economics of anesthesia, plz here me out

The surgeon or the GI doc doesn't "hire" an anesthesiologist.

The anesthesiologist bills the patient or the patient's 3rd party pay for fees.

It doesn't cost the surgeon or the GI doc ANY money.

And medicare reimburses a MD or a CRNA the same money for the same procedure.

Chances are you're not going to find a CRNA in a plastic surgeon's office at $120k either.

militarymd said:

The surgeon or the GI doc doesn't "hire" an anesthesiologist.

The anesthesiologist bills the patient or the patient's 3rd party pay for fees.

It doesn't cost the surgeon or the GI doc ANY money.

And medicare reimburses a MD or a CRNA the same money for the same procedure.

Click to expand...

The truth. So, if it doesn't cost him anything, which one do you think he'll rather have?

You should go to med school b/c you want to be a physician, not an anesthesiologist. It's an interesting career and will guarantee you an upper-middle class or better job basically as long as you want anywhere that you want.

If you're looking at a career in medicine, or anesthesia care in particular, from a cost/benefit ratio then medicine is a bad choice. Move on. Or at least a risky one - there are lots of credible scenarios in which the anesthesiologist job market could turn really bad. Right now we don't compete with CRNA's on price - but it could easily happen.

Nursing is a great career. If you have a Bacheor's already, you can get a BSN in 18 months or less and you've got a guaranteed middle class job for life anywhere you want. You then have the option of moving on to NP, DrNP, CRNA and so on if you want, when you want.

That said - if I were advising someone, go to AA or PA school. You're trained more in a physcian than nursing model, which I find much more palatable.

urge said:

The truth. So, if it doesn't cost him anything, which one do you think he'll rather have?

Click to expand...

depends...if the person needing anesthesia services is someone who wants 2 rooms, so that he can flip rooms....

do you think 2 anesthesiologists are willing to staff those 2 rooms...and essentially sit around half the day while the GI doc makes a killing because he has no turn over???

2 CRNAs are more likely willing to do that....and it that case...the CRNA wins....because $$$$ always wins.

militarymd said:

depends...if the person needing anesthesia services is someone who wants 2 rooms, so that he can flip rooms....

do you think 2 anesthesiologists are willing to staff those 2 rooms...and essentially sit around half the day while the GI doc makes a killing because he has no turn over???

2 CRNAs are more likely willing to do that....and it that case...the CRNA wins....because $$$$ always wins.

Click to expand...

I think you are talking more about likes and dislikes. 2 MDs could do it if they wanted to. But yeah, you are right. There is not too many of us willing to take a job like that.

Actually there is NO cost difference b/t CRNA and M.D. Both are paid the same for the same procedure by ALL payors. Insurance co/ Medi care pay the same for the service provided regardless of providers... There is no pay or cost difference in M.D. vs CRNA argument. e.g. lap chole RVU around 10 units x about 20/unit from medicare = 200. The bill can be sent by M.D. or CRNA. Anesthesiologists are in high demand because of their overall skill with multiple modaliites, sicker patients, judgement, experience and surgeons preferring the BEST care for their patients without taking on "extra" liability. I know of several hospitals who have lost surgeons and cases b/c of introducting CRNAs.

Yes and all FPs will be replaced with nps, and on and on and on and on. Eventually the janitors will not only clean the rooms but do the surgery and the anesthesia at the same time.

Laryngospasm said:

Yes and all FPs will be replaced with nps, and on and on and on and on. Eventually the janitors will not only clean the rooms but do the surgery and the anesthesia at the same time.

Click to expand...

You forgot about the part where Obama cuts salaries by 99% within 2 months of being president.

sevo85288 said:

Anesthesiologists are in high demand because of their overall skill with multiple modaliites, sicker patients, judgement, experience and surgeons preferring the BEST care for their patients without taking on "extra" liability. I know of several hospitals who have lost surgeons and cases b/c of introducting CRNAs.

Click to expand...

Come on guys ... stop thinking like anesthesiologists at a mutual admiration society meeting and start thinking like a capitalist.

Yes ... payors will pay the same for an anesthetic regardless of provider. What does that mean? The less an employer pays a provider the more that emplyer profits. Imagine the CRNA schools manage to turn out a modest oversupply of CRNA's and salaries fall to high five figures. A savvy hospital administrator will boot the MD group, hire all CRNA's and maybe a few MD's to put out fires. They take in another $5 million a year.

You say patients will object - not if you give them a private room in return
You say surgeons will object - not if they can run 2 rooms more often
You say malpractice will rise - it might - just a cost of doing business

militarymd said:

The surgeon or the GI doc doesn't "hire" an anesthesiologist.

The anesthesiologist bills the patient or the patient's 3rd party pay for fees.

It doesn't cost the surgeon or the GI doc ANY money.

And medicare reimburses a MD or a CRNA the same money for the same procedure.

Click to expand...

