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Anesthesia vs IM

Discussion in 'Anesthesiology' started by msmith83, Feb 25, 2014.

  1. sevoflurane

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    Just depends on the person. Allergy doc for me would be.... :vomit:... soooo boring. :sleep::sleep::sleep::sleep::sleep:

    I love the ORs... there is a very fun and social aspect to the ORs and we are at the forefront of a lot of great action.

    Mitral clips and Watchmen procedures have been the latest thing in my little corner of the universe. Just so completely reliant on our echo skills to get these procedures done well. When you go from systolic reversal in the pulmonary veins to a normalized pattern you KNOW you've done something very meaningful for that patient. NOT boring... ever evolving and making the most of our new technology.

    [​IMG]

    I love stomping out pain with needles... but that's another story.

    Had a friend request me for his AVR/aortic aneurysm. Placed an intuity valve and noticed a significant leak when we came off CPB. Surgeon could not see it. Showed him a Color flow 3D en face view of exactly where it was after I cropped down on it... asked him to put some stitches in the NCC location. Came off the second time with zero leak and I feel like I made a significant difference for my friend.

    I am definitely NOT built for clinic. :sleep::sleep::sleep:

    Love the ORs. You just see so much stuff... it's the only place I can practice medicine.
     
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  3. anbuitachi

    anbuitachi ASA Member

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    Here for the Mitral clips, the cardiologist does the TEE =(.

    Is your place doing Lariat procedure for A fib? If so how have they been going?
     
  4. magicdock

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    We should push for anesthesia public awareness and for pts being able to choose who puts them under so anesthesiologist dare more valuable to hospitals too


    Sent from my iPhone using Tapatalk
     
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  5. sevoflurane

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    We quit doing lariat procedures about 2 years ago. They were fine most of the time, but did have a couple of bleeders.
     
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  6. MEN2C

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    Man, some of the specialties on that list are pretty low down on the list of physician satisfaction scores. Many of them would see Anesthesia as the amazing perfect specialty if you asked them.

    Physician career satisfaction within specialties

    No one is THAT satisfied overall (but probably true for most careers). But top ten in this survey are 1) Pedi EM 2) Geriatrics 3) Dermatology 4) Pediatrics 5) IM & Peds 6) 'Other' ped subspecialty 7) Neonatology 8) A&I 9) Child psych 10) Rad onc.

    NSG is dead last and ortho is in the bottom third (though they don't break out spine specifically). This survey didn't have Anesthesiology.

    Another survey, slightly older (Physician Career Satisfaction Across Specialties) also has Geriatrics, Dermatology, Neonatology and pediatrics in the top five. So a somewhat stable set of specialties.

    Derm is derm but most of the rest aren't particularly at the top of the income scale (if anything, towards the bottom) and only moderately competitive (Average step score for Peds is 230, IM is like 233. For comparison, Anesthesiology is 232. Essentially the same.*) Just interesting, that's all.

    *Source: NRMP Outcomes in the match for US allopathic seniors
     
    #255 MEN2C, Mar 4, 2018
    Last edited: Mar 4, 2018
  7. OutRun

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    If you could go back would you do IM?

    This post scares me.
     
  8. skankhunt42

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    I will try to be succint because people on these forums can be negative and rambling.

    The day of Physician only Anesthesia is long gone. But I feel firmly that the value of a MD anesthesiologist is in taking care of sicker, more complex patients.

    My advice is to do a fellowship. You should never be in the position where a CRNA can walk into a room and argue they are just as good. To me, this means doing CV, Crit Care (or Peds/ Peds CV).
     
  9. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    This is not true. Many parts of the Midwest and the vast majority of the Western US are still MD only. There’s not a PP group within several hundred miles of me that’s an ACT practice.
     
  10. skankhunt42

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    Sorry- I was trying to be brief. You are of course right, many Anesthesiologists still work 1:1 bedside. But I do feel that you should not train specifgically for a 1:1 lollipop job. Now more than ever the incentives and safety you get with a fellowship is big. Take that extra year and try to learn skills that sets you apart. Do if the sky every truly does fall with CRNAs, you're protected (some).
     
  11. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    I think that’s good advice.
     
  12. agammaglobulin

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    Are you saying CRNAs don't do 'specialty' anesthesia? Because I've seen CRNAs at Children's hospitals, CRNAs doing CT cases, and NPs working in the ICU. I would argue, it isn't about finding a subspecialty with less risk of midlevel encroachment, but rather we as anesthesiologists should be protecting our field. Something the older generation did not do. I.e. stop hiring and training CRNAs/NPs like they are residents.
     
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  13. gasman2014

    gasman2014 SDN Gold Donor
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    This. I don't know how it is everywhere else, but our NPs and CRNAs already call their "clinicals" residency. I've even seen a few of them complain when residents are given the sickest patients in the OR/ICU, instead of the SNPs/RNAs, because it's "not fair." Seriously....mind boggling. It's up to us to try and right this ship...if we can.
     
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  14. agammaglobulin

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  15. Psai

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    The **** do they get off thinking they deserve what we do
     
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  17. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    To me this only means CV. Critical care doesn't mean crap for most OR cases. Same goes for Peds (how many difficult peds cases are there, how many children's hospitals?). People should do peds because they like children, not for job safety.

