anesthesiology competitiveness and its future

[drseanlive]

for the residents/docs in the field...it seems like anesthesiology is a dream field....making more $ than gen surgeons for relatively less difficult work/residency...

can someone speak about why the residencies aren't super competitive? It seems odd to me that an anesthesiologist can make as much as someone in cards yet my impression is that its not so hard for an US grad to match...

also what is the highest/lowest paid sub-specialities out of anesthesia.

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[stewiegriffinFG]

Competitiveness isn't all about the benjamins.

#1: No respect. Surgeons see you as lazy bums and they think they can do your job, and sometimes they even think they can tell you what to do. CRNAs want to take your job...

#2: CRNA encroachment. Nurses think anesthesiologists do nothing and can replace them completely. They have fierce lobbying power and are quite arrogant. This is starting to change with AA legislation coming through and peri-OR medicine becoming more important, and the flourishing of fellowships.

#3: Anesthesiology is trying to find its niche. Most people agree that the field can't be all about stool-sitting and passing gas.

#4: The job market for anesthesiologists is currently at a high point. This is not guaranteed forever.

#5: Future reimbursement schedules will focus less on procedures and more on cognitive work in order to address primary care shortages. Since anesthesiology is heavily procedure-based, this is going to hurt anesthesiology payments quite a bit.

#6: You don't have long-term patients. Good and bad, but if you want to feel like you're taking care of someone long-term, you're in the wrong specialty (you could always do pain though...).

#7: It's hard to increase gross income without increasing volume. Other "lucrative" specialties can open their own shops and do the money shots all day. Dermatology comes to mind. Plastics too.

#8: Academic anesthesiology will die unless you have talented anesthesiologists forgoing private practice. As it is now, most of the best anesthesiologists go straight to private practice and never look back.

#9: Last but not least: someone asks you what you do, and you say you're an anesthesiologist. Then they ask what you do, then you say that you're the person who puts you to sleep during surgeries and monitors your health throughout it. Then they say "ohhh, they're just as important as the doctor."

 

[amyl]

for the residents/docs in the field...it seems like anesthesiology is a dream field....making more $ than gen surgeons for relatively less difficult work/residency...

can someone speak about why the residencies aren't super competitive? It seems odd to me that an anesthesiologist can make as much as someone in cards yet my impression is that its not so hard for an US grad to match...

also what is the highest/lowest paid sub-specialities out of anesthesia.

I am not sure I agree with less difficult work....different but not necessarily any less difficult. Why do you think it is harder to be a general surgeon or a cardiologist than an anesthesiologist? I disagree.
I don't think that it is hard to match anywhere in Anesthesiology, but it is difficult to match well. Many people here will disagree with me but I think it does matter where you do your residency. I have been exposed to a number of CA-1s as a med student...comparing them, I think it does matter where you do your residency. There are exceptions, I have met some very talented people at what would be considered a mediocre residency but they are the exceptions.

 

[powermd]

Head off some badness in a visible way and surgeon respect comes pretty quickly. Delay cases and f things up, and the opposite occurs. I've yet to meet a real patient who said #9. Many say "I'm not afraid of the surgery, but I am worried about the anesthesia", "a good anesthesiologist is MORE important than a good surgeon", "YOU'RE the guy I wanna talk to...". Patient misconceptions seem to favor us, in my experience.

Competitiveness isn't all about the benjamins.

#1: No respect. Surgeons see you as lazy bums and they think they can do your job, and sometimes they even think they can tell you what to do. CRNAs want to take your job...

#2: CRNA encroachment. Nurses think anesthesiologists do nothing and can replace them completely. They have fierce lobbying power and are quite arrogant. This is starting to change with AA legislation coming through and peri-OR medicine becoming more important, and the flourishing of fellowships.

#3: Anesthesiology is trying to find its niche. Most people agree that the field can't be all about stool-sitting and passing gas.

#4: The job market for anesthesiologists is currently at a high point. This is not guaranteed forever.

#5: Future reimbursement schedules will focus less on procedures and more on cognitive work in order to address primary care shortages. Since anesthesiology is heavily procedure-based, this is going to hurt anesthesiology payments quite a bit.

#6: You don't have long-term patients. Good and bad, but if you want to feel like you're taking care of someone long-term, you're in the wrong specialty (you could always do pain though...).

#7: It's hard to increase gross income without increasing volume. Other "lucrative" specialties can open their own shops and do the money shots all day. Dermatology comes to mind. Plastics too.

#8: Academic anesthesiology will die unless you have talented anesthesiologists forgoing private practice. As it is now, most of the best anesthesiologists go straight to private practice and never look back.

#9: Last but not least: someone asks you what you do, and you say you're an anesthesiologist. Then they ask what you do, then you say that you're the person who puts you to sleep during surgeries and monitors your health throughout it. Then they say "ohhh, they're just as important as the doctor."

 

[stewiegriffinFG]

Head off some badness in a visible way and surgeon respect comes pretty quickly. Delay cases and f things up, and the opposite occurs. I've yet to meet a real patient who said #9. Many say "I'm not afraid of the surgery, but I am worried about the anesthesia", "a good anesthesiologist is MORE important than a good surgeon", "YOU'RE the guy I wanna talk to...". Patient misconceptions seem to favor us, in my experience.

Oh, I agree. I was referring more to the kind of person who doesn't know much about medicine or surgery, and who hasn't had a surgery to know the specifics of the tasks of an anesthesiologist.

 

[deleted126335]

.

 

[militarymd]

In Anesthesiology, respect for clinical skill and hard work frequently does not translate into political clout at the decision making table within the health care system. Anesthesiologist political clout is based just as much or more so on local supply/demand factors as it does your clinical acumen and work ethic and ability to build relationships at work. The same is true for other hospital based specialties.

as accurate as it's going to get.

