Anesthesia Economics

[jetproppilot]

I've copied, below, my reply to that exact same question posed on a different forum:

>>> Thanks to everyone who replied to my original post, which started this thread.
To answer the questions posed in the interim:

(a) Med School Debt: I've got 16 years combined active duty and reserve military service. I've already contacted the motherhouse in Washington DC about a military scholarship for med school, and the age waiver is almost automatic based on my prior service.

(b) Work as a CRNA for a few more years and retire young: the word "retire" is not in my personal vocabulary. Without trying to sound preachy, I have a very strong religious foundation to my life and my goals. I don't feel I was given my particular gifts to retire early, when there are people out there in need of my services. Want a scary read? The retirement versus new grad rate of both CRNAs and anesthesiologists is not pretty from the general public's view. It's great from the anesthesia job security view. With the ageing of the baby boomers, demand for services is projected to skyrocket over the next two decades.

(c) Just take the path of least resistance and remain a CRNA / why med school?:
For lack of a better word (and please forgive if this sounds conceited) I'm stagnant. I need further academic and professional challenge/stimulation, expanded scope of responsibility and practice, and because it's what I believe I'm called to pursue. If I'm wrong, the door won't open.

My ideal scenario: get accepted for 2006 with military scholarship in hand, switch from reserves to fulltime active duty, and complete a military medical career taking care of our troops. The military routinely gives career age waivers to physicians up to age 70.

Best of luck, Don, I mean Trinity...actually you don't need luck, being the intelligent, hard working dude that you are. You're a high quality dude with true human compassion- and you're able to do your work with a positive, motivated, fun attitude, even on the sucky days. Whatever practice you enter after med school and residency will be fortunate to have you in it. And you deserve the gratification you'll receive from a physicians line of work.

---

Members don't see this ad.

 

[apma77]

I agree with mcguyver 100%..its MDAs like jetprop who have whored out the profession...how sad that these types of MDAs sell out for an extra buck!

 

[zippy2u]

Ok entropy here ya go. The 4 room surgical center provides anesthesia with 1 million collections. Run it with 4 docs or 5 docs and you make $250,000 to 200,000/year. Now run it with 4 crnas and 1 doc. The crnas make $150,000/year and the doc makes $400,000/year.

 

[UTSouthwestern]

The bureaucracy, however, only exists to spawn more administrative endospores which cannot be eradicated once spawned. In fact, VA scientists have recently discovered a new element: Administratium. No useful application, excess atomic mass, rapidly fissuring into more useless isotopes.

I nearly busted a gut when I read this. I have to file that away for future use.

 

[MDEntropy]

Ok entropy here ya go. The 4 room surgical center provides anesthesia with 1 million collections. Run it with 4 docs or 5 docs and you make $250,000 to 200,000/year. Now run it with 4 crnas and 1 doc. The crnas make $150,000/year and the doc makes $400,000/year.

Neither the patients nor the healthcare system saved one penny. But, a few salaries were shifted around.

How is this 'cost-effective'?

It's not.

Try again kid.

 

[bestiller]

This question is directed towards practicing anesthesiologists and residents; given that AA's can provide essentially the same services as CRNA's and are significantly less costly, has anyone seen a situation where a MDA will use AA's instead of CRNA's ? This would seem to make a lot more economic sense, it would serve to both decrease the cost of the anesthesia services and would also increase the profit margin for the supervising MDA. Any comments are appreciated.

In response to economics of your question and w/o being confrontational. There happens to be MDAs out there making $600-800k/yr. This is how they do it (it's no secret by the way) They hire CRNAs and have the CRNA sign over 50% of their reimbursement and then bill all cases as "unsupervised" or "non-medically directed" to get around the 1/4 ratio that they must adhere to with AAs. I'll use the following example say they have a hospital that has 10 ORs to start in the AM, 1 MDA will go w/ 10 CRNAs vs 3 MDAs w/ 10 AAs. It is a way to take advantage of the CRNAs ability to practice "independently" while making 50% of their reimbursement. This practice structure is the difference b/t a 275k/yr MDA and a $600k/yr MDA and it gives the CRNA $200-250k/yr and everyone goes home happy.