There are a number of places where the CRNA is an employee of the surgery center. The center bills for the anesthesia services and collects the money. The CRNA is paid salary. If you remember the recent Nevada HCV scandal, the CRNAs were all Endoscopy Center employees. Depending on how busy a surgery center is, this can add several hundred thousand and up for the partners.

David Carpenter, PA-C

core0 said:

There are a number of places where the CRNA is an employee of the surgery center. The center bills for the anesthesia services and collects the money. The CRNA is paid salary. If you remember the recent Nevada HCV scandal, the CRNAs were all Endoscopy Center employees. Depending on how busy a surgery center is, this can add several hundred thousand and up for the partners.

David Carpenter, PA-C

Click to expand...

ok

core0 said:

There are a number of places where the CRNA is an employee of the surgery center. The center bills for the anesthesia services and collects the money. The CRNA is paid salary. If you remember the recent Nevada HCV scandal, the CRNAs were all Endoscopy Center employees. Depending on how busy a surgery center is, this can add several hundred thousand and up for the partners.

David Carpenter, PA-C

Click to expand...

So for a short term gain of a few hundred thousand, they will lose millions in lawsuits, lost their medical lic. and may end up going to jail. Nice. This is what happens when you cut corners. Eventually, you will be caught with your pants dow.

sevo85288 said:

So for a short term gain of a few hundred thousand, they will lose millions in lawsuits, lost their medical lic. and may end up going to jail. Nice. This is what happens when you cut corners. Eventually, you will be caught with your pants down.

Click to expand...

I don't think that really has anything to do with MD vs CRNA. An LPN should have known not to share vials like they did.

sevo85288 said:

So for a short term gain of a few hundred thousand, they will lose millions in lawsuits, lost their medical lic. and may end up going to jail. Nice. This is what happens when you cut corners. Eventually, you will be caught with your pants dow.

Click to expand...

If you read the articles in the Las Vegas paper (not exactly peer reviewed I know) the CRNAs claimed that the physician directors told them to reuse syringes as a cost saving method. A practice is only as smart as the lowest common denominator.

The economics are really quite interesting. When I was in Denver I know at least one AEC looked at hiring CRNAs to do Propofol without getting reimbursed. If you can shave time off the endoscopy it even makes sense. If you are doing a colon ever 30 minutes the reimbursement is something like $165 professional fee and $900 for the center (call it $5-600 profit) Comes out to around $700 per case. If you are doing two cases and hour thats $1400 per hour. If you can do propofol and get three cases an hour that extra $700 pays for the $80/hr of the CRNA and then some. The problem is that most of the endoscopy centers are designed for two cases an hour and you don't have enough recovery space for that volume. So they would have to leave one room empty which really doesnt pay. Also most of the studies show that it really doesn't change the time for the procedure that much (+/- 1-2 minutes). Note this is in a market where neither Medicare or private payors will reimburse for anesthesia at an AEC. If you are in NY for example it makes total sense since you can collect the reimbursement. I am guessing Nevada is in that same situation.

David Carpenter, PA-C

Pilot Doc said:

Come on guys ... stop thinking like anesthesiologists at a mutual admiration society meeting and start thinking like a capitalist.

Yes ... payors will pay the same for an anesthetic regardless of provider. What does that mean? The less an employer pays a provider the more that emplyer profits. Imagine the CRNA schools manage to turn out a modest oversupply of CRNA's and salaries fall to high five figures. A savvy hospital administrator will boot the MD group, hire all CRNA's and maybe a few MD's to put out fires. They take in another $5 million a year.

You say patients will object - not if you give them a private room in return
You say surgeons will object - not if they can run 2 rooms more often
You say malpractice will rise - it might - just a cost of doing business

Click to expand...

I agree with all of the above. It sounds great for the CEO but here is the REALITY:

1. CRNA can't intubate patient. Airway disaster or long case delay until the ONE MD (A) can make it into the room. The entire staff notices and the surgeon is NOT happy.

2. CRNA can't get the line or has a major complication. AGain, the ONE MD (A) was no where to be found. Again, the surgeon was not happy.

3. CRNA has to make preop judgement calls on "sick" patients. THey consult Surgeon or try to find that ONE MD (A) again. The buck now stops with the surgeon about pre-anesthetic evaluation.

4. The Post-OP care now falls on the Surgeon as the one MD (A) is quite busy putting out fires from those SOLO CRNA's all day. THe surgeon's phone calls now double or triple.

5. Morbidity/Mortality may increase unless the upper 1/4 of CRNA's in the USA hired by the hospital. THese CRNA's demand lucrative salaries in the $250,000 range or will go elsewhere.

So, actual dollars saved by the CEO is nowhere near the amount expected and COMPLICATIONS increase in the O.R. along with unhappier surgeons.

My scenario is real world and not theoretical.

Blade

Don't necessarily agree with all of the above, but fair enough ... say it's true.

