. As you can see, it does not add up to the millions like most people think.



  8. How many people manage to actually pay this if they don't have insurance? My understanding is, people who don't have health insurance either have no jobs, or really ****ty jobs, both leaving them with next to no spending money. Is this my realization of a bad economy and why everyone is in debt?
  9. panetrain

    panetrain

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    People with no insurance are called "self pay"
    (at my hospital, self pay make up over 50% of our patients) and rarely if ever pay one dime. These patients flood through the doors of every ER in the USA and end up in every OR in the USA with emergency surgeries and the docs including the anesthesia will never receive one dime for their services.:scared::scared::scared:. However, they assume all the risk for treating these patients. One mistake could cost the docs their careers/kids college funds/house etc....:thumbdown:thumbdown:thumbdown:thumbdown:thumbdown:thumbdown

  10. Bertelman

    Bertelman Maverick!

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    Wrong. Many industries don't routinely provide insurance. Waiters. Valets. Basically any company with less than 50 employees is not required to provide health insurance. There are thousands of small business owners that do not provide insurance to their employees.

    What about college students? Very few of them have reliable insurance.

    A few points:
    ~Over 8 in 10 uninsured people come from working families – almost 70 percent from families with one or more full-time workers and 11 percent from families with part-time workers.2
    ~The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 62 percent in 2007. This is the lowest level of employment-based insurance coverage in more than a decade.
    ~In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member.6
    ~In 2007, 37 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium even when coverage is at their fingertips.1
    ~Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2007 – 28.1 percent of this group did not have health insurance.1
    Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more.1 A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.
  11. How do you fix this?
  12. lord_jeebus

    lord_jeebus 和魂洋才 Moderator

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    Supply of anesthesiologists.

    Demand for anesthesiologists.

    Lobbyists. Donate to ASAPAC today!
  13. panetrain

    panetrain

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    The only way that this is going to be pseudo-fixed is to redistribute resources and wealth evenly to everyone regardless of individual productivity (see Obama and socialism). This will result in plummeting physician salaries. My advice to pre-meds is to apply to your state med school only! Private money machine (30-50K and up per year) medical schools are so damn fiscally irresponsible in this new era and IMO are one of the biggest scams in medicine today. You will never be able to repay your debt and lost opportunity costs. These money machines know the end is near and are raising their class sizes and tuition at staggering rates to get your money while lenders are willing to hand it out.:eek: In the near future, the only way to entice students to enter medicine will be to subsidize their education at state owned institutions. These private med schools currently bank on pre-med's ignorance regarding the financial future of medicine. I have noticed that the average med student's understanding of the economics of medicine is outdated by 2-4 years and the average understanding of the economics of medicine of a pre-med is 4-8 year outdated or nonexistent.
  14. AK_MD2BE

    AK_MD2BE New Member

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    As an MS3 paying 48K/year in tuition...I couldn't agree more.
  15. highvoltage

    highvoltage

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    They come in to work extra early every morning and every morning they think that it is a REAL possibility that someone will and can die today and they will be directly responsible for that. How much do you pay someone for that? Not to mention all the things everyone else has just mentioned. Stress, the constant motion of the specialty, no lunch, procedures. Its a lot of work. The who examine/ diagnose and write a prescription is not as stressful in my opinion. Its low level stress constantly for a long continuous period of time with bursts of high stress here and there . Try that for 30 years.
  16. panetrain

    panetrain

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    I would argue that anesthesia results in the most accumulation of stress units over any other specialty. Furthermore, I think anesthesiology residency is the most stressful as well. This stress accumulation leads to poor sleeping habits, weight gain, bitterness, burnout, irritability, relationship problems, divorce, drug abuse, ETOH abuse etc....On top of maintaining patient survival while their being gnawed on by the surgeon and poisoned by toxic anesthetics, you have to deal with the most difficult personalities in medicine (surgeons and OR personnel):scared:.


  17. bigdan

    bigdan SDN Donor

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    Take this to heart, pre-meds. We (fourth years at my school) just had our debt management/loan repayment meeting today. This was one hell of an eye-opener, especially after the intoxication of Match Day happiness.

