Anesthesiology Has Biggest Increase In Residency Applicants Per Program Of All Specialities!!!!

[Splenda88]

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I think you're thinking of the guy who claimed to be seeing 60+ patients a day, which breaks down to about 8 minutes a patient or less, charting included.

Maybe he was working 14 hrs/day.

 

[Modanq]

I think one of the reasons people are also attracted to anesthesiology is because the actual practice of anesthesiology is very much based on procedures and intervention. Thats how the Doctoring cards fell. If you look at the eventual practice of EM, once out of the big trauma centers, you basically are there to move the patients through the system. There is no incentives, currently, to do procedures rather the bottom line is patients per hour. In Anesthesiology literally its our jobs to place ETT, Arterial lines, Central lines, Epidurals, Spinals, CSE, Regional, anesthetize and in my field CV and ICU we do TEE and in the cardiac rooms depending on the center, we place the groin lines, cardioversions, and ECMO. So literally every day I am doing procedures and although we have to move the patients through too - like EM - at least we get to work with our hands all day long. Even simple tasks like reconstituting vancomycin, drawing up prop, inducing patients, is a technical hands on task. If you look at credentialing - Adminstering anesthesia is a procedural category. In the vast majority of EDs in the country which there is a lot of level 2 and 3 bays there are ED docs or family docs, or even non EM are not doing any procedures. I have two family members in ED and literally in the past 5 years they have done a handful of procedures and resuscitated very few patients. Plus we don't have to round, we don't write notes.

Literally the mom and pop anesthesiologist even at Ortho ASCs are doing regional, or intubating and sure maybe not many CVCs or A lines but that is found in any typical bread and butter anesthesiology job at any hospital surgical operating room.
We do have our "CNRA" problem but so does EM and they have PAs, APPs, FM, Burned out surgeons, Hospitalists, IM, anyone with a pulse to contend with. At least in anesthesiology we know our achilles heal.

The other area that I think Anesthesiology is growing is that our bed-fellows are proceduralists and surgeons. They pine for us hard - We literally get called everyday to come staff some far flung case
When you work with people who are always trying to do the next procedure we are there to pick up the side procedure
Few examples from my world
Interventional Echocardiography - Cardiology wants people to help guide procedures - who better than the board certified echocardiographer inducing because we are already there
ECMO cannulation, Coronary sinus, TV pacing wires, PA vents - CT surgery needs hands in ICU and OR for cannulation who better than the vascular access gurus in the room
From General Anesthesia - Ortho needs blocks, spine needs pain interventional people
From OB - Regional is making a real strong push there with TAPs, and QL blocks etc.

Hell in the IR suite I started to help doing the PICC lines while the IR attending does the PEG tubes.
Anything to get the cases moving. And trust me everyone in the IR suite is excited when we chip in...
Case in point 5 PICC lines for me while the IR attending does the PEG tubes was a nice 2 pm day.

 

[Arch Guillotti]

Case in point 5 PICC lines for me while the IR attending does the PEG tubes was a nice 2 pm day.

Are you staffing cases as well? PICC lines seem like a waste of time not to mention who is the revenue going to?

 

[Modanq]

Are you staffing cases as well? PICC lines seem like a waste of time not to mention who is the revenue going to?

Unfortunately not right now. Just obtaining access and moving the day along. Any suggestions on how to start billing for out of OR vascular access? I heard at Boston Children's and some Peds places they teach the anesthesiologists how to do and bill for PICC line with sedation.
Thoughts.

 

[Modanq]

Unfortunately not right now. Just obtaining access and moving the day along. Any suggestions on how to start billing for out of OR vascular access? I heard at Boston Children's and some Peds places they teach the anesthesiologists how to do and bill for PICC line with sedation.
Thoughts.

Might be a topic for a separate thread.

 

[10KHertz]

Psychiatrists tend to prescribe far less benzos than primary care, which is where most of those scripts actually come out of (83% of scripts are written by non-psychiatrists). Cash-only practices don't require catering to drug seekers (we're very okay with our patients hating us) and any time an unscrupulous practice opens it tends to get reported and shut down quickly. The vast majority operate like any other psych practice and exist because when you're one person operating solo, the infrastructure required for insurance billing can cost you six figures while netting you less money per patient compared to what the market will bear. Why would you pay 100k plus yearly fees to set up an EMR to make $125/visit when you can charge $250/visit, spend more time diagnosing appropriately and providing therapy, and not have to worry about insurance headaches? I'm more of a community mental health center guy, but it's easy to set why about 40% of psychiatrists are cash only since it's the best way to stay afloat as a solo practitioner.