Suppose CEO fires anes group run at 1:3 ACT model and changes it to 1:5 ACT. If you had a 15 man group before you've just lost 6 MD jobs. Do that at a couple of hospitals and you can change market dynamics pretty quick.

Do I think this will necessarily happen? Maybe not. Would it EVER happen with most medical specialties ... absolutely not. It's a risk inherent in anesthesiology and should be considered by anyone doing a cost/risk/benefit analysis in choosing a career.

Pilot Doc said:

Don't necessarily agree with all of the above, but fair enough ... say it's true.

Suppose CEO fires anes group run at 1:3 ACT model and changes it to 1:5 ACT. If you had a 15 man group before you've just lost 6 MD jobs. Do that at a couple of hospitals and you can change market dynamics pretty quick.

Do I think this will necessarily happen? Maybe not. Would it EVER happen with most medical specialties ... absolutely not. It's a risk inherent in anesthesiology and should be considered by anyone doing a cost/risk/benefit analysis in choosing a career.

Click to expand...

I don't mean to slam you here but I got decades of supervising these Nurses. They can't do what the AANA says they can and they need a lot of help. The best of the best can do most things on their own but they are a rare breed and are very expensive $$$.

The surgeons who have been around 20 years plus see the same things i do. The CRNA is nice but limited. A good MD (A) is WORTH the money and they want them around. As for 1:3 that is a dream job. We are already running 1:4 and sometimes 1:5 for emergency cases, over-lap, etc. The administration sees everyone is working hard and that the CRNA's SOLO can't cut the mustard.

Again, if you want to hire an elite core of ex. army CRNA's along with the best of the best you can stretch it to 1:7. But, those types of CRNA's want $250,000 plus full benefit package. So, where is the savings?

I doubt you have much real world experience in terms of supervision and hiring/paying for CRNA coverage; so, sometimes it is better to listen than speak. You learn more that way.

As for the "economic" risk of choosing Anesthesiology I agree it is present. However, if you invest in ONE additional year of training called a fellowship and join the fight against the AANA
the odds improve you will survive the war.

Blade

BLADEMDA said:

I doubt you have much real world experience in terms of supervision and hiring/paying for CRNA coverage; so, sometimes it is better to listen than speak. You learn more that way.

Click to expand...

I have zippo and will readily admit it. If I claimed any expertise in supervising CRNA's it wasn't purposeful.

I guess my point is that right now there seem to be about 105 jobs chasing every 100 anesthesiologists - makes for a good market. It will only take very subtle changes to turn that to 105 anesthesiologists chasing every 100 jobs and a very bad market. Denying the possibility of those changes is foolish.

Pilot Doc said:

I have zippo and will readily admit it. If I claimed any expertise in supervising CRNA's it wasn't purposeful.

I guess my point is that right now there seem to be about 105 jobs chasing every 100 anesthesiologists - makes for a good market. It will only take very subtle changes to turn that to 105 anesthesiologists chasing every 100 jobs and a very bad market. Denying the possibility of those changes is foolish.

Click to expand...

I am not denying anything. I have seen the fied evolve over two decades. I know what MD (A)'s used to do; those days are gone in my State. I bet they will vanish in every other State as well.

If you don't mind getting a good education, working hard and investing an additional year in a subspecialty then there will be work for you. This work will be hard but it will pay at least 25% more than a CRNA- even a DNAP CRNA. But, if you think being a "stool sitter" is your path to financial freedom those days are coming to an end. Only the most lucrative areas/practices can support an all MD model. Even the 1:3 model may/will come to an end sooner than you think.

But, are you willing to work hard? Do you want to do more than just sit on the couch like the MD (A)'s of yester-year while "supervising" three rooms? Then, there will be work for you. BUt, I agree with EX. Mil. MD. that being a "stool sitter" is not the future of our specialty. Those who want a CRNA/AA type job will end up getting paid for one. Those that recognize we get paid for our skill and knowledge will strive to be the best of the best. They will be the ones to survive and prosper.

Blade

To the OP -

You're smart for considering all this economic crap as an M3 - don't let anyone tell you otherwise.

Are you considering anything else besides anesthesia?

jumpingjax said:

To the OP -

You're smart for considering all this economic crap as an M3 - don't let anyone tell you otherwise.

Are you considering anything else besides anesthesia?

Click to expand...

Of course, one should consider the "invasion" by the AANA into Indepenent Practice when considering the field of Anesthesia. In fact, the AANA is the number one reason you may want to look elsewhere for a career choice.

The field will evolve AWAY from personally administering anesthesia by the MD. Instead, he/she will end up as a perioperative specialist "supervising" 6-7 midlevel providers. This is how the former President of the ASA sees out and how I see it evolving.

The job will get harder and the income "gap" bewteen MD and DNAP CRNA will narrow. Today, that gap is about 50-100% but in 10-15 years it will be 25-50%. The cushy jobs will be harder to find and Anesthsesiology as a career choice may lose its current luster.