    The government has just changed some of the repayment requirements for federal loans, and most importantly, has eliminated some of the easiest pathways with which to get economic hardship deferment that residents have relied on for a little while to keep from repaying their loans during training. I had failed to grasp exactly how much money it is that we are really paying back over the 10 (or 25 or 30) years...the average debt is something like 150K for a med student now, but the amount that you actually pay back is RIDICULOUS.

    *sigh*

    dc
  18. Lonestar

    Lonestar Senior Member

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    Well, I just put 20 pts to sleep today. 1 gave me trouble. Pt was apneic in the recovery room b/c CRNA decided to give my pt 1mg of Dilaudid on top of the 150 mcg of fentanyl the pt received in the OR in the last half hour of surgery.

    After doing my nerve block in the holding area, I walk over to the Pacu to check on my other pts. As i walk in, I observe an apneic pt with O sat in high 70s. Pacu nurse is fiddling around with the pulse ox which shows a pulsatile pattern. I get an ambu bag and a mask and ventilate this pt. Get the sats up. Give narcan and flumazenil. And viola. Pt is awake and breathing. Alert and Oriented. No issues. Then i go over to the OR 4 and have a chat with my CRNA.

    How much would would you pay me if this pt was your mother?

    Oh and BTW, I have 170K in student loans which will take years for me to pay back. I had 136K in loans which turned into 170K after residnecy.
  19. Bertelman

    Bertelman Maverick!

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    Sorry, I think that would have to be surgery
  20. Alright, but what about Pain Management. Everywhere I look job advertisments, PM is always paid more then operations. Unless there is more then putting opiates and what not into a sober person, then that makes no sense. (Again, speculation. Really have no idea)
  21. Gern Blansten

    Gern Blansten Account on Hold

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    It is funny that most don't have any idea what a pain management clinic is. I had a surgery resident tell me the other day that she doesn't know how anyone could do pain because it would just be like a family med clinic writing opioid scripts all day long and very boring. She had no idea of the procedural side of pain work.
    Cows, I wonder what your agenda is here. This forum has been inundated with premed students who have no clue about medicine and wish to inform all of us how it should be run. If that is your goal, please spare us.
  22. panetrain

    panetrain

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    I've got a board certified general surgeon in my anesthesia program (CA 3) who would disagree!

  23. Bertelman

    Bertelman Maverick!

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    Fair enough. I've got 14 fellow co-residents in my anesthesia program that would definitely agree.

    Care to take this point over to the surgery forums? Or maybe we can check ACGME numbers on average hours worked per specialty. Of course, the surgery numbers would be artificially low, as they are much more likely to underreport duty hours.
  24. mercaptovizadeh

    mercaptovizadeh ἀλώπηξ

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    136 > 170 in just 4 years because of accrued interest?
  25. pgg

    pgg Laugh at me, will they? Moderator

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    5-6% isn't unusual these days. Do the math.
  26. ozzie20

    ozzie20

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    There aren't many pre-meds who know this much about anesthesia, and there are even fewer of them who know that you can get to pain management by going through anesthesia.
  27. powermd

    powermd Lifetime Donor

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    On what planet is an anesthesiology resident more stressed out than pretty much any surgery resident? The hours and sleep deprivation alone make for a much more stressful life. I had 3 full weekends off per month at Columbia during my residency. Sure, we were busy during the week, and put in solid 10-12, and occasionally 15 hour days. But the surgeons were doing 15+ hrs every single day. I never had to lie about my hours. All of the surgeons did. I spent most of my days reading journals, or working on projects on my laptop all day as the patient's slept. The surgeons got to be on their feet operating. They're on call all the time, and their pagers are always going off with floor issues and ER consults. I was only on call occasionally, and only as the team captain did my pager go off routinely.

    Maybe out in practice things even up a bit, but surgeons still take a whole lot more call than we do. And they have to make much tougher decisions that have great impact of quality and length of life. Very little of our work is truly elective (epidural or no epidural, CVL, or no CVL, AL or no AL). We either do the case (99.99% of the time), or postpone it.