    Besides cardiac, the only fellowship worth it is pain, IF one has a good post-fellowship pathway/market.
     
    #265 FFP, Apr 16, 2018 at 4:17 PM
    Last edited: Apr 16, 2018 at 4:26 PM
  18. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    As a FMG, maybe. As an AMG, with a good chance for a fellowship, definitely.

    Whatever you do, try to avoid becoming your employer's bitch. The only way for that is to have your own stable of chronic patients that would drive 10-20 miles more to see you elsewhere, and to be irreplaceable by midlevels.

    Most (but not all) people who choose anesthesia nowadays do it for the lack of better choice, regardless of what they lie to others. It can seem like a decent compromise.

    Last, but not least (au contraire): if you are NOT an extrovert, you have NO business being in anesthesia.
     
    #266 FFP, Apr 16, 2018 at 4:21 PM
    Last edited: Apr 16, 2018 at 4:33 PM
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  19. ERRES2288

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    Care to elaborate ?
     
  20. gasman2014

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    As someone whose number 1 choice was anesthesiology and is not an introvert, maybe FFP means we tend to have too many people willing to just rollover for surgeons, crnas, nps, admins, rns, etc etc and forget that they are, indeed, physicians, with a very intimate role to play in a patients care.
     
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  21. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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  22. anbuitachi

    anbuitachi ASA Member

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    Just curious, if mid west and west are mostly MD only, and the pay is similar to East coast, why is east coast using so many CRNAs? Clearly it's doable with just MD only as shown by the west side of the country..
     
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  23. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay

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    Yes. Very doable. The reason plain and simple is greed.

    ACT at low ratio is really no more profitable than MD only. You have to run at least 3:1 and ideally 4:1. At that point you do make more in an ACT model.

    A bigger difference is scheduling. In an ACT practice, you need less docs to run the same number of rooms. Typically the call burden may be more frequent, but on the flip side, you will have less late days and be able to take more vacation than working MD only.

    Also, with less docs, there’s less ways you have to split up that stipend pie.
     
    #271 SaltyDog, Apr 17, 2018 at 7:25 AM
    Last edited: Apr 17, 2018 at 7:43 AM
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  24. chocomorsel

    chocomorsel Senior Member
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    And that is the real deal. All these people who keep saying that we can't function without CRNAs are busy drinking the cool aid and stuffing their pockets.

    Most anesthesiologists work in ACT models not because they necessarily believe in it, but because they have no choice due to location and family ties, want to make more money or don't like being in a room all day. The ones who say they believe it's the best model for patients are lying to themselves.
     
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  25. anbuitachi

    anbuitachi ASA Member

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    I can see the attraction to covering 1:2, good balance between in and out of OR. Good case load/procedures. More just sound like torture. I imagine a huge chunk of the day once you get to 1:4 will be spent pre opping/post opping, and jumping into rooms to induce/extubate, give breaks.. not cool. How much more do you make anyway on average with 1:3 to 1:4..? I can't believe so many people sold themselves to this model
     
  26. Man o War

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    Yes and don’t forget bailing out CRNAs from dumb [email protected]@t they do in your absence, not to mention things they just can’t handle properly.
    It’s truly miserable to cover too many, and I’ll retire before I will do it.
     
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  27. W19

    W19 SDN Gold Donor
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    Unfortunately, this is true... Some people will include IM as well, but inpatient IM might be too tricky for midlevels to handle.
     
  28. Psai

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    Nah everytime you can't handle something, either you scan everything nearby hoping for a radiologist to bail you out or consult someone who actually knows what they're doing. We cover for their inadequacies all the time.
     
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  29. GA8314

    GA8314 Regaining my sanity

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    A disgusting reality is that CRNA's are currently doing "Peds Fellowships" at one major tertiary center that I know of...... They will also be taking more and more US guided regional, and I'm sure TEE courses in the future.
     
  30. AdmiralChz

    AdmiralChz ASA Member

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    I’m inclined to agree, and that’s why I would suggest doing a fellowship that emphasizes higher-level management and evidence-based practice. In layman’s terms - using your brain.

    Peds, cardiac both accomplish this. CCM and Pain is a separate practice environment with their own individual issues but also fit the bill. In my honest opinion I don’t see regional accomplishing this - it’s not really higher-level anesthetic management just experience in placing (often esoteric) blocks. That can be taught to anyone off the street as FFP alludes.
     
  31. GA8314

    GA8314 Regaining my sanity

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    I don't think fellowships are that protective. There are only so many super tertiary care places with the sickest and most advanced cases. Most of anesthesia is NOT done in such places. I think we simply need to be vigilant and active politically to protect our interests. As others have said, CRNA's are being taught that NOTHING is off limits to them. Literal equivalency.

    For those in ACT models, don't ever ever let your OR skills diminish. While this is not as likely as one would think, I've seen it among some older docs. Never let that happen, and it's actually easy to maintain those skills. There will always be a job for good "anesthesia" folks even if we lose political battles.
     
  32. Psai

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    The problem is that we teach them. If we didn't teach them how to do the cases, the problem would stop there.
     

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