Anesthesiology and Managed Care

[rs2006]

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Hi all,

I hope all is well for everyone in the forum. I recently completed my medicine sub i only to note how much the attendings (who were fresh from private practice( were complaining about the impact of managed care on their day to day practice (ie they dictate how "efficient" you should be as a hospitalist managing inpts, or as an outpt internists how you should document and what "endpts" you should achieve, etc). Now getting back to my pt, after having been on anesthesiology it seems as if the field is "immune" to the realities of real world medicine (sorry if this statement offends you) in terms of financial "realities" (ie lower salaries in most other fields), increased pressure from managed care (it seems as if anesthesiology has not been touched by managed care), and malpractice litigation (from what I have heard anesthesia is a completely low risk field). Any thoughts on this from the attendings here who work in the real world? Also, if this is in fact reality, what is it that is keeping it so "pure"-- are there laws that are doing this, and if not how long do you think it will last? Any thoughts?.......... Thanks

 

[militarymd]

What do you think billing Medicare is?????

You send them a bill for $1,000.00....they send you a check for $5.24.....3 months later.

 

[rs2006]

with all due respect to all of the attendings who are posting on this forum, while I agree that medicare may not compensate very well, the fact is anesthesiologists make a large amount of money despite this. In addition, doctors in MOST other fields do not get compensated well at all (as the poster above stated), but it seems that anesthesiologists do without having to manage seeing many patients, pay out thousands of dollars in malpractice insurance, and deal with red tape associated with managed care-- that is what I was getting at in my original post and would be grateful if anyone had any ideas as to what is keeping the field this way and if so, do you think this "paradise" of medicine will continue? Any thoughts?

Thanks

 

[Orchard]

with all due respect to all of the attendings who are posting on this forum, while I agree that medicare may not compensate very well, the fact is anesthesiologists make a large amount of money despite this. In addition, doctors in MOST other fields do not get compensated well at all (as the poster above stated), but it seems that anesthesiologists do without having to manage seeing many patients, pay out thousands of dollars in malpractice insurance, and deal with red tape associated with managed care-- that is what I was getting at in my original post and would be grateful if anyone had any ideas as to what is keeping the field this way and if so, do you think this "paradise" of medicine will continue? Any thoughts?

Thanks

Well, paradise is a relative term. I guess based on your perceptions, anesthesia IS a paradise when compared to other specialties. I tend to agree with your viewpoint since I love what I am doing and don't have to deal with the specific "red tape" YOU mentioned. Dealing with surgeons, OR inefficiencies, the multitude of personality types you encounter on a daily basis are unique challenges in and of themselves. Although I don't need any "ego stroking", I'd imagine that for some it would be difficult to deal with the relative lack of recognition in our specialty.

Anesthesiologists ARE well compensated but please remember the relatively linear relationship between hours worked/how hard you work to amount of money earned. You will need to work harder/longer in order to make the sick, sick cash. You have a misperception in regards to the relationship between number of patients being seen and compensation. Granted, the pre-anesthetic interview is a lot shorter then an initial patient visit at Dr. Family Practice but a large number of patients are seen during the day. For instance, when I supervise 2 ORs and the Short Procedure Unit (colonoscopies, EGDs) and there are 5 cases in each, that,s 15 patients seen - typically before 1 p.m.

I personally feel that comparatively speaking, anesthesia IS the utopia of the medical field. Remember that there are stresses and nonsense associated with this field; it's just that they seem less when compared to other fields.

 

[militarymd]

that is what I was getting at in my original post and would be grateful if anyone had any ideas as to what is keeping the field this way and if so, do you think this "paradise" of medicine will continue? Any thoughts?

Thanks

You are asking for us to predict the future........No one can do that.

As for your perceived "paradise" of anesthesia.....its all supply and demand...ain't nothin but business.....If you offer something that is sought after, then you get paid for it.

 

[VentdependenT]

You are asking for us to predict the future........No one can do that.

As for your perceived "paradise" of anesthesia.....its all supply and demand...ain't nothin but business.....If you offer something that is sought after, then you get paid for it.

Yeah. Just like those strip clubs by the airport. See you there at 10!