 

[Dryacku]

Every field of medicine to a certain respect is repetition. Its the complications and the curve balls that make us doctors and not nurses. I think over the years anesthesia has become more and more of a perfect science, however when **** hits the fan we dont have time to turn to a book for a differential or go get consultants to help us. Thats why it's crucial to understand a patients comorbidities and the potential complications during a case. That is why I dont think anesthesia is any easier then other fields.

The reason I think it is not as competitive is because medical students have very little exposure to anesthesia and the exposure you have is generally watching somebody else do most of the work. When things do hit the fan the medical student doesnt really get to do much in most situations.

I urge all medical students who enjoy pharm and physio to do a solid anesthesia rotation early in their medical school training or at least get some exposure.

 

[coprolalia]

for the residents/docs in the field...it seems like anesthesiology is a dream field....making more $ than gen surgeons for relatively less difficult work/residency...

I disagree with this statement.

We have to know how to give anesthetics to all variety of surgical patients, from a simple lap chole on an otherwise healty 40-year-old to a craniotomy on a sick 8-year-old with an infratentorial tumor to a 86-year-old colectomy with critical aortic stenosis... etc., etc. (you get the picture).

Throw in the fact that we have to be the OR's ambassador, and sometimes the whipping post, for people who generally don't understand or give us the respect we think we deserve, and I think this clearly becomes a far cry from "less difficult" work. Furthermore, as an anesthesiologist, you cover every square inch of the hospital. I assure you that I have surgical colleagues who have no idea where the MRI scanner is, let alone the ability to find the PICU (and forget about the gamma knife... hell, most don't even know what that thing does).

There are a lot of misconceptions about our field. I've been doing this long enough now, as I soon approach my CA-3 year, that I am able to really start seeing the distinctions in thought process compared to a "seasoned" CRNA who's been doing this for 15+ (or more) years. There's no comparison.

Are we overtrained? Do we not get any respect? Can our job be just as expertly done by an wanna-be tube jockey with basic monkey skills? My answer is a resounding "no" to each of those questions. You get the respect you earn. And, if you deliver smooth anesthetics to complex patients who subsequently have an easy post-operative course because you've thought of those details that others didn't, you're going to get noticed... in a good way.

It has been said on this forum before how scary it is that certain people don't know what they don't know, yet trod along as "pseudo-experts" blissfully ignorant about the cliff upon which they're dancing. You can either try to educate them, or you can ignore them. It ultimately depends on what you want outta life, and to whom you think you have something to prove... which, if you're honest, is only probably yourself.

-copro

 

[Jeff05]

to original poster:

if you put a lot of stock into what other people think of you - anesthesiology is likely the wrong choice.
in my experience, as an almost ca3 (I REALLY HOPE THIS WILL CHANGE IN PRIVATE PRACTICE AS AN ATTENDING) you have got to have a pretty thick skin and a great sense of humor.

an ENT chief resident was actually arguing with me today about duration of action of remi. she was trying to tell me that a patient of my had opioid related respiratory depression 25 minutes after i stopped remi (at 0.05mcg/kg/min...). she could not care less what i thought about the subject. she ended up giving narcan. it did nothing.

 

[Pilot Doc]

Why do you think it is harder to be a general surgeon than an anesthesiologist?

Any number of reasons - at least in an academic center, you have
1) rounding & clinic
2) pre-op and post-op care (some overlap with #1)
3) ER
4) no real limit on the volume of work you can accrue in 24 hours.
5) much less shift work
6) clinical workload fairly evenly distributed 24-7-365 compared to 90%+ 7-3 for gas
7) patient phone calls

I think it's pretty easy to say that GS is harder than gas. That's not a knock on anesthesiologists. It's probably harder to dig ditches all day long - doesn't diminish the importance of a good anesthesiologist.

 

[Jeff05]

90% 7-3pm for gas? where?

if it's 90% in a span of 8 hours...we work 44 hours a week?

 

[filter07]

No one in their right mind can say that Anesthesiology is just as hard as General Surgery. How many Anesthesiologists give up and go into General Surgery for the lifestyle?

Whenever there are overlaps in the schedule, the hardest rotations in Anesthesiology are often the easiest General Surgery months.

There are Anesthesiology residents warning people not to go to Program A because they are overworked; working almost 80 hours a week.

Anesthesiology is a decent field. But it is not that hard. That's why all the burnouts defect to gas.

 

[2win]

Competitiveness isn't all about the benjamins.

#1: No respect. Surgeons see you as lazy bums and they think they can do your job, and sometimes they even think they can tell you what to do. CRNAs want to take your job...

#2: CRNA encroachment. Nurses think anesthesiologists do nothing and can replace them completely. They have fierce lobbying power and are quite arrogant. This is starting to change with AA legislation coming through and peri-OR medicine becoming more important, and the flourishing of fellowships.

#3: Anesthesiology is trying to find its niche. Most people agree that the field can't be all about stool-sitting and passing gas.

#4: The job market for anesthesiologists is currently at a high point. This is not guaranteed forever.

#5: Future reimbursement schedules will focus less on procedures and more on cognitive work in order to address primary care shortages. Since anesthesiology is heavily procedure-based, this is going to hurt anesthesiology payments quite a bit.

#6: You don't have long-term patients. Good and bad, but if you want to feel like you're taking care of someone long-term, you're in the wrong specialty (you could always do pain though...).

#7: It's hard to increase gross income without increasing volume. Other "lucrative" specialties can open their own shops and do the money shots all day. Dermatology comes to mind. Plastics too.

#8: Academic anesthesiology will die unless you have talented anesthesiologists forgoing private practice. As it is now, most of the best anesthesiologists go straight to private practice and never look back.

#9: Last but not least: someone asks you what you do, and you say you're an anesthesiologist. Then they ask what you do, then you say that you're the person who puts you to sleep during surgeries and monitors your health throughout it. Then they say "ohhh, they're just as important as the doctor."