 

[jetproppilot]

I agree with mcguyver 100%..its MDAs like jetprop who have whored out the profession...how sad that these types of MDAs sell out for an extra buck!

A *****? Hmmmm.. Nah, my porn star days are long gone.

 

[sevoflurane]

A *****? Hmmmm.. Nah, my porn star days are long gone.

Ha, ha, ha...

 

[jwk]

In response to economics of your question and w/o being confrontational. There happens to be MDAs out there making $600-800k/yr. This is how they do it (it's no secret by the way) They hire CRNAs and have the CRNA sign over 50% of their reimbursement and then bill all cases as "unsupervised" or "non-medically directed" to get around the 1/4 ratio that they must adhere to with AAs. I'll use the following example say they have a hospital that has 10 ORs to start in the AM, 1 MDA will go w/ 10 CRNAs vs 3 MDAs w/ 10 AAs. It is a way to take advantage of the CRNAs ability to practice "independently" while making 50% of their reimbursement. This practice structure is the difference b/t a 275k/yr MDA and a $600k/yr MDA and it gives the CRNA $200-250k/yr and everyone goes home happy.

How many hospitals would still have 1 MDA with 10 CRNA's? Very few operate that way these days, although it was not uncommon in the past. Aren't most hospitals with lots of anesthetists doing 1:3 or 1:4 medical direction anyway?

 

[end_tidal]

A 1:10 ratio for MDA : CRNA ?! I've only seen 1:4 at the most and I've been around ORs for a good part of my life.

 

[jwk]

A 1:10 ratio for MDA : CRNA ?! I've only seen 1:4 at the most and I've been around ORs for a good part of my life.

That was my point - VERY few hospitals with more than just a few OR's are going to have high ratios of anesthetists to MDA's. It makes for an interesting economics spreadsheet, but in reality, it just doesn't happen.

 

[Frank Rizzo]

To get a glimpse of nationalized healthcare, just walk through any VA inpatient hospital. The rank-and-file employees care about their patients. The bureaucracy, however, only exists to spawn more administrative endospores which cannot be eradicated once spawned. In fact, VA scientists have recently discovered a new element: Administratium. No useful application, excess atomic mass, rapidly fissuring into more useless isotopes.


Funniest thing I've heard in awhile. Try arranging for a home nebulizer... fissuring rate increases exponentially!

 

[matbrat23]

This post has been omitted due it's inflammatory & accusatory nature and general lack of maturity & professionalism

 

[coccygodynia]

Wow ... someone needs a hug.

 

[JamesNunez]

I just read all of your posts and you seem like a big +*+*+*+* that needs to be manually disimpacted.

Lighten Up!

 

[jwk]

Well there's a great first post for ya.

 

[jetproppilot]

Rat-tat-tat-tat late at night with my gat
on the streets of LA
wonderin' where this homies at
straight for ya, lookin' for ya Moe
hangin' out, rollin' in my 64
16 switches for the trolls in this hood
17 shells so I make it understood
stay back, lay back, way back in the cut
Ya come outside troll ya gettin' ***ked up

HAHAHAHHAHHAHAHAHHAHAHHAHAHAHAHAHHHAAHHA
Theres a little modified Dre for ya, Dude. Enjoy.

 

[JamesNunez]

Rat-tat-tat-tat late at night with my gat
on the streets of LA
wonderin' where this homies at
straight for ya, lookin' for ya Moe
hangin' out, rollin' in my 64
16 switches for the trolls in this hood
17 shells so I make it understood
stay back, lay back, way back in the cut
Ya come outside troll ya gettin' ***ked up

HAHAHAHHAHHAHAHAHHAHAHHAHAHAHAHAHHHAAHHA
Theres a little modified Dre for ya, Dude. Enjoy.

Loved that!

 

[bigdan]

Did you just quote gangsta rap?!?

dc

 

[jetproppilot]

Did you just quote gangsta rap?!?

dc

Yeah, why? Don't all cracka anesthesiologists like Dre?

Dre's The Chronic is the best hip hop album of all time. Adds at least 40 pounds to squats on leg day.

 

[DrDre']

Jetprop,
I was going to chime in and compliment you for your professional insider views that add so much to this forum. It is nice to hear about the light at the end of the tunnel.