    Pane, I like your posts, but I think that was a brain fart.
  28. My agenda is to find out what I want to know. Like i said in original post, this is a question, not a statement. I have no idea what Anesthesiologists do in pain management. I know that you all do more then just sit around while the surgeon works. I know you're REAL doctors. I'm just trying to fill in the gaps of what I do not know, because Anesthesiology is one of my (so far) preferable choices. That or Psychiatry. And let me tell you, I really don't want to do Psychiatry, I just happen to be good with Psychological part of the brain. But I'm fascinated by medicine, and want a position where I get to see, exactly what I do, and get to witness the medicine working before my eyes.
  29. LonghornJPS

    LonghornJPS Member

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    I'm curious... what makes it one of your preferable choices? The money?
  30. panetrain

    panetrain

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    I second that. You have stated that you don't know anything about the field, yet it is one of your top choices???? If this were an interview for medschool or residency... you would have just F'd yourself!!!:eek:


  31. Gern Blansten

    Gern Blansten Account on Hold

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    So, your top choices for a career in medicine are anesthesiology (which you have no idea what we do) and psychiatry (which you seem to despise). If you go into medicine, you will be miserable. Although, I think psych would be the better choice for you. Like my med school classmates that chose that field, perhaps you can diagnose what disorder it is that would make you do this to yourself.
    I am curious. What is your motivation for going into medicine? Since you are on a medicine forum discussing money and not medicine, one has to assume it is money. You will be a sad shell of a person when you finish if you do it for the money. I would say that the money is going away quickly and your return on a huge investment will be sparse.
    Best of luck.
  32. Bluemirage

    Bluemirage Senior Member

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    I agree with what has already been said about your questionable motives. Your posts have mostly concentrated on the reimbursement and financial issues rather than the more important questions about the field: the actual practice and science of anesthesiology itself. I don't even know what to say about your comment about Psychiatry. Why would you want to put it as one of your "choices" when you "really don't want to do it?" If you are really sincere about finding out more about anesthesiology then you should find one in your area and spend some time doing some shadowing.

  33. Bluemirage

    Bluemirage Senior Member

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    Perhaps if we told the OP that some Child Psychiatrists can make $400K+ in some areas working less than 60 hours a week and that anesthesiologists are about to take a hit in reimbursement then maybe he/she will suddenly have a change of heart and choose psychiatry.
  34. goosedander

    goosedander

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    So would you. Or are you one of the noble ones?
  35. Bluemirage

    Bluemirage Senior Member

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    No..nothing with being "noble." I am not one of these bright eyed people that got into medicine with the "save the world" mentality without perspective into the practicalities of finances (as you are trying to imply). I gave up a $100k+ per year career working less than 50-60 hours/week to pursue medicine. Why? Because I was not getting the career satisfaction I was looking for. I've never said money is irrelevant but I would want to at least make sure I like the clinical practice of the field first. It's not much good getting paid the big bucks if you hate your job everyday. You have to admit, the OP has not asked anything about the field itself except for the money. Every question on this post have been money related and his/her decision seems to be purely financially driven. I'm alittle confused as to why you would support the OP's posts?
  36. goosedander

    goosedander

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    Because money is at the top of most people's minds, especially when they're at the place in life where they're forced to choose a career. Money seems like a good starting point for determining the contenders. Hell, you did it yourself. You chose a career, presumably based on money, and later found no satisfaction in it. I'd bet if that 100k salary were bumped up to 400k, your satisfaction level might rise a bit.
  37. Code Brown

    Code Brown Low man on the totem pole

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    While the thread has deviated from the original question, part of the reason that the surgeon gets his 9.5K is that this fee most often includes any and all associated pre-op, hospital rounding, and follow up visits. Some can bill out seperately for each, but most get a global fee (or whatever your hospital calls it).
  38. Bluemirage

    Bluemirage Senior Member

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    Please re-read my post. Let me repeat what I had stated since it seems like you have missed my point. I never said money is irrelevant. Ofcourse it is important given the amount of loans and sacrifices we are making in our medical education. But money should not be the sole determining factor of your career decisions. As for why I chose my previous career, it was definitely not for the money because I could have easily just gone into something like I-Banking with my finance degree if that was my primary motive. Your implication that I had left because I was "only" making 100k and would have stayed for 400k is just silly. I left because I did not see myself happy in the industry for the rest of my career. Assume that I was content to not get promoted and stayed at low 100's/year, I am losing over $1 million in opportunity cost and owe $180,000 in medical school loans + interest (assume 4 years med school + 4 years residency +1 year fellowship) after I'm done. I would have been financially better off at my old career assuming promotions. Not everyone is as focused on money as you and the OP. Some of us actually have an interest in the science and practice of medicine.
    Last edited: Mar 24, 2009
  39. Are you serious? I hope I'm not in a state of mind to refer to a forum, when I'm about to put myself into a situation as serious as if I was getting ready for an interview. I'm just at the beginning.