-Thank you for the post - We do have to face some of the chalenges posted...I will try to respond one by one to your statements - you are right regarding the way that we are seen, but doesn't mean that this is the correct way
- #1 - we doesn't care a lot about the way that surgeons are looking at us, there are also surgeons that are seen by us beeing bums - motivated only by some money...they think that they can tell you what to do - that's ok - if they only "think" and keep their mouth closed. CRNA-s - blame us for this situation.
- #2 - arogant - yes. Most of them - I've met some very professional and good. And I am not a fan of CRNA-s..
- #3 - the field is amazing, going from anesthesia to pain and aging medicine. The way that this field is perceived is because the "old school". things are changing fast - there are some posters here that I believe will make a difference!
- #4 - job market is relative for all of us...Let's see what is happening next year. The need for us is increasing.
-#5 possible, let's do bronchoscopies and ICU more than now.
-#6 you're right
-#7 pain for us. I envision our speciality taking care about a new field- patient comfort in hopsital. Beeing obsesive - compulsive we are able to take care at the best of patient comfort - from ER to discharge.
- #8 academic will stay - we'll have all the time md-s with enough money form private and desire to spend time and energy with the new generation. At least me I would enjoy that to some moment in my life.
-#9 we need and ER type of movie with us...ASA I remember tried to some moment. Let's press them to do that. Advertising, you're right is essential for us. Time will tell us - but we have to move in the right direction to survive at our full potential.

 

[Jeff05]

all the burnouts defect to gas? nice.

No one in their right mind can say that Anesthesiology is just as hard as General Surgery. How many Anesthesiologists give up and go into General Surgery for the lifestyle?

Whenever there are overlaps in the schedule, the hardest rotations in Anesthesiology are often the easiest General Surgery months.

There are Anesthesiology residents warning people not to go to Program A because they are overworked; working almost 80 hours a week.

Anesthesiology is a decent field. But it is not that hard. That's why all the burnouts defect to gas.

 

[urge]

I wasn't going to chime in because I thought this thread was BS. But, it needs some direction now.


Basically, it depends on what you mean by hard. Is Surgery "harder" than anesthesia?- Yes and no. Yes, if by hard you mean more scutwork, longer hrs, and more brown nosing. No, if by hard you mean the amount of knowledge you are required to master during residency.

As an attending surgeon, is being in clinic few days a week hard? Not if you like people. Is doing 5 lap choles hard? Not really. Is filling the paperwork hard? Yes, it's a PITA. I'll give you that.

As an attending anesthesiologist, is it hard to do preops, intubate, or do blocks? Most of the time no. Yet, can be a bit hectic if you are running 4 rooms. Covering OB is not easy. It's a PITA. However, the hardest thing about anesthesiology is knowing that everyday you walk into the OR you have a decent chance of killing somebody. If you don't think that's hard there is something wrong with you. Not too many surgeon walk around with that in their head.

 

[jetproppilot]

Any number of reasons - at least in an academic center, you have
1) rounding & clinic
2) pre-op and post-op care (some overlap with #1)
3) ER
4) no real limit on the volume of work you can accrue in 24 hours.
5) much less shift work
6) clinical workload fairly evenly distributed 24-7-365 compared to 90%+ 7-3 for gas
7) patient phone calls

I think it's pretty easy to say that GS is harder than gas. That's not a knock on anesthesiologists. It's probably harder to dig ditches all day long - doesn't diminish the importance of a good anesthesiologist.

UHHHH.....MY TRUCK IS HIGHER THAN YOURS! CAN YOU DRIVE AROUND WITHOUT THE INCESSANT POTHOLES ON OUR S HITTY ROADS BOTHERING YOU? CAN YOU DRIVE AROUND WHEN THE ROADS ARE FLOODED? HUH? I DIDNT THINK SO! I CAN!



WHEW! I FEEL BETTER since I just contributed to the STUPIDEST PISSING CONTEST ON EARTH.
all that said, Pilotdoc, you're absolutely right. [/B]

 

[Strength&Speed]

yeah...you really can't say gas is as hard as general surgery. you may have as much knowledge, but there's no way in hell you are spending the same hours. christ, thank your lucky stars, don't get defensive. the hours spent in GS aren't exactly well spent all the time. be glad you have a more efficient program.

 

[TaiShan]

Please remember who are going to take care of the difficult patients post-operatively. You might have a difficult eight-hour with the patient in the OR, but the poor surgery folks are going to deal with the mess for the days or weeks.

 

[Pilot Doc]

all that said, Pilotdoc, you're absolutely right.

Didn't mean to get into, nor am I really interested in a pissing match. I don't think deciding which specialty is hardest serves much purpose. But maintaining good relationships with surgeons is - and saying anesthesia is as hard as surgery isn't a good way to do it.

 

[PACMDA]

However, the hardest thing about anesthesiology is knowing that everyday you walk into the OR you have a decent chance of killing somebody. If you don't think that's hard there is something wrong with you. Not too many surgeon walk around with that in their head.

I'd like to think the chances of me killing somebody everyday are least less than OJ Simpson's.
R.I.P.

 

[fakin' the funk]

for the residents/docs in the field...it seems like anesthesiology is a dream field....making more $ than gen surgeons for relatively less difficult work/residency...

can someone speak about why the residencies aren't super competitive?

First of all, why hasn't anyone called this troll out yet? This guy has spent the majority of his other posts talking about compensation and plastic surgery. There are lots of fields that are better compensated than GS with a perceived "easier" lifestyle/residency. Dermatology comes to mind.

Anesthesiology residency isn't super-competitive because
1) there are a ton of spots (EM and Anes are the largest non-primary-care residencies)
2) the nature of the work suits only a small portion of people
3) many medical students have little exposure to anesthesiology (other than surgeons mocking them during their surgery clerkships) with few role models
4) it's not "prestigious" like surgery or cardiology etc.