Your stock went through the roof with me when you quoted Dre'. My friends have called me Dr. Dre' since 1990 and in 340 days or so, I will finally be the non-rapping one.



Thanks again for contributing to this forum. It is unfortunate that most attendings lose interest or do not have enough time.



Now if you like Suicidal Tendencies from back in the day, you will be elected King of the realm...

 

[jetproppilot]

Jetprop,
I was going to chime in and compliment you for your professional insider views that add so much to this forum. It is nice to hear about the light at the end of the tunnel.


Your stock went through the roof with me when you quoted Dre'. My friends have called me Dr. Dre' since 1990 and in 340 days or so, I will finally be the non-rapping one.



Thanks again for contributing to this forum. It is unfortunate that most attendings lose interest or do not have enough time.



Now if you like Suicidal Tendencies from back in the day, you will be elected King of the realm...

Thanx for the kind words, Dude. Yep, Dre's the king- his gruff rap enhanced with Snoop and his smooth, melodic groove chimin' in...great, great album.

Guess I won't be King of the Realm- never got into Suicidal Tendencies. Still like the old school hip hop stuff, more so than the new stuff. Black Sheep, Whodini, Public Enemy, the dude that sings "I'm The Magnificant" (whats the dudes name?..cant remember). Anyway, the rap genre has changed and I'm not too into alot of the new stuff.
Now I'm more into the industrial metal stuff...Korn (ARE YOU REEEAAADY!!!) being my favorite. Their greatest hits album is awesome and it comes with a DVD of a little gig they did at CBGBs...man, watching that on the Sony Wega 70" screen with 5.1 surround sound...almost like being there! My wife loves my music...(YEAH RIGHT!)
Fred Durst's first cuppla albums are good. Havent heard from Limp in a while; they're do for an album.
Gotta love the low tuned bass guitars, huh?
Metallica's St Anger is pretty good but it doesnt touch their black album.

 

[coccygodynia]

... the dude that sings "I'm The Magnificant" (whats the dudes name?..cant remember). .

Special Ed

 

[jetproppilot]

Special Ed

THATS IT!!

 

[VentdependenT]

Fred Durst's first cuppla albums are good. Havent heard from Limp in a while; they're do for an album.
Gotta love the low tuned bass guitars, huh?
Metallica's St Anger is pretty good but it doesnt touch their black album.

Jetprop you are NOT droppen the Durst name are you?! Chagrined am I! Forgiven are you. Metal-wise I am useless with only Tool and A Perfect Circle (not really metal though eh) sharing space on my IPOD.

just picked up the new Common alblum. Guy's from Chicago and flows like no other. You can still find Tribe rotating through my car's disc changer every so often.

Speaking of old rap I used to really like 3rd bass and Del the funky homo sapien. ohhhhh man thats oooold.

Been into down tempo, tech house, minimal dub, ambient, tech dub, minimal techno for a while now. Strange beats for a strange bird.

Enjoy the rest of the memorial day festivities y'all.

 

[DrDre']

I saw Public Enemy back in 1993 or so in Lawrence, Kansas of all places. GReat show. I love metal too. My wife also "loves" my music.

I call it "angry black music" and 'angry white music" that i listen to. Classical music is wonderful when you are being sophisticated at home. But when I am slogging thru a 20 mile run, I want something to make me move.


love Metallica too. I really prefered them in their raw-er days: Kill em All and Master.

I guess when I grow up and become an anesthesiologist, we're gonna have fun at some shows after the conferences are over with Jet and Vent!

 

[Frank Rizzo]

Here I thought I was the only one listening to metal. Nobody listened to it in my medschool... couldn't find anyone to go to concerts with me, and didn't see any of them at the shows... oh well, their loss.

Jetprop, you a Ministry fan? If not, you should check out any of their albums from the late 80's (The Land of Rape and Honey, and The Mind is a Terrible Thing to Taste) to the present(Houses of the Mole). They're the godfathers of industrial music. Always put on a good show. Hardcore.

CDs in my changer at the moment:
1. Ministry- Houses of Mole
2. As I lay Dying- Frail Words Collapse
3. Chimaira- The Impossibility of Reason
4. NIN- With Teeth... I was a little disappointed with this new album
5. Mastodon- Leviathan... saw them in concert last month, put on a hell of a good show.