That said, there are many other medical specialties facing serious problems. But, Anesthesiology has the Marines of Nursing at its doorstep and they will not stop until 100% Independence is achieved. Ironically, Academia has been the PRIMARY reason for the AANA's success in producing good foot-soldiers for the war. The best CRNA's graduate from our University Programs and the Military. Thus, the Chairman are helping to produce the Midlevel Provider that will one day seriously impact your career. Another exmple of Academic hypocrisy at its finest.

Blade

BLADEMDA said:

I am not denying anything.

Click to expand...

I think we're arguing past each other and not with each other. I don't disagree with your points. I don't think you understand mine.

BLADEMDA said:

Instead, he/she will end up as a perioperative specialist "supervising" 6-7 midlevel providers.

Click to expand...

That's what I see too. And by corollary, if the nation as a whole shifts from a 1:3 or 1:3.5 supervision ratio to 1:6-7 - then 50% of the MD's lose their jobs. Put 10K expd, board certified anesthesiologists on the market and even hard-working fellowship trained guys are gonna have a rough time. There are going to be gangs of MDA's roaming the halls with miller shivs and mac brass knuckles looking for the next anesthetic

From the looks of it, the CRNA/AA issue of anesthesia doesn't seem to be all that different from the primary care vs NP battle thats going on as well. It just seems that we as anesthesiologists have a better view of the issue than the primary care docs who are aware of the problem, but it hasn't fully set in. Now that walmart is starting their own healthcare initiative with NP's, I think ALL doctors of the future will start to feel the pinch across the board from midlevels. And really for us residents/med students, the ones who created the problem are to blame in our eyes, we've just gotta deal with it.

Pilot Doc said:

I think we're arguing past each other and not with each other. I don't disagree with your points. I don't think you understand mine.

Click to expand...

I have read your posts several times. I am not disagreeing with you as much as trying to explain the complicated cross-roads the FIELD of Anesthesia is at right now. Let me elaborate. First, the Academic Community is JUST NOW beginning to realize the monster they helped to create in the AANA. I have dozens of posts on this subject in the private club. There you can read the real pickle we are in as a Specialty.

Second, Anesthesia is Nursing. Yes, you read that right. The field is both a Medical Specialty and a Nursing area. That is why the AANA has been successful in Wisonsin and other States in getting "opt-out" legislation passed. Thousands of CRNA's work every day with NO ANESTHESIOLOGIST present. They work in hospitals, GI offices, SDS centers, Dentist offices, Plastic Surgery, etc.

Academia trains your "competition" right alongside you at your programs. That meek, quiet Nurse will become a CRNA. He/She will join the AANA and send dues to fight for 100% Independence in all areas of Anesthesia.
Thus, he/she can theoretically REPLACE you one day for economic reasons. This is the equivalent of training your enemy's army in a time of war. Ridiculous. As long as we continue to train CRNA's (soon to be DNAP CRNA's) at our academic Institutions instead of AA's our fate as Anesthesiologists are over. We MUST become Perioperative Physicians because the "stool sitters" are being trained to do the job for less.

Academic Medicine has sold out the specialty to the AANA for free labor.
Yet, they still "rot" you in the room all day to get even more "cheap" labor.
However, your FUTURE is NOT in the room giving Anesthesia. On the contrary, your future is pre-op, intra-op and post-op care. You need to be the ICU/Internal Medicine/Pulm/Renal Doctor of hospital. In short, you need to be the BEST trained Physician on Staff in as many areas as possible.

If Academia wants to "save" the current role of administering Anesthesia by the MD it needs to "throw out" the Nurses and the AANA ASAP. But, GREED $$$$ will prevent that from happening. In fact, those Chairman know they are selling you out but most don't care. You are cheap labor and will need to do an even longer Fellowship to survive against the DNAP CRNA. But, that is your problem isn't it?

Again, we are at a cross-roads in the field. Some like me want to fight the AANA for control of the O.R. We believe the most qualified individual should be in charge of the Anesthetic and not a CRNA. But, Academia so far has decided to let the status-quo continue. This means training future DNAP CRNA's right next you and the death of the specilaty as it now exists. While I will continue the fight against the AANA those "blood-suckers" will win in the end.

Blade

Pilot Doc said:

That's what I see too. And by corollary, if the nation as a whole shifts from a 1:3 or 1:3.5 supervision ratio to 1:6-7 - then 50% of the MD's lose their jobs. Put 10K expd, board certified anesthesiologists on the market and even hard-working fellowship trained guys are gonna have a rough time. There are going to be gangs of MDA's roaming the halls with miller shivs and mac brass knuckles looking for the next anesthetic

Click to expand...

I have sort of rebuttal to this scenario as mentioned before.