 

[amyl]

First of all, why hasn't anyone called this troll out yet? This guy has spent the majority of his other posts talking about compensation and plastic surgery. There are lots of fields that are better compensated than GS with a perceived "easier" lifestyle/residency. Dermatology comes to mind.

Anesthesiology residency isn't super-competitive because
1) there are a ton of spots (EM and Anes are the largest non-primary-care residencies)
2) the nature of the work suits only a small portion of people
3) many medical students have little exposure to anesthesiology (other than surgeons mocking them during their surgery clerkships) with few role models
4) it's not "prestigious" like surgery or cardiology etc.

well said...this pretty much sums it up I think.

 

[divinemsm]

As far as I am concerned...you can have the " prestige " while I am able to make a decent living without the burden of having to build a patient base/work like a slave for a system that benefits no one but "The Powers That Be"-believe that. I just don't get this ridiculous notion of never leaving the hospital, being available to THE PATIENT at the ready. Please.
Even if ( when ) reimbursement declines, I will still have the possibility to work as much or as little as I want. If " academics " is what I desire, I will have the ability to take care of critically ill patients for 10-14 twelve hour shifts a month, with the option to do OR time or pursue endeavors OTHER than medicine if I get burned out. Medicine and its culture will have you believe that it is honorable and necessary to lose yourself to this career path. Don't be fooled-It's a just a job for most of us.We just have happened to , in general, have paid more money than most , and sacrificed ourselves in ways we were likely warned about but could not believe until we actually experienced it.
For many of us, it is too late to fully pull out based on the financial burden accrued. I suspect many more would leave the profession( medicine, not anesthesia per se ) if they could reasonably do so: they are just afraid to openly, and in all seriousness , say so. Just my .02

 

[me454555]

As far as I am concerned...you can have the " prestige " while I am able to make a decent living without the burden of having to build a patient base/work like a slave for a system that benefits no one but "The Powers That Be"-believe that. I just don't get this ridiculous notion of never leaving the hospital, being available to THE PATIENT at the ready. Please.
Even if ( when ) reimbursement declines, I will still have the possibility to work as much or as little as I want. If " academics " is what I desire, I will have the ability to take care of critically ill patients for 10-14 twelve hour shifts a month, with the option to do OR time or pursue endeavors OTHER than medicine if I get burned out. Medicine and its culture will have you believe that it is honorable and necessary to lose yourself to this career path. Don't be fooled-It's a just a job for most of us.We just have happened to , in general, have paid more money than most , and sacrificed ourselves in ways we were likely warned about but could not believe until we actually experienced it.
For many of us, it is too late to fully pull out based on the financial burden accrued. I suspect many more would leave the profession( medicine, not anesthesia per se ) if they could reasonably do so: they are just afraid to openly, and in all seriousness , say so. Just my .02

+1

 

[Iquitos]

Competitiveness isn't all about the benjamins.

#1: No respect. Surgeons see you as lazy bums and they think they can do your job, and sometimes they even think they can tell you what to do. CRNAs want to take your job...

#2: CRNA encroachment. Nurses think anesthesiologists do nothing and can replace them completely. They have fierce lobbying power and are quite arrogant. This is starting to change with AA legislation coming through and peri-OR medicine becoming more important, and the flourishing of fellowships.

#3: Anesthesiology is trying to find its niche. Most people agree that the field can't be all about stool-sitting and passing gas.

#4: The job market for anesthesiologists is currently at a high point. This is not guaranteed forever.

#5: Future reimbursement schedules will focus less on procedures and more on cognitive work in order to address primary care shortages. Since anesthesiology is heavily procedure-based, this is going to hurt anesthesiology payments quite a bit.

#6: You don't have long-term patients. Good and bad, but if you want to feel like you're taking care of someone long-term, you're in the wrong specialty (you could always do pain though...).

#7: It's hard to increase gross income without increasing volume. Other "lucrative" specialties can open their own shops and do the money shots all day. Dermatology comes to mind. Plastics too.

#8: Academic anesthesiology will die unless you have talented anesthesiologists forgoing private practice. As it is now, most of the best anesthesiologists go straight to private practice and never look back.

#9: Last but not least: someone asks you what you do, and you say you're an anesthesiologist. Then they ask what you do, then you say that you're the person who puts you to sleep during surgeries and monitors your health throughout it. Then they say "ohhh, they're just as important as the doctor."

Is this really going to be the trend? (#5)? It seems pretty clear that something will have to change in the future, but I have a hard time seeing reimbursement increasing for any field. It seems like medicare/medicaid/insurance will keep chipping away at specialty reimbursement and cutting FP's and IM's salaries down to a PA salary. In the end primary care physician salary will roughly equal midlevel's salaries (maybe somewhere around 100K), and specialties around 100-200K. The exception maybe being neuro/spinal surgery among others. If this sad scenario occurs, I see fewer and fewer medical students choosing primary care (which is already the trend). After all why bust your @ss for a decade+ and come out 250K in debt just to make the same pay as a nurse or midlevel? Sure, you will gain a superior education, but does anyone care or reimburse you for what your worth?