What I find interesting is that both our fields seem to be gaining in applicants with very opposite forces at work. I'd venture that the more "clock in, clock out" types are going into anesthesia while the more entrepreneurial are heading to psych since it's one of the last places with any freedom in medicine

Cash-only payments for suboxone therapy (essentially all cash in Northeast) charged by psychiatrists don’t cater to drug seekers....hmmm

I have had over six psychiatrists closed down due to unethical prescribing the last few years. It’s no different than our unscrupulous pain colleagues... both fields have lead to massive distribution and public health issues.

At least the psychiatrists aren’t dispensing marijuana cards yet...For cash of course

 

[Mass Effect]

Benzodiazepines: our other prescription drug epidemic

Most people have heard of "benzos," but few people realize how many people get addicted to and die from them.

www.statnews.com

There is a huge health issue with over utilized benzos, suboxone and methadone , both cash and medicaid payments(no incentive to wean).

not my opinion, it’s a societal and physician problem...

I’m all for capitalism and psychiatrists making coin, appropriately....
I’m not for massive benzo distribution (cash for most psychiatrists and urgent care center/pcps) causing a well known sedative epidemic nationwide. We prescribe a ridiculous amount of sedatives in this country. A small subset of rogue physicians cause major DPH issues.

Read more ...

Antianxiety drugs — often more deadly than opioids — are fueling the next drug crisis in US

Even more of a crisis than the chilling number of people suffering from anxiety — 40 million in the U.S. — is the number of people who are addicted to the drugs that treat it, along with the rising number of people dying from overdoses. It's reached epidemic proportions, say mental health experts.

www.google.com

Yes, thank you for the links. Now if you can kindly tag PCPs and NPs, I'd be most grateful. These scripts absolutely do not come from MD/DO psychiatrists (except in rare cases where the prescribing is 80 yo). These are PCPs and PCP/psych NPs who either don't understand anxiety/addiction or understand it and refuse to tell the patient no.

 

[Mass Effect]

I tend to see unwarranted criticism of unethical behavior in the psych forum when a psych doc report his/her salary way above average, and I am not sure why is that to be honest.

I remember a poster get roasted there because he reports that he stacks a couple of jobs and because of that his salary was in the 95th+ percentile. Almost everyone in the psych forum was quick to tell him he was probably engaged in unethical behavior in order to make tat kind of money.

That's because you're not a psychiatrist. You don't see this type of behavior in the real world and the rest of us do. We see the psychiatrist who stacks jobs and spends 10 min on intakes and 5 min on followups (only way to do it if you're seeing 20 patients in 3 hours so you can make it to your next job). I actually saw a psychiatrist who was seeing 60 pts a day over the weekend at a for-profit psych hospital. He also tried to shrug it off as no big deal. In residency, we had an attending work weekends. I went up to our inpatient unit and this individual would pass a patient in the hall, say hello how are you, and that would be his follow up. For mood, he wrote whatever the patient said as they passed each other in the hall. Anyone with a grain of competence and ethics understands that this is egregious.

The trouble with psych is, it sometimes lures people with questionable ethics to be unethical because it's so easy to get away with it. It's so easy to pass a pt in the hall and count that as your follow up when you're rounding. Who's going to argue with you? The manic patient who can't keep his clothes on? The psychotic patient who can barely talk? The patient population on inpatient units is so sick that you can get away with it, but that doesn't make it good medicine or good psychiatry. In fact, it makes it much worse because the patients are so vulnerable.

So yeah, come to the psych forum and watch us roast anyone doing something questionable with the mentally ill. If you want more money, work after hours or find more lucrative gigs or work on the Upper East Side or in Beverly Hills and charge cash only for the worried well on Prozac, add in a sprinkle of marriage counseling packages (see the movie Hope Springs), and cash in. Don't go work with the sickest of the sick and cut corners to make it to your next 3 gigs.

 

[Mass Effect]

Maybe he was working 14 hrs/day.

He wasn't. The whole point was making as much as possible while maintaining the lifestyle. No one denied you can make a ton more if you're willing to work more. But that wasn't the point. Also, 14 hours a day seeing 60 patients is till BAD care.