So supervision rules change even though currently 1:4 is a stretch, and I agree with Blade that few CRNAs are exceptional. I would expect MDs to be hired in place of CRNAs BUT at lower salaries. I agree that stool sitting will not be the wave of the future. Yet I don't see CRNAs undoing MDs except in the salary category. All they are doing in their quest to undo us is drop both of our value in the market.

Now = maybe CRNA 180K, maybe MD 300K
Then = CRNA and MD less

So who will the hospital pick considering surgeon satisfaction and liability issues. Probably us, but at a lower price. This is probably going to happen all across the board in medicine. How much do GI docs bank right now on butt scopes? Lots. Do people believe that the butt scope is going to reimburse as well as it does now? Remember the cataract for eye docs. Then I assume GI will become a less "interesting" specialty. Same I assume for cath/stent cards. I have seen cardiology NPs basically run the cards service with minimal cardiologist input, especially with routine things like heart failure, etc. Also, the knee and hip guys will see their procedure devalued over the coming years.

Let's all agree, politics and CEOs make medicine suck in general. Who knows what will be worthy of my education? I never thought GI was going to become great in the 90s. I never imagined a lot of things even in medical school. Only if I had a magic 8 ball or orb....

And I was wondering if anybody was going to get back to me about that restricted forum/club.

Here is another Irony:

As more Medical Students realize the BIG problems the Specialty of Anesthesiology faces in the future many will choose other fields.
This means only the "weaker" students will enter the specialty. So, the greedy Chairmen will "import" many FMG's to fill their slots. When these FMG's and weak MD's grauate from their programs they will face a STRONGER, INDEPENDENT DNAP CRNA. The end result may not be a good one for the specialty.

GassiusClay said:

I have sort of rebuttal to this scenario as mentioned before.

So supervision rules change even though currently 1:4 is a stretch, and I agree with Blade that few CRNAs are exceptional. I would expect MDs to be hired in place of CRNAs BUT at lower salaries. I agree that stool sitting will not be the wave of the future. Yet I don't see CRNAs undoing MDs except in the salary category. All they are doing in their quest to undo us is drop both of our value in the market.

Now = maybe CRNA 180K, maybe MD 300K
Then = CRNA and MD less

So who will the hospital pick considering surgeon satisfaction and liability issues. Probably us, but at a lower price. This is probably going to happen all across the board in medicine. How much do GI docs bank right now on butt scopes? Lots. Do people believe that the butt scope is going to reimburse as well as it does now? Remember the cataract for eye docs. Then I assume GI will become a less "interesting" specialty. Same I assume for cath/stent cards. I have seen cardiology NPs basically run the cards service with minimal cardiologist input, especially with routine things like heart failure, etc. Also, the knee and hip guys will see their procedure devalued over the coming years.

Let's all agree, politics and CEOs make medicine suck in general. Who knows what will be worthy of my education? I never thought GI was going to become great in the 90s. I never imagined a lot of things even in medical school. Only if I had a magic 8 ball or orb....

And I was wondering if anybody was going to get back to me about that restricted forum/club.

Click to expand...

Good post. I hope to see you in the restricted Club Forum. I have dozens of posts for you to read. You will lean much about our Specialty and war with the AANA.

I don't care if you agree with me. I just want to get you thinking about the problems we face and the war we are in against the AANA.

Blade

Here is a DIRECT answer to the original OP's question:

Based on my knowledge and experience in the field if I were choosing a Specialty today Anesthesiology would NOT be my first choice.

But, I surmise many of you already guessed that fact. Again, there is much more discussion in the Private Club Section of SDN.

Blade

Remember, the AANA does NOT give a crap about patient care or reducing morbidity/mortality. All this blood-sucking organization cares about is power and money.

Hence, the AANA's drive for 100% Independence for all of its membership including the bottom 25% of CRNA's. Plus, the AANA's quest for all of its members to have the RIGHT to practice Pain Medicine.

So, do you really think the AANA will agree with a 1:4 ratio? or, even a 1:7 ratio? The AANA openly claims you are NOT needed at all and are simply a very expensive CRNA. DNAP CRNA= MDA per the AANA.

Blade

Asking every Resident to Join the Private Club and the fight against the AANA

Asking every Resident to Join the Private Club and the fight against the AANA[/QUOTE]


How does one go about joining this club? I would love to read more and help out...

gasguy06 said:

How does one go about joining this club? I would love to read more and help out...

Click to expand...

Click on the "My Account" button near the top of your screen.

You will see a column on the Left.

Under "Networking" click "Group Memberships"

Then chose the ASA group. Send your info to either "sleep is good" or "Toughlife" (They want ASA number, and name and adress on file with the ASA).

Then wait for their response. Send them a PM if you haven't heard anything in a while.

Now when you sign in to the Forum and enter the general anesthesia section, at the top you can see Anesthesiology Club, Anesthesiology Positions, CRNA Debates, in that order.

Click Anesthesiology Club and it will take you to the members section. You will find lots of interesting threads there. Good luck.