As far as I am concerned...you can have the " prestige " while I am able to make a decent living without the burden of having to build a patient base/work like a slave for a system that benefits no one but "The Powers That Be"-believe that. I just don't get this ridiculous notion of never leaving the hospital, being available to THE PATIENT at the ready. Please.
Even if ( when ) reimbursement declines, I will still have the possibility to work as much or as little as I want. If " academics " is what I desire, I will have the ability to take care of critically ill patients for 10-14 twelve hour shifts a month, with the option to do OR time or pursue endeavors OTHER than medicine if I get burned out. Medicine and its culture will have you believe that it is honorable and necessary to lose yourself to this career path. Don't be fooled-It's a just a job for most of us.We just have happened to , in general, have paid more money than most , and sacrificed ourselves in ways we were likely warned about but could not believe until we actually experienced it.
For many of us, it is too late to fully pull out based on the financial burden accrued. I suspect many more would leave the profession( medicine, not anesthesia per se ) if they could reasonably do so: they are just afraid to openly, and in all seriousness , say so. Just my .02

I know people that feel this way. I'm not sure if I have got to this point yet. I am somewhat ashamed to admit this, but I sometimes wonder if med school was the most economically sound decision based upon the current trends in health care. Right now things seem to be decent. Midlevel's are encroaching steadily, but are being held at bay and are not being reimbursed to the same level as a physician....yet. As for the future who knows? Are my college buddies that chose to be PA's, CRNA's instead of physicians going to be in a better financial situation in 7 years after I finish residency? Hopefully not. I am definitely grateful that I am receiving a high quality education and in the end, I believe being a competent well trained physician is probably the most important thing to consider. I apologize for the rant. I just get frustrated as I prepare to take out another 35K+living expenses while at the same time read about all the BS proposed reimbursement cuts.

 

[amyl]

today, during my med school graduation rehearsal, one of my classmate said she wasn't afraid of socialized medicine as it would open the door for true private medicine...people who could would pay more for better care. is this what we are headed for in medicine.... people like OJ get the best lawyers money can buy vs. the public defender applied to medicine...

 

[stewiegriffinFG]

today, during my med school graduation rehearsal, one of my classmate said she wasn't afraid of socialized medicine as it would open the door for true private medicine...people who could would pay more for better care. is this what we are headed for in medicine.... people like OJ get the best lawyers money can buy vs. the public defender applied to medicine...

Or, to put it another way, you will have the VA system on a larger scale, and then you have the private system. But, socialized medicine probably is not going to happen in our lifetime.

 

[stewiegriffinFG]

Is this really going to be the trend? (#5)? It seems pretty clear that something will have to change in the future, but I have a hard time seeing reimbursement increasing for any field. It seems like medicare/medicaid/insurance will keep chipping away at specialty reimbursement and cutting FP's and IM's salaries down to a PA salary. In the end primary care physician salary will roughly equal midlevel's salaries (maybe somewhere around 100K), and specialties around 100-200K. The exception maybe being neuro/spinal surgery among others. If this sad scenario occurs, I see fewer and fewer medical students choosing primary care (which is already the trend). After all why bust your @ss for a decade+ and come out 250K in debt just to make the same pay as a nurse or midlevel? Sure, you will gain a superior education, but does anyone care or reimburse you for what your worth?

No, the way that payments are made right now are based on a relative scale called the RUC/RVU system. It's a group of physicians in the AMA, dominated by specialists, who determine the ratio of the pie that will be paid for certain activities, which is then used by CMS and private insurance companies. Because it is dominated by specialists and not primary care physicians, more of the pie is given for procedures and specialist workups instead of cognitive work. The goal of the system is to prevent health care costs run away since there is a fixed pie that is worked from every year, but in reality, it just increases the amounts of procedures done and it pits doctors against each other to get more money for our respective work when we should be working together to overthrow that system.

There is a very significant trend to reform the RUC/RVU system, perhaps even throwing it out and starting over. When that happens, all procedure-based specialties will be hurt, even the orthopods and radiologists, and primary care will enjoy a golden age. There is a huge shortage of primary care doctors in this country, and mandated health insurance is enacted, the primary care shortage will have to be addressed forcefully.

(So, it might come to: orthopods and anesthesiologists will have yearly earnings of $200,000 and primary care physicians will have yearly earnings of $250,000.)

 

[GSresident]

today, during my med school graduation rehearsal, one of my classmate said she wasn't afraid of socialized medicine as it would open the door for true private medicine...people who could would pay more for better care. is this what we are headed for in medicine.... people like OJ get the best lawyers money can buy vs. the public defender applied to medicine...

Your med student friend is making 2 very dubious assumptions.

1) She is assuming that private medicine will be allowed in this country. If we follow the example of Canada, private medicine will be explicitly banned and seeking care outside of the system/country will be called "cheating." I think I remember reading that Canada's supreme court found it unconstitutional to ban private medicine but I'm not positive.

2) She is assuming that you will be able to avoid the socialized system entirely. What is likely to happen is that you won't be able to get a license to practice medicine without participating at least to some extent in the socialized scheme. All a state has to do is to tie licensure to public service and you're screwed.

The best advice I can give to anyone about to start or join a practice is to continue to live the resident lifestyle until you have all of your debt paid and your retirement fully funded. There will be MUCH less money in medicine in the very near future.

 

[PACMDA]

I am much closer to the retirement end of my career than it's infancy, and once it looks like I'll be busting a ss for less than my investment income can provide they can kiss my laryngoscope goodbye, I'll be sniffing that sweet "unearned income" blossum.

 

[177983]

Your med student friend is making 2 very dubious assumptions.

1) She is assuming that private medicine will be allowed in this country. If we follow the example of Canada, private medicine will be explicitly banned and seeking care outside of the system/country will be called "cheating." I think I remember reading that Canada's supreme court found it unconstitutional to ban private medicine but I'm not positive.

2) She is assuming that you will be able to avoid the socialized system entirely. What is likely to happen is that you won't be able to get a license to practice medicine without participating at least to some extent in the socialized scheme. All a state has to do is to tie licensure to public service and you're screwed.

The best advice I can give to anyone about to start or join a practice is to continue to live the resident lifestyle until you have all of your debt paid and your retirement fully funded. There will be MUCH less money in medicine in the very near future.