 

[Mad Jack]

Cash-only payments for suboxone therapy (essentially all cash in Northeast) charged by psychiatrists don’t cater to drug seekers....hmmm

I have had over six psychiatrists closed down due to unethical prescribing the last few years. It’s no different than our unscrupulous pain colleagues... both fields have lead to massive distribution and public health issues.

At least the psychiatrists aren’t dispensing marijuana cards yet...For cash of course

Weird, we don't have a single psychiatrist in my region that runs a suboxone clinic, it's all MAT-certified PCPs. It would raise a *lot* of eyebrows if anyone got in that line of business as a psychiatrist around here. There was one guy that lost his license and got himself incarcerated for prescribing benzo-stimulant combos to everyone for cash though.

 

[CidHighwind]

I was deciding on it for a while. It makes sense why it’s so competitive. Good hours, sick patients, decent amount of breaks during work, high pay, etc. People are starting to realize the whole CRNA thing is more doom and gloom than docs being unemployed because of CRNAs. There’s a reason it’s a “ROAD” specialty (which even though everyone says don’t exist except for Derm, are still better than pretty much everything else)

 

[10KHertz]

Weird, we don't have a single psychiatrist in my region that runs a suboxone clinic, it's all MAT-certified PCPs. It would raise a *lot* of eyebrows if anyone got in that line of business as a psychiatrist around here. There was one guy that lost his license and got himself incarcerated for prescribing benzo-stimulant combos to everyone for cash though.

It raises eyebrows that non addictionologists (psych) are NOT primarily prescribing suboxone... patients need to be weaned off suboxone, methadone and benzos with CBTs and coping skills. Not perpetually medicated for monitory gain. Cash or covered benefits. One of the goals of the ACA was assess for psych and addiction services.

We clearly are in different regions of the country...

 

[Mad Jack]

It raises eyebrows that non addictionologists (psych) are NOT primarily prescribing suboxone... patients need to be weaned off suboxone, methadone and benzos with CBTs and coping skills. Not perpetually medicated for monitory gain. Cash or covered benefits. One of the goals of the ACA was assess for psych and addiction services.

We clearly are in different regions of the country...

CBT and coping skills are generally the domain of therapists, counselors, and psychologists around here, which are mandatory parts of most of the addiction clinics in the area (for therapeutic rea$on$ I'm $uuuure). Given the nature of these clinics, most psychiatrists just aren't interested, as the patients aren't really the sort that most people went into the field to work with on an exclusive day-in, day-out basis, nor is the pay as good as standard psychiatry practice. The ACA can do whatever it wants, but it can't just make an unappealing job more appealing without substantially increasing pay over what ordinary psychiatrists make.

 

[twospadz]

Redirect Notice

Example if you put the hours in you can make good money in psychiatry. And he is taking a very low base hourly pay too.

 

[twospadz]

Redirect Notice

Different lifestyle friendly opprotunities out here too for psych

 

[10KHertz]

Since this thread has become an income blog...

News brake: specialist consult codes will NOT be paid by commercial plans . A transition that has taken years since the ACA was enacted. We are all going to take income hits...

 

[anbuitachi]

Redirect Notice

Example if you put the hours in you can make good money in psychiatry. And he is taking a very low base hourly pay too.

when i was a med student rotating in a city hospital. there was a psychiatrist there who topped 550k as well. he was the highest paid doctor on staff i heard.

 

[anbuitachi]

Since this thread has become an income blog...

News brake: specialist consult codes will NOT be paid by commercial plans . A transition that has taken years since the ACA was enacted. We are all going to take income hits...

sorry, billing noob here. can you give some examples of how this affect anesthesiology

 

[10KHertz]

sorry, billing noob here. can you give some examples of how this affect anesthesiology

Pain medicine and ICU billing...consults
Psych consults .
less money overall

 

[coffeebythelake]

I was deciding on it for a while. It makes sense why it’s so competitive. Good hours, sick patients, decent amount of breaks during work, high pay, etc. People are starting to realize the whole CRNA thing is more doom and gloom than docs being unemployed because of CRNAs. There’s a reason it’s a “ROAD” specialty (which even though everyone says don’t exist except for Derm, are still better than pretty much everything else)

I barely have time to sit down, I am always running around, putting out fires. dont know why you think there are plenty of breaks?

 

[anbuitachi]

I barely have time to sit down, I am always running around, putting out fires. dont know why you think there are plenty of breaks?