Good stuff...

 

[bigdan]

Hey look! Everyone IS getting along!!!!

dc

 

[gaslady]

This forum always cracks me up!! It's awesome

 

[jetproppilot]

Here I thought I was the only one listening to metal. Nobody listened to it in my medschool... couldn't find anyone to go to concerts with me, and didn't see any of them at the shows... oh well, their loss.

Jetprop, you a Ministry fan? If not, you should check out any of their albums from the late 80's (The Land of Rape and Honey, and The Mind is a Terrible Thing to Taste) to the present(Houses of the Mole). They're the godfathers of industrial music. Always put on a good show. Hardcore.

CDs in my changer at the moment:
1. Ministry- Houses of Mole
2. As I lay Dying- Frail Words Collapse
3. Chimaira- The Impossibility of Reason
4. NIN- With Teeth... I was a little disappointed with this new album
5. Mastodon- Leviathan... saw them in concert last month, put on a hell of a good show.

Good stuff...

Hey Frank,
Yep, got some Ministry in my work out bag- Filth Pig I think is the name of the album. It rocks. I'm writing down the other ones you mentioned and I'll have them Amazoned to my house in no time.
I've got every NIN album. Trent is a weird dude but his music rox!
I even like the dark dude himself, Mariliyn Manson...yeah alot of his lyrics are not for the impressionable, but alot of the beats kick ass..

THEYRE BEAUTIFUL PEOPLE
tHEYRE BEAUTIFUL PEOPLE...deh neh neh
IT ALL HAS TO DO WITH THE SIZE OF YOUR STEEPLE...

how prophetic is that, what with all the crooked televangelists out there? Hey, even freaks like Marilyn have some truths in their mostly-wacko lyrics!
Screw the lyrics, the beat of that song makes me wanna bang my head!!!

Yeah, I'm kinda in mourning since Korn's guitarist left- and I never had the opportunity to see them live...(sigh)
I'm on a real Korn kick lately.....

I'M GONNA CUT MYSELF
AND WATCH THE BLOOD HIT THE FLOOR

GEEZ, where do these dudes come up with these ****ed up lyrics? Like I said, though, you can't beat the rush you get when you open up the volume, sit back with a Gray Goose martini, and hear..

DUH NUH NUH NUH NUH NUH NUH NUH
AARRRREEE YOU REEEAAAAADDYYYYY!!!!!!

korn rocks, dudes, much to my wife's dissent. I love her more than life itself, but her Charlie's Angels soundtrack has gotta go!

Hope ya'll are having a great day.

 

[jetproppilot]

Jetprop you are NOT droppen the Durst name are you?! Chagrined am I! Forgiven are you. Metal-wise I am useless with only Tool and A Perfect Circle (not really metal though eh) sharing space on my IPOD.

just picked up the new Common alblum. Guy's from Chicago and flows like no other. You can still find Tribe rotating through my car's disc changer every so often.

Speaking of old rap I used to really like 3rd bass and Del the funky homo sapien. ohhhhh man thats oooold.

Been into down tempo, tech house, minimal dub, ambient, tech dub, minimal techno for a while now. Strange beats for a strange bird.

Enjoy the rest of the memorial day festivities y'all.

3rd BASS!!!! Yep, luvved them too. Michael Berrin (MC SERCH) and Pete Nash proved us crackas CAN RAP!!
Pop Goes The Weasel was a little too mainstream, though, kinda like Public Enemy's 911s a Joke......
Yep, me's a strange bird too...

 

[Frank Rizzo]

Jetprop,

Filth Pig is a great album. A lot of ministry fans dog it, but I love it... nice and heavy, some fast songs coupled with some slow grinding tunes. If you get House of the Mole, you won't be disappointed! Fair warning about Chimaira and As I Lay Dying... too heavy for most, but I have the feeling you'll like 'em. As far as Korn goes, I made it to three of their shows(all in the late 90's)... definitely a good act. I like their old stuff a lot better than their new stuff. Same goes for Manson.

Metal will never die!

 

[tkim]

The live recordings - "In Case You Didn't Feel Like Showing Up" is really one of Ministry's best.

Saw them twice in concert in the 90's. Can't beat that.