Don't you think this is getting a little 1984? None of the three major presidential candidates are calling for anything vaguely like what you're talking about. Even Hilary, who's got the most "social" medical reforms is only talking about setting up government "insurance companies" that would insure everyone. Every American would be totally free to keep their private health insurance if they were inclined to do so. She learned her lesson from "Hilary-care". Americans don't want and won't have entirely socialized medicine anytime soon.

Further, Canada does not bar private medicine. Canada isn't even a "socialized" medicine system. It's a fee-for-service system like Medicare (but for everyone). People are free to seek and pay for private services. In fact, if Wikipedia is to be believed, 65% of Canadians have some form of supplimentary insurance paid for by themselves (or their employers) to cover other medical expenses. All privately done. So, let's reign in the the hysteria a bit.

 

[Coastie]

Anesthesiologists will move to the ICU, combining it with OR charges, and could be even more golden than PCP. After all, dedicated intensivits reduce costs, and with people getting sick, ICU infusions of cash could help us out alot.

 

[amyl]

so, just to be clear... you are saying the sky is falling?

anybody looked into jumping ship...meaning going to practice elsewhere...all those plastic surgeons hacking people up in brazil must need anesthesiologists? europe, etc. is there anywhere that medicine is still a good gig?

 

[Monty Python]

today, during my med school graduation rehearsal, ...

Congratulations!

 

[GSresident]

Don't you think this is getting a little 1984? None of the three major presidential candidates are calling for anything vaguely like what you're talking about. Even Hilary, who's got the most "social" medical reforms is only talking about setting up government "insurance companies" that would insure everyone. Every American would be totally free to keep their private health insurance if they were inclined to do so. She learned her lesson from "Hilary-care". Americans don't want and won't have entirely socialized medicine anytime soon.

I don't really care what the three presidential candidates are talking about. I don't believe a word any of them say and I don't think they will have any impact whatsoever on whatever happens to healthcare. You point out that Americans don't want entirely 'socialized medicine' and they want to keep their private insurance. With the same breath, 70% of Americans will tell you that healthcare is a right. Most people are calling for 'universal health care'. Call it what you want but in the end, the provider becomes an employee and grabs the ankles.

Further, Canada does not bar private medicine. Canada isn't even a "socialized" medicine system. It's a fee-for-service system like Medicare (but for everyone). People are free to seek and pay for private services. In fact, if Wikipedia is to be believed, 65% of Canadians have some form of supplimentary insurance paid for by themselves (or their employers) to cover other medical expenses. All privately done. So, let's reign in the the hysteria a bit.

Canada does not bar private medicine now. It took a supreme court ruling to allow people choice in healthcare.

http://www.opinionjournal.com/editorial/feature.html?id=110006813

This supreme court ruling came in 2005 and you are speaking as if Canadians have always had choice in healthcare. I've been in this game a little longer than 2 years.

I understand that people are a little sensitive about applying labels like 'socialized' to the beloved healthcare system in Canada. You would probably prefer that I call it 'The medicine system where no one pays for their care, gets top notch care the second they need it and the doctors are happy and make a crapload of money.' I will call it whatever you want me to but the reality of the situation is the same.

Realistically, when 'The medicine system where no one pays for their care, gets top notch care the second they need it and the doctors are happy and make a crapload of money' comes to the US, participation, at least to start, will be compulsory. Many of you would sign up to eat at the government trough and be employees. You wouldn't mind being told when you must come to work, when you can leave, when you can take vacation and that you will be paid just a tad more than the nurses. Most of us probably would reject that scenario and Uncle Sugar knows it. There are 2 ways to draw the doctors into the system. One is to sweeten the deal with lots of extra sugar and then slowly cut salaries and make life more miserable every year. Sound a little like medicare to you? The other is to make participation compulsory. Given the history of governments around the world and of the government in this country I would not be at all suprised if option #2 was relied upon more heavily.

I might be a little on the pessimistic side with regards to this issue but I would rather be pessimistic than naive. I am hoping that I will be pleasantly suprised but I'm not about to be caught off gaurd.

 

[scotchnwater]

I understand that people are a little sensitive about applying labels like 'socialized' to the beloved healthcare system in Canada. You would probably prefer that I call it 'The medicine system where no one pays for their care, gets top notch care the second they need it and the doctors are happy and make a crapload of money.' I will call it whatever you want me to but the reality of the situation is the same.

The second they need it? Really?

 

[TX515]

I don't get the respect thing. Give me $250,000/year and I will smile while sweeping the floor.

 

[GSresident]

The second they need it? Really?

Oh yes, that is the one thing all these Canadian Socialism lovers do. You can give them facts until you are blue in the face and they just deny everything. They will say that all Canadians get excellent free healthcare, there are no waits for service, the doctors are happy and the income tax rates in Canada are lower than in the US. To the socialism lovers, there is no downside to your enslavement.

 

[Magnus67]

Oh yes, that is the one thing all these Canadian Socialism lovers do. You can give them facts until you are blue in the face and they just deny everything. They will say that all Canadians get excellent free healthcare, there are no waits for service, the doctors are happy and the income tax rates in Canada are lower than in the US. To the socialism lovers, there is no downside to your enslavement.

In one month of ER my intern year i had numerous candiens in our ER, complaining about the horrific waits in canada. This is after waiting 8 hours in our hellish ER. peoples med list's read like they were from the early 70's. One chick even dashed after she stole some sumatriptan for her migraines because in good ole canada she only could get dihydroergotamine, which gave her some nasty side effects.