Ender

BLADEMDA said:

I have read your posts several times. I am not disagreeing with you as much as trying to explain the complicated cross-roads the FIELD of Anesthesia is at right now. Let me elaborate. First, the Academic Community is JUST NOW beginning to realize the monster they helped to create in the AANA. I have dozens of posts on this subject in the private club. There you can read the real pickle we are in as a Specialty.

Second, Anesthesia is Nursing. Yes, you read that right. The field is both a Medical Specialty and a Nursing area. That is why the AANA has been successful in Wisonsin and other States in getting "opt-out" legislation passed. Thousands of CRNA's work every day with NO ANESTHESIOLOGIST present. They work in hospitals, GI offices, SDS centers, Dentist offices, Plastic Surgery, etc.

Academia trains your "competition" right alongside you at your programs. That meek, quiet Nurse will become a CRNA. He/She will join the AANA and send dues to fight for 100% Independence in all areas of Anesthesia.
Thus, he/she can theoretically REPLACE you one day for economic reasons. This is the equivalent of training your enemy's army in a time of war. Ridiculous. As long as we continue to train CRNA's (soon to be DNAP CRNA's) at our academic Institutions instead of AA's our fate as Anesthesiologists are over. We MUST become Perioperative Physicians because the "stool sitters" are being trained to do the job for less.

Academic Medicine has sold out the specialty to the AANA for free labor.
Yet, they still "rot" you in the room all day to get even more "cheap" labor.
However, your FUTURE is NOT in the room giving Anesthesia. On the contrary, your future is pre-op, intra-op and post-op care. You need to be the ICU/Internal Medicine/Pulm/Renal Doctor of hospital. In short, you need to be the BEST trained Physician on Staff in as many areas as possible.

If Academia wants to "save" the current role of administering Anesthesia by the MD it needs to "throw out" the Nurses and the AANA ASAP. But, GREED $$$$ will prevent that from happening. In fact, those Chairman know they are selling you out but most don't care. You are cheap labor and will need to do an even longer Fellowship to survive against the DNAP CRNA. But, that is your problem isn't it?

Again, we are at a cross-roads in the field. Some like me want to fight the AANA for control of the O.R. We believe the most qualified individual should be in charge of the Anesthetic and not a CRNA. But, Academia so far has decided to let the status-quo continue. This means training future DNAP CRNA's right next you and the death of the specilaty as it now exists. While I will continue the fight against the AANA those "blood-suckers" will win in the end.

Blade

Click to expand...

I would like to send this piece to the ASA newsletter so they can publish it. I would love to see a response from the "highers ups" about it.

toughlife said:

I would like to send this piece to the ASA newsletter so they can publish it. I would love to see a response from the "highers ups" about it.

Click to expand...

The change should start at the ASA level, they simply need to say that the administration of anesthesia should be done under the supervision of an Anesthesiologist, not under the supervision of "a Physician".
If they can say that monitoring end tidal CO2 is a standard of care they need to be able to say that the presence of an anesthesiologist is a standard of care.
This needs to happen now.

BLADEMDA said:

Here is a DIRECT answer to the original OP's question:

Based on my knowledge and experience in the field if I were choosing a Specialty today Anesthesiology would NOT be my first choice.

But, I surmise many of you already guessed that fact. Again, there is much more discussion in the Private Club Section of SDN.

Blade

Click to expand...

That's pretty distressing talk.

NPR said:

That's pretty distressing talk.

Click to expand...

Sorry, but sometimes the truth hurts. We have not lost the war yet. We have played "defense" pretty well over the past few years and have held the AANA advances at bay. There have been no new "opt-out" States and the AANA has suffered losses in Pain Medicine.

That said, the AANA is starting to re-group. They are planning an all out assault on taking on Pain Medicine as an official CRNA right. THis includes meetings, courses and a short, formal CRNA fellowship program.

How long will our defensive posture work? All it takes is for a favorable ruling from a Judge or a new Administration to join with the AANA. While this may take 4-12 more years it will likely happen. Despite my rhetoric and desire to defeat the AANA that is unlikely to occur.

The odds favor the AANA over the ASA. However, if we as a Group and a Medical Specialty begin to make real changes in whom we train to be midlevel providers the war is not yet lost. We still have a few years to demand MD/DO Anesthesiologist involvement in every case. We can open up our University Programs to hundreds of new PA/AA students. We can discourage academia from teaching SRNA's and shove these SRNA's to the community hospitals.

We can and must rise to the occasion. But, if we continue on our current course of trying to get along with the AANA then Anesthesia becomes 100% Nursing in 20 years. We become Perioperative Physicians. It wouldn't suprise me to see 50% of the research in our journals become DNAP CRNA authored studies.

My friends we are losing this war. For example, look at the PA branch of the AANA. They openly proclaim we are not needed in Public. How many more years until the DNAP CRNA convinces some legislature that is indeed the case? 5 maybe 10?