    You all are going to try to school me on priorities and motives in medicine simply because I've chosen to discuss money? I would assume that when you spend 12 years of your life in education for a career, the money matters. I'm interested in Anesthesiology because it is fascinating. I believe I may be good at it. It is something I could master easier then some areas (Surgery, Cardiology). The money is good. I've always thought that I belonged more to Psychiatry, but after seeing what your average Psych does, I don't want to spend the rest of my life prescribing SSRI's. I want to be able to come in, push some medicine, keeping the patient alive, safe, and comfortable through the procedure, and walk out with very little medical concern afterwards.

    I mean don't get me wrong, I want medicine for the challenge, money and respect, but also because you get to serve people in a way that no one else can. People come to you if they're about to die, or in any other kind of harmful situation, and you help. Yeah, I want to help people. Don't accuse me of being hungry for self importance and gratuity, now. It's a combination of everything that makes the field of medicine exactly what I want. And I have no interest in nursing, being an assistant or technologist. I want to be the doctor. And be an Anesthesiologist so I can read newspapers while the surgeon works and make people quit complaining when they're hurting from the cancer.
  40. Coastie

    Coastie Junior Member

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    Three weekends a month? I didn't know Columbia was that chill.

  41. ProRealDoc

    ProRealDoc Anti-AANA

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    Is that is your view of the anesthesiologists' work, I suggest you find another career. We don't need idiots like you in our specialty.
  42. Jeff05

    Jeff05 Senior Member

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    anesthesiology is not "easier" than cardiology, etc. it's very different. also, if you want "respect" anesthesia is NOT the field for you.


  43. I want respect as a doctor in general. And I didn't say it was easier, I said it was easier for ME.

    You all need to chill the **** out and pay attention. I know you're good at it.
  44. Jeff05

    Jeff05 Senior Member

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    easier for you...
    like you KNOW what cardiologists do and you KNOW what anesthesiologists do...
    have you tried doing both and have found anesthesiology to be easier? or do you understand the key skill sets and cognitive issues in both professions?
    did you pick up all that information while failing high school or in community college?

    dude, you're just starting out. no need for profanities. calm down. that fiery temper will not serve you well in medicine.


    Last edited: Mar 24, 2009
  45. Look up see where I've mentioned how I have no idea what I'm talking about. Maybe the stress is getting to you all, because you all are acting like I've thrown sand in the eyes of your child. I'm an early premed looking for answers so I know that this is the right field for me. Soon enough I will shadow, and will bug that doctor about everything. Until then, just answer my ignorant questions and don't jump to conclusions.

    I swear I'm being trolled.
  46. proman

    proman Member Moderator

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    He also wrote of the "occassional 15 hour day". That's brutal.
  47. Jeff05

    Jeff05 Senior Member

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    the vast majority of people starting medical school change their mind about their specific speciality during 3rd or 4th year of med school. don't worry about the specifics - because it is TOO EARLY for you to appreciate or understand the nuances. just do some shadowing and study hard.


  48. jetproppilot

    jetproppilot Turboprop Driver

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    Speaking from my shoes, a dude with 13 years private practice experience,

    I don't even know where to start addressing the issues in this thread.

    So I'm gonna make a Patron margarita instead.:laugh:

    All I'll say to you, Slim, is I hope you're six-foot-four sporting at least 275 lbs with NO MORE THAN seven percent body fat.

    Cuz thats what its gonna take to back up naive, flagrant posts from a college student here.

    P.S. Theres NO WAY you can "know" a certain medical specialty is "for you" when you're in college unless you're planning on going into practice with your dad.
    Last edited: Mar 24, 2009
  49. Gimlet

    Gimlet Cardiac Anesthesiologist

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    I think he meant he is looking for answers so he can know that this is the right field for him. Poorly worded, but I don't think he's that presumptuous. Although it is rather presumptuous for him to assume that anesthesiology will be easier (for him) than cardiology.
  50. akpete

    akpete Drinks, anyone?

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    Yet he thinks he knows psychiatry is for him. Until he apparently realized what they do. I wonder if that will become a habit.

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