 

[Strength&Speed]

As far as I am concerned...you can have the " prestige " while I am able to make a decent living without the burden of having to build a patient base/work like a slave for a system that benefits no one but "The Powers That Be"-believe that. I just don't get this ridiculous notion of never leaving the hospital, being available to THE PATIENT at the ready. Please.
Even if ( when ) reimbursement declines, I will still have the possibility to work as much or as little as I want. If " academics " is what I desire, I will have the ability to take care of critically ill patients for 10-14 twelve hour shifts a month, with the option to do OR time or pursue endeavors OTHER than medicine if I get burned out. Medicine and its culture will have you believe that it is honorable and necessary to lose yourself to this career path. Don't be fooled-It's a just a job for most of us.We just have happened to , in general, have paid more money than most , and sacrificed ourselves in ways we were likely warned about but could not believe until we actually experienced it.
For many of us, it is too late to fully pull out based on the financial burden accrued. I suspect many more would leave the profession( medicine, not anesthesia per se ) if they could reasonably do so: they are just afraid to openly, and in all seriousness , say so. Just my .02

+2. well said. I can leave financially, and very well may, for the above reasons.

 

[amyl]

my grandfather in law lived in canada very near the boarder until he passed a little while ago. while he did appreciate the medication prices in canada, he always came to see doctors in america a few hours away. he could never get in to see doctors in canada, certainly not the second he needed it. he constantly complained about the doctors there, according to him it was the farthest thing from top notch health care.
He died in a hospital up there, from respiratory depression from a morphine overdose. he was admitted for pneumonia...no idea why they gave him morphine. now, i am days away from being a lowly intern but it didn't sound like top notch health care to me.

 

[Strength&Speed]

my grandfather in law lived in canada very near the boarder until he passed a little while ago. while he did appreciate the medication prices in canada, he always came to see doctors in america a few hours away. he could never get in to see doctors in canada, certainly not the second he needed it. he constantly complained about the doctors there, according to him it was the farthest thing from top notch health care.
He died in a hospital up there, from respiratory depression from a morphine overdose. he was admitted for pneumonia...no idea why they gave him morphine. now, i am days away from being a lowly intern but it didn't sound like top notch health care to me.

morphine overdose? that was the cause of death? that's pretty incredible if that's true. I dont think ive ever heard that. I mean...theoretically it's possible, but usually you dose morphine as needed. Unless they had PCA settings set wrong.

 

[GSresident]

In one month of ER my intern year i had numerous candiens in our ER, complaining about the horrific waits in canada. This is after waiting 8 hours in our hellish ER. peoples med list's read like they were from the early 70's. One chick even dashed after she stole some sumatriptan for her migraines because in good ole canada she only could get dihydroergotamine, which gave her some nasty side effects.

This can't be true. Didn't you see Michael Moore's movie Sicko? Canadians all love their healthcare system and the doctors are all happy.

Read this description of the Canadian Healthcare System by Weldon7:

Further, Canada does not bar private medicine. Canada isn't even a "socialized" medicine system. It's a fee-for-service system like Medicare (but for everyone). People are free to seek and pay for private services. In fact, if Wikipedia is to be believed, 65% of Canadians have some form of supplimentary insurance paid for by themselves (or their employers) to cover other medical expenses. All privately done.

Canada doesn't have socialized medicine! While it may be true that the Canadian government uses tax money to pay for healthcare, the doctors providing the healthcare are private. Granted, the doctors have no choice but to participate in the plan, and granted, up until 2005 patients could not seek care outside the plan, but how dare anyone call that socialized medicine! Can't you see that its all love and bunny rabbits up there?

Of course I am not serious. I've been engaged in this argument for about 15 years. I've heard all of the arguments from the pro-socialists. One thing that socialists can never admit is that there are problems with socialism. Another thing they can't stand is to have their socialist plans called socialism. They prefer new language like "universal coverage" or "single payer healthcare" that scores a little better with focus groups. Since Weldon7 brought up 1984, the socialists prefer to use "double good duckspeak" to describe their plans.

Unfortunately I think that we are headed towards compulsory universal healthcare in this country. 70% of Americans want to pay nothing for their healthcare. Your services, after all, are their God given right. I think the medical profession will eventually become like the teaching profession. Remember, education is a right paid for by uncle sugar. Look at how great its been to have the government involved with the teaching profession.

I know you are all thinking that doctors would never put up with it. Doctors in the US would strike. Not only are there laws against you striking (patient abandonment issues), but a strike to avoid socialized medicine has been tried before in Canada and failed miserably.

You can read how that turned out here.

All I am saying is don't go crazy spending money. Keep living like a resident so that you can save money, get out of debt and have a way out of the system should the American citizens get their way.

 

[amyl]

yes there was an error in interpretation of the order. he stopped breathing...

 

[177983]

One thing that socialists can never admit is that there are problems with socialism. Another thing they can't stand is to have their socialist plans called socialism. They prefer new language like "universal coverage" or "single payer healthcare" that scores a little better with focus groups. Since Weldon7 brought up 1984, the socialists prefer to use "double good duckspeak" to describe their plans.

I think you do yourself a disservice by setting up a crazy, socialist strawman, GS. I'm not a socialist, and I never claimed Canada's system was flawless (or even good), or that I wanted to import the system to America. I did see Michael Moore's Sicko, but like all Moore films, I watched with a very skeptical eye. To believe that doctors in Cuba love practicing medicine in Cuba and wouldn't have the medical system any other way is quite naive. I believe that you're an intelligent guy (gal?) with a nuanced opinion. How about the same respect paid to me?

Unfortunately I think that we are headed towards compulsory universal healthcare in this country. 70% of Americans want to pay nothing for their healthcare. Your services, after all, are their God given right.

I'm really curious how you think the new universal healthcare policies/laws will come about. You stated in a previous post that you didn't think the president would have any impact on how healthcare changes. Who will?

Finally, what, if any, changes would you like to see in the U.S.'s healthcare policy? You state that 70% of Americans think healthcare is a right. I'm conflicted on that point, but I do think if I had to choose a side, it'd be with the majority. I guess my qualms come down to what kind of healthcare. I think everyone should be able to have a PCP and access to basic (maybe generic?) drugs. However, it seems untenable even to me to say that you can have a PCP and a generic version of Lipitor, but if you get cancer or a brain aneurysm, we can't help. So, I'm stuck on whether or not it's possible to draw a line and if so, where.