A Medical Student really needs to make certain he/she wants to enter a field that is considered "Part-Nursing" by State legislatures because in 10 years that same legislature may consider it 90% Nursing. The AANA devalues our education and training by equating the DNAP CRNA=MDA. We devalue ourselves by training that DNAP CRNA.

Blade

Fighting against the AANA

BLADEMDA said:

Here is another Irony:

As more Medical Students realize the BIG problems the Specialty of Anesthesiology faces in the future many will choose other fields.
This means only the "weaker" students will enter the specialty. So, the greedy Chairmen will "import" many FMG's to fill their slots. When these FMG's and weak MD's grauate from their programs they will face a STRONGER, INDEPENDENT DNAP CRNA. The end result may not be a good one for the specialty.

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is that right?

i really just can't wrap my brain around why we train the people hoping to eradicate us. only in medicine will you see business sense this poor.

i also don't understand why in the crap CRNAs will be at our national meeting in october. again, we seem to revel in helping our enemy kill us.

BLADEMDA said:

Here is another Irony:

As more Medical Students realize the BIG problems the Specialty of Anesthesiology faces in the future many will choose other fields.
This means only the "weaker" students will enter the specialty. So, the greedy Chairmen will "import" many FMG's to fill their slots. When these FMG's and weak MD's grauate from their programs they will face a STRONGER, INDEPENDENT DNAP CRNA. The end result may not be a good one for the specialty.

Click to expand...

I know a few FMG's and some DO's that I would put up against the best stateside trained MD's any day. It doesn't really matter in some cases where you got your degree but more importantly where you trained. So I'd say that if a good program takes a solid FMG or DO for that matter, the anesthesiologist coming from that program will be solid and better than any DNAP crna in general.
The problem with your statement is that you are generalizing the group. It is all in the training. We all come to the residency with a knowledge base far greater than any nurse from any program. But if the residency program fails to capitalize on this then they are the problem, not the resident. Hell, just writing this makes me want to go back to academics.
I do agree however if these FMGs don't speak engrish well. but we are not the only specialty with a growing influx of FMG's. There is a drastic shortage of doc coming our way and the FMG's are here to stay. And they are a much better option than nurses. As long as they speak engrish.
Have you heard what the president of the board of surgery (I don't know the official name right now) has said recently? "Bring on the FMG's, we need them."

Why the hell are SRNAs being trained along side anesthesiology residents? Why are academic medical centers killing the specialty? Will they stop? Or is it expanding even more? Why does the ASA invite CRNAs to there meetings? Does the AANA invite anesthesiologists to their meetings? I think anesthesiologists need to stop sharing their knowledge with those that want to get rid of them.

Planktonmd said:

The change should start at the ASA level, they simply need to say that the administration of anesthesia should be done under the supervision of an Anesthesiologist, not under the supervision of "a Physician".
If they can say that monitoring end tidal CO2 is a standard of care they need to be able to say that the presence of an anesthesiologist is a standard of care.
This needs to happen now.

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I totally agree that hhe ASA should take this stance ASAP: supervision by a podiatrist!! that's some f***ed up $hit

Noyac said:

Hell, just writing this makes me want to go back to academics.
I do agree however if these FMGs don't speak engrish well. but we are not the only specialty with a growing influx of FMG's. There is a drastic shortage of doc coming our way and the FMG's are here to stay. And they are a much better option than nurses. As long as they speak engrish.
Have you heard what the president of the board of surgery (I don't know the official name right now) has said recently? "Bring on the FMG's, we need them."

Click to expand...

With the drastic increase in new DO schools that have been created in the past decade, we'll either see a marked decrease in FMG residents across the board or program directors taking higher scoring FMGs over MD/DO students. States are also currently expanding their MD enrollment.

This is combined with my impression that Anesthesia is becoming a tougher match. I've looked at the resident profiles of every program I'm seriously considering and seen very, very few FMGs. And I'm not only talking about the cream of the crop. Heck, UAB advertises on their website that their 2007 match class averaged around 235 on both Step 1 and Step 2. In the next 10-15 years you'll see groves of newly minted Anesthesia residency graduates who scored comfortably above the national average on both Step 1 and Step 2 and were in the top half of their class academically. I hope this will be very good for the specialty.

Noyac said:

I know a few FMG's and some DO's that I would put up against the best stateside trained MD's any day. It doesn't really matter in some cases where you got your degree but more importantly where you trained. So I'd say that if a good program takes a solid FMG or DO for that matter, the anesthesiologist coming from that program will be solid and better than any DNAP crna in general.
The problem with your statement is that you are generalizing the group. It is all in the training. We all come to the residency with a knowledge base far greater than any nurse from any program. But if the residency program fails to capitalize on this then they are the problem, not the resident. Hell, just writing this makes me want to go back to academics.
I do agree however if these FMGs don't speak engrish well. but we are not the only specialty with a growing influx of FMG's. There is a drastic shortage of doc coming our way and the FMG's are here to stay. And they are a much better option than nurses. As long as they speak engrish.
Have you heard what the president of the board of surgery (I don't know the official name right now) has said recently? "Bring on the FMG's, we need them."