I get a 30 min lunch break!

 

[CidHighwind]

There were plenty of breaks for the residents during my rotation, and “putting out fire

I get a 30 min lunch break!

It’s funny. The PCP with the hour long lunch break probably thinks that’s nothing. The surgery/EM people are probably really jealous of you. On my rotation the residents got 30 minutes for lunch and several 15 minute breaks.

 

[anbuitachi]

There were plenty of breaks for the residents during my rotation, and “putting out fire


It’s funny. The PCP with the hour long lunch break probably thinks that’s nothing. The surgery/EM people are probably really jealous of you. On my rotation the residents got 30 minutes for lunch and several 15 minute breaks.

As a resident i get on most days, 15 min break x2, and 30 min lunch break.
As attending, its mostly 30 min lunch break.

In my opinion the only reason we even have these breaks is because we arent allowed to bring food into OR, and our schedules are highly unpredictable.

When i rotated on EM/surgery as a resident, i remember getting food and just eating it in front of a computer, while writing notes or something. I didn't need someone to break me out specifically cause i can work and eat at the same time.

EM/Surgery at least in my hospital have zero reason to be jealous of us.. EM gets half the week off.. id rather not get any breaks, work shift work even if its busy, and get 3-4 days off a week, than working 5-6 days a week right now.

Also at my hospital attending surgeons can easily take lunch breaks. the surgeons dont have to set up there own equipments. the anesthesiologist here has to turn over their own room, preop next patient and be ready. we aren't private practice. we are academic. every surgeon has residents on their service. most anesthesiologists here work alone. the surgeon can do whatever they want during turnover time, work or break.

 

[CidHighwind]

Well then my surgery rotation must have been a bad example, since many times I just ate a granola bar or something on me between cases and kept it moving. I would rather get 30 minutes where I can eat, chat, or check social media vs eating while working.

 

[abolt18]

As a resident i get on most days, 15 min break x2, and 30 min lunch break.
As attending, its mostly 30 min lunch break.

In my opinion the only reason we even have these breaks is because we arent allowed to bring food into OR, and our schedules are highly unpredictable.

When i rotated on EM/surgery as a resident, i remember getting food and just eating it in front of a computer, while writing notes or something. I didn't need someone to break me out specifically cause i can work and eat at the same time.

EM/Surgery at least in my hospital have zero reason to be jealous of us.. EM gets half the week off.. id rather not get any breaks, work shift work even if its busy, and get 3-4 days off a week, than working 5-6 days a week right now.

Also at my hospital attending surgeons can easily take lunch breaks. the surgeons dont have to set up there own equipments. the anesthesiologist here has to turn over their own room, preop next patient and be ready. we aren't private practice. we are academic. every surgeon has residents on their service. most anesthesiologists here work alone. the surgeon can do whatever they want during turnover time, work or break.

OR rotations as a resident, we regularly get a morning break, lunch break, and sometimes afternoon break.

In the ICU, as noted, you just eat food while you're writing notes or putting in orders.

 

[deleted171991]

The reason people get eating breaks is so that the employee can never blame the employer for a mistake due to "hypoglycemia" etc. Period. It's about liability, not tender loving care. It's about not looking like the Big Bad Monster in front of the jury. (When it's not state law or union contract.)

That's why they are just enough so that you can eat/pee/whatever, and then get the F back to making money for the man.

 

[PieOHmy]

I think one of the reasons people are also attracted to anesthesiology is because the actual practice of anesthesiology is very much based on procedures and intervention. Thats how the Doctoring cards fell. If you look at the eventual practice of EM, once out of the big trauma centers, you basically are there to move the patients through the system. There is no incentives, currently, to do procedures rather the bottom line is patients per hour. In Anesthesiology literally its our jobs to place ETT, Arterial lines, Central lines, Epidurals, Spinals, CSE, Regional, anesthetize and in my field CV and ICU we do TEE and in the cardiac rooms depending on the center, we place the groin lines, cardioversions, and ECMO. So literally every day I am doing procedures and although we have to move the patients through too - like EM - at least we get to work with our hands all day long. Even simple tasks like reconstituting vancomycin, drawing up prop, inducing patients, is a technical hands on task. If you look at credentialing - Adminstering anesthesia is a procedural category. In the vast majority of EDs in the country which there is a lot of level 2 and 3 bays there are ED docs or family docs, or even non EM are not doing any procedures. I have two family members in ED and literally in the past 5 years they have done a handful of procedures and resuscitated very few patients. Plus we don't have to round, we don't write notes.