I totally agree with you that Americans want to have their cake and eat it to. Everyone wants full access to cutting edge medical technology without bearing the associated cost. My dilemma is finding the middle ground where we can afford good care for everyone while leaving enough freedom in the market to let people make whatever choices they want and can afford.

PS: Touché on the Canada and private insurance pre-2005. I had not seen that.

 

[GSresident]

I believe that you're an intelligent guy (gal?) with a nuanced opinion. How about the same respect paid to me?

I am extremely sorry. I must have misread your post. I would never intentionally disrespect the other side, I just like to throw jabs and rile them a little. I have great respect for anyone who would be willing to force me to do something. I respect them like I respect polar bears. It seems you are not even saying what I thought you were. Please accept my apologies.

I'm really curious how you think the new universal healthcare policies/laws will come about. You stated in a previous post that you didn't think the president would have any impact on how healthcare changes. Who will?

I don't have a great answer to the who/who/when aspect. I think I can safely say that one person, even a president, will not be able to subvert an entire industry the size of healthcare. It will take the effort of many people and there will be a lot of lying and double crossing. I'm going to send away for a truckload of popcorn when it starts. Also, I stated that I don't believe a word any of them says. Therefore I don't really care about the specifics of each of their plans because they are all liars anyway.

Finally, what, if any, changes would you like to see in the U.S.'s healthcare policy?

That is a question that would take far too long for me to answer with the time I have right now. Suffice it to say that I don't like the current system either.

You state that 70% of Americans think healthcare is a right. I'm conflicted on that point, but I do think if I had to choose a side, it'd be with the majority.

What is a right?

I guess my qualms come down to what kind of healthcare. I think everyone should be able to have a PCP and access to basic (maybe generic?) drugs. However, it seems untenable even to me to say that you can have a PCP and a generic version of Lipitor, but if you get cancer or a brain aneurysm, we can't help. So, I'm stuck on whether or not it's possible to draw a line and if so, where.

There has to be a line drawn. The question is who do you want to be drawing the line? Can you give me examples of governments/countries who you think would be trustworthy and wise enough to draw the line between life and death for you?

I totally agree with you that Americans want to have their cake and eat it to. Everyone wants full access to cutting edge medical technology without bearing the associated cost. My dilemma is finding the middle ground where we can afford good care for everyone while leaving enough freedom in the market to let people make whatever choices they want and can afford.

I think you and I basically agree with what we want out of the system. The question now is how to get there.

 

[supercut]

As far as I am concerned...you can have the " prestige " while I am able to make a decent living without the burden of having to build a patient base/work like a slave for a system that benefits no one but "The Powers That Be"-believe that. I just don't get this ridiculous notion of never leaving the hospital, being available to THE PATIENT at the ready. Please.
Even if ( when ) reimbursement declines, I will still have the possibility to work as much or as little as I want. If " academics " is what I desire, I will have the ability to take care of critically ill patients for 10-14 twelve hour shifts a month, with the option to do OR time or pursue endeavors OTHER than medicine if I get burned out. Medicine and its culture will have you believe that it is honorable and necessary to lose yourself to this career path. Don't be fooled-It's a just a job for most of us.We just have happened to , in general, have paid more money than most , and sacrificed ourselves in ways we were likely warned about but could not believe until we actually experienced it.

For many of us, it is too late to fully pull out based on the financial burden accrued. I suspect many more would leave the profession( medicine, not anesthesia per se ) if they could reasonably do so: they are just afraid to openly, and in all seriousness , say so. Just my .02

I WILL say it...I am actively looking for other things I can do that would allow me to leave medicine altogether. Being a doctor is no more than trading time for money, often a LOT of time, and often with a HUGE hassle factor. As a general surgery resident, I got to the point where I felt like the patients were
sucking the life out of me. (Or what little life I had left). I am hesitating as to whether (or when) I should apply for gas postions. I still like dealing with physiology, but not the people. Part of the problem is I have to generate enough revenue to cover my student loan debt, which is more than my mortgage.

 

[jetproppilot]

so, just to be clear... you are saying the sky is falling?

Absolutely.

And its been falling, per the "predictors", ever since my residency training 1992-1996.

Heard all the horror predictions back then!

If my career is the result of "the sky is falling",

I PREFER LOW ALTITUDE FLYING.

 

[Hockeyguy]

Absolutely.

And its been falling, per the "predictors", ever since my residency training 1992-1996.

Heard all the horror predictions back then!

If my career is the result of "the sky is falling",

I PREFER LOW ALTITUDE FLYING.

LOL - When I was an undergraduate and I told my advisor I wanted to go to med school he gave me an article from Newsweek or Time or whatever talking about how the emminent implosion of our healthcare system was a year or two away. I think he was trying to discourage me because he tried and failed to get into med school. Today I was doing an awake crani with one of our CA-3s who is all giddy about his first job - 350K starting salary with 8 weeks vaca. Who really knows what will happen but if you enjoy Anesthesiology do it. I enjoy it and 350K seems like a good money to me to do something you enjoy. These post always remind me of a great little story my uncle once told me. Guy is at the bar watching the NBA finals on TV and wishing he could have gone to the game. Guy at the game looks at the people sitting courtside and wishes he had those seats. Guy sitting courtside sees the players and thinks man how sweet would it be those guys. PLayers looking up at he owners box saying man that guy is making a ton of money off me I wish I was him. Owner looks over at the luxury box and says there is my buddy that runs a Bank this arena is named after him he is loaded. I wish I was him. And so on and so on...

Enjoy your life guys and stop worrying so much we have it better than 99% of people out there. You think Jet is sweating much? I've never met the dude but don't you get the feeling he wakes up each morning with a big s hit eating grin?