 

[GMO2003]

Yeah, why? Don't all cracka anesthesiologists like Dre?

Dre's The Chronic is the best hip hop album of all time. Adds at least 40 pounds to squats on leg day.

JP you are my phuckin' mo fo...pass a little gas in the AM and pushing the metal in the PM...It's good to see docs lifting and debunking the myth that all physicians are fat, bald, pasty out of shape bastards...the next time you have leg day I highly recommend Guns N Roses, "welcome to the jungle" it was instrumental in pushing my squat past 405 x15...my max is now up to 575...yeah baby!!! as a GMO in the military all I do in my spare time is lift...it sorta feels like prison

 

[Frank Rizzo]

The live recordings - "In Case You Didn't Feel Like Showing Up" is really one of Ministry's best.

Saw them twice in concert in the 90's. Can't beat that.

Definitely a good album. Some of the EARLY 80's stuff is a little to techno for me, thats why I prefer the heavy stuff in Land of Rape and Honey onward. Ministry's my favorite act to see live. Always good. I was actually quite pi$$ed that I couldn't see them last fall due to interivewing... I was even checking if they were going to be in the cities as I was going to be during different interviews. Didn't work.

 

[Frank Rizzo]

Sorry for officially hijacking your thread. It was starting to circle the drain anyway thanks to some trolls.

 

[VentdependenT]

3rd BASS!!!! Yep, luvved them too. Michael Berrin (MC SERCH) and Pete Nash proved us crackas CAN RAP!!
Pop Goes The Weasel was a little too mainstream, though, kinda like Public Enemy's 911s a Joke......
Yep, me's a strange bird too...

They made "the Gasface" while Biz Markee (sp?) made "the Vapors." Both paying homage to making fun of suckahs. Props for remembering MC Search.

Is Lords of Acid metal or something else? My roomate blasted it for me once in college while, uh..., I was in an altered state and I almost flipped out. Insane.

Speaking of Marylin Manson my opinion of they guy totally changed when I saw his interview on Bowling for Columbine. Really intellegent outlook on American media. Getting rich off the antichrist angle isn't something I'll contribute to but I'll be damned if the guy isn't brilliant for exploiting that.

 

[jetproppilot]

The live recordings - "In Case You Didn't Feel Like Showing Up" is really one of Ministry's best.

Saw them twice in concert in the 90's. Can't beat that.

Dude, I've got a dog that looks very similar to the one in your picture- he's a 110 lb pyrrenese mix- his name is...you guessed it...Jet. Beautiful dog. Big baby.

 

[uwalum]

With all due respect, Argentus, I humbly disagree with your implication that "strong financial incentive" is present particularly in the anesthesia arena.

Call me cynical, but money is a primary determinant force in most secular, and even in some religious (Benny Hann, the crook televangelist who owns a Gulfstream-5, the utopia of all business jets) arenas. Nurse practioner vs. family practice dudes. Physical therapists and their proliferating rehab facilities vs. PMNR and orthopedist docs. Ophthalmologists vs. ODs.

Nope, the balance of power between mid and upper level providers is definitely not confined to the anesthesia arena. Just the nature of everyone wanting Benjamins. P-Diddy was right. Its all about the benjamins.

 

[tkim]

Definitely a good album. Some of the EARLY 80's stuff is a little to techno for me,

LOL - "Halloween"

Alien must have been on some mellow yellow kick.

 

[tkim]

Dude, I've got a dog that looks very similar to the one in your picture- he's a 110 lb pyrrenese mix- his name is...you guessed it...Jet. Beautiful dog. Big baby.

That's my yellow - Murphy. A respectable 75 lbs ...

 

[Frank Rizzo]

LOL - "Halloween"

Alien must have been on some mellow yellow kick.

Thats awesome... 'Halloween,' pretty much sums it up. How about 'America'... straght from the early 80's, complete with plenty of synthesizer(sp?). It took a couple of years, and a lot of smack, for Al to start making the heavy $hit.

 

[tkim]

Thats awesome... 'Halloween,' pretty much sums it up. How about 'America'... straght from the early 80's, complete with plenty of synthesizer(sp?). It took a couple of years, and a lot of smack, for Al to start making the heavy $hit.

Let's not forget RevCo ...