Literally the mom and pop anesthesiologist even at Ortho ASCs are doing regional, or intubating and sure maybe not many CVCs or A lines but that is found in any typical bread and butter anesthesiology job at any hospital surgical operating room.
We do have our "CNRA" problem but so does EM and they have PAs, APPs, FM, Burned out surgeons, Hospitalists, IM, anyone with a pulse to contend with. At least in anesthesiology we know our achilles heal.

The other area that I think Anesthesiology is growing is that our bed-fellows are proceduralists and surgeons. They pine for us hard - We literally get called everyday to come staff some far flung case
When you work with people who are always trying to do the next procedure we are there to pick up the side procedure
Few examples from my world
Interventional Echocardiography - Cardiology wants people to help guide procedures - who better than the board certified echocardiographer inducing because we are already there
ECMO cannulation, Coronary sinus, TV pacing wires, PA vents - CT surgery needs hands in ICU and OR for cannulation who better than the vascular access gurus in the room
From General Anesthesia - Ortho needs blocks, spine needs pain interventional people
From OB - Regional is making a real strong push there with TAPs, and QL blocks etc.

Hell in the IR suite I started to help doing the PICC lines while the IR attending does the PEG tubes.
Anything to get the cases moving. And trust me everyone in the IR suite is excited when we chip in...
Case in point 5 PICC lines for me while the IR attending does the PEG tubes was a nice 2 pm day.

The procedure nature of our specialty is a double-edged sword.

First off, the more procedures you do, the more liability it carries. Sometimes serious liability. Sticking needles into people carries risk, and one HAS to understand that.


And, usually the more procedures you do does not equalto more money. More procedures means same money for more risk.

The procedures we do are very elementary procedures with the exception of TEE Central Line placement, and swan-ganz catheter placement. Even Nurses do it.

The major problem with our specialty is we take on major risk while someone else is getting the money.
We dont know our value.

 

[CidHighwind]

The reason people get eating breaks is so that the employee can never blame the employer for a mistake due to "hypoglycemia" etc. Period. It's about liability, not tender loving care. It's about not looking like the Big Bad Monster in front of the jury. (When it's not state law or union contract.)

That's why they are just enough so that you can eat/pee/whatever, and then get the F back to making money for the man.

Isn’t that theoretically why there are breaks in most jobs? Point is some other specialties like EM and general surgery would LOVE to have any break.

 

[nimbus]

The procedure nature of our specialty is a double-edged sword.

First off, the more procedures you do, the more liability it carries. Sometimes serious liability. Sticking needles into people carries risk, and one HAS to understand that.


And, usually the more procedures you do does not equalto more money. More procedures means same money for more risk.

The procedures we do are very elementary procedures with the exception of TEE Central Line placement, and swan-ganz catheter placement. Even Nurses do it.

The major problem with our specialty is we take on major risk while someone else is getting the money.
We dont know our value.

It really depends on how the practice is set up and how compensation is calculated. And the procedures are fun.

 

[Modanq]

The procedure nature of our specialty is a double-edged sword.

First off, the more procedures you do, the more liability it carries. Sometimes serious liability. Sticking needles into people carries risk, and one HAS to understand that.


And, usually the more procedures you do does not equalto more money. More procedures means same money for more risk.

The procedures we do are very elementary procedures with the exception of TEE Central Line placement, and swan-ganz catheter placement. Even Nurses do it.

The major problem with our specialty is we take on major risk while someone else is getting the money.
We dont know our value.

Regional, pain are also advanced procedures. I think we need to be better about advocating for our specialty. And not teach our art to non physicians. We did go through a period of lounge sitters but with the changing social environment in the hospitals many many surgeons appreciate a regional master in ortho, or a cardiac anesthesiologist or even a strong generalist. Other physicians recognize it. Remember surgery training is changing too. Regarding reimbursement we need stronger lobbying and stronger national exposure. Definitely something that the new generation of medical students are acutely aware of since every specialty is under assault.

Optho losing ground to optometrists
GI having a real question if NPs can do colonoscopies
ER as I mentioned
I have seen Cath labs where techs and nurses obtain access and even get catheters up to the coronaries without engaging.
Go look at the rad onc forum it's a disaster

We just need to keep on keep on