Click to expand...

I was afraid that my import FMG statement would be misconstrued. In general, a specialty becomes weaker and is viewed as less desirable by American Medical Graduates as its % of imported FMG's increase.
Surgery is a prime example as is Pediatrics.

Can the specialty survive with good FMG's? Yes. Is it the best scenario for the specialty? No. Will the DNAP CRNA use the fact that Anesthesia became 50% FMG against the specialty in its argue of equality? You bet.
Will the likelihood of a total AANA victory increase as the number of FMG graduates goes up? Yes.

Surgery is NOT facing a Midlevel Provider at war with them over 100% Independent practice rights. Perception is very important in the eyes of the public, our colleagues and the CEO's who run the hospitals.

Again, I am not "slamming" a particular Group of people but pointing out the obvious: Our success depends on recruiting and retaining excellent American Medical Graduates

Blade

Look at the bright side. In about 5 years those threads about "will i be able to match" will no longer exist as any American MD or DO will be able to get a spot as long as they have a pulse.

Southpaw said:

With the drastic increase in new DO schools that have been created in the past decade, we'll either see a marked decrease in FMG residents across the board or program directors taking higher scoring FMGs over MD/DO students. States are also currently expanding their MD enrollment.

This is combined with my impression that Anesthesia is becoming a tougher match. I've looked at the resident profiles of every program I'm seriously considering and seen very, very few FMGs. And I'm not only talking about the cream of the crop. Heck, UAB advertises on their website that their 2007 match class averaged around 235 on both Step 1 and Step 2. In the next 10-15 years you'll see groves of newly minted Anesthesia residency graduates who scored comfortably above the national average on both Step 1 and Step 2 and were in the top half of their scores academically. I hope this will be very good for the specialty.

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That sounds great and I hope it happens. But, there is at least a 50% probability the AANA continues its advacement towards 100% Independent Practice over the next few years. Pain Management is next on its agenda. If and when a new administration decides to lobby in favor of MORE midlevel/CRNA practice rights your statement won't hold water.

Medical Students will begin to see past the "hype" and realize that Anesthesia has become Nursing. When that happens the bottom 1/4 of the class may consider the specialty. So, those same Chairmen selling you all that hype are jusy as busy selling out the profession by training the next generation of actual anesthesia providers: the CRNA.

badasshairday said:

Why the hell are SRNAs being trained along side anesthesiology residents? Why are academic medical centers killing the specialty? Will they stop? Or is it expanding even more? Why does the ASA invite CRNAs to there meetings? Does the AANA invite anesthesiologists to their meetings? I think anesthesiologists need to stop sharing their knowledge with those that want to get rid of them.

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Answer: $$$$$

The Departments get free labor from the SRNA. Do you know how expensive a 50 hour per week CRNA is per body? $220,000 or more. This means millions of dollars saved in CRNA expenses per department. Thus, the chairmen are selling you the hype on one hand while selling you down the river on the other. Nice. They want it both ways; but, in the end the same academia that gave birth to the specialty is also going to be the cause of its demise.

Once the DNAP CRNA start becoming Chairpersons it will be obvious the specialty is nearly dead.

I don't mean to be all "doom and gloom" about Anesthesiology. Right now, things are great out there in terms of job outlook/economics. CRNA's are making money hand over fist. MD/DO graduates can skip the fellowship and earn more money in their first year than I made in my first three.

However, that is NOT the whole story to the field. There is a WAR going on with the AANA. The Chairmen are NOT your friends and have sided with the AANA. These Academic types are training your FUTURE replacement and competition right next to you. In order to prop up a lot of departments these Chairmen are willing to kill the specialty in the long run so their departments can stay open in the short term. These academics are smelling the $$$$ just as much as private practice and have decided to join with the AANA in training SRNA's even though it is detrimental to the Specialty.

Why not train AA's? There are not enough schools while almost every University Program has a Nursing School and is thus eligible for a CRNA program. Money, convenience and politics all favor SRNA training over AA/PA students.

In the Private Club I go into detail about this relationship and how harmful it is in the long run.

Anesthesiology is still a great Specialty and very lucrative right now. But, where will push by the AANA and the DNAP CRNA leave us in ten years?

Blade

Southpaw said:

i really just can't wrap my brain around why we train the people hoping to eradicate us. only in medicine will you see business sense this poor.

i also don't understand why in the crap CRNAs will be at our national meeting in october. again, we seem to revel in helping our enemy kill us.

Click to expand...

Some mentally challenged dude at the ASA must have come up with this idea. We need to introduce a resolution at the ASA that will ban all CRNAs from being able to obtain an ASA membership. Try to get an AANA membership as a non-CRNA to see if you can.