 

[Etomidate]

Not sure if this is the right thread for this, but rs2006 brings up some valid questions. It seems many resident and attending anesthesiologists on this forum choose denial as their defense mechanism.

With the federal gov't about to make changes to anesthesia reimbursement and the obvious CRNA threat, things can only go downhill.

Obviously the sky isn't falling yet, and no one can predict when it will.

But all it takes is a few honest conversations with private practice anesthesiologists and the consensus is universal.

Salaries will fall. Does this mean gasdocs will starve? No way. But with the recent influx of medical students entering the field based largely on lifestyle/money issues, they will likely be in for a rude awakening. Only those who enjoy what they are doing and are happy with ~200K/year will not regret their decision.

On a bright note, an article in the ASA newsletter a few months back said something about 22% of all anesthesiologists are predicted to retire within the next 5 years based on their age.

 

[Dr. J?]

Yeah. Just like those strip clubs by the airport. See you there at 10!

OK, so it's supply & demand, just like everything else in the world. Sure, makes sense. For M4's who are interested in the field.... 😀

Does anyone out there know the number of 'strippers' (currently practicing today) vs. the number of 'clients' who need to have supervision while at the 'treating' facility?

Also, how many 'strippers' are set to retire in the near-term? How many new 'strippers' are currently being trained? And, how many 'strippers' are arriving for advanced training in the US from foreign schools?

One more, by how much are the 'club' visits going to increase in the near-term?

I fear this analogy will soon break down under its own weight....

 

[militarymd]

Does anyone out there know the number of 'strippers' (currently practicing today) vs. the number of 'clients' who need to have supervision while at the 'treating' facility?

Also, how many 'strippers' are set to retire in the near-term? How many new 'strippers' are currently being trained? And, how many 'strippers' are arriving for advanced training in the US from foreign schools?

One more, by how much are the 'club' visits going to increase in the near-term?....

I recommend you stay out of anesthesia. In general, this field requires physicians who learn quickly.

It has already been stated that we can not forecast the future, and yet you ask for the future again....clearly someone who does not listen or learn quickly. So....I recommend you pick Family Practice where beng wrong rarely gets a patient killed right away.

 

[militarymd]

I recommend you stay out of anesthesia. In general, this field requires physicians who learn quickly.

It has already been stated that we can not forecast the future, and yet you ask for the future again....clearly someone who does not listen or learn quickly. So....I recommend you pick Family Practice where beng wrong rarely gets a patient killed right away.

This is meant in fun....in case you thought I was being mean.

 

[jwk]

with all due respect to all of the attendings who are posting on this forum, while I agree that medicare may not compensate very well, the fact is anesthesiologists make a large amount of money despite this. In addition, doctors in MOST other fields do not get compensated well at all (as the poster above stated), but it seems that anesthesiologists do without having to manage seeing many patients, pay out thousands of dollars in malpractice insurance, and deal with red tape associated with managed care-- that is what I was getting at in my original post and would be grateful if anyone had any ideas as to what is keeping the field this way and if so, do you think this "paradise" of medicine will continue? Any thoughts?

Thanks

Surely you jest. Surgeon's get a much higher %age reimbursement from CMS relative to their usual fee, sometimes as high as 80%. Anesthesia is in the 15-20% range. Medicare pays about $700 flat rate for anesthesia for open hearts, including swan, a-line, etc. That barely covers anesthetist costs on a 3-4 hr case, and is a money-loser on a robotic heart that takes 10 hours.

 

[Dr. J?]

I recommend you stay out of anesthesia. In general, this field requires physicians who learn quickly.

It has already been stated that we can not forecast the future, and yet you ask for the future again....clearly someone who does not listen or learn quickly. So....I recommend you pick Family Practice where beng wrong rarely gets a patient killed right away.

Thanks alot for telling the whole wide world about my learning disability. 😳 I guess now I'm going to have to resolve myself to doing a veterinarian anesthesia residency in the Phillipines. 😀

 

[Orchard]

I guess now I'm going to have to resolve myself to doing a veterinarian anesthesia residency in the Phillipines. 😀

I don't know......they're pretty competetive. I couldn't get in and had to do a human anesthesia residency in the US.