Any current anesthesiologists actually recommends pursuing anesthesia???

[Twiggidy]

This happens when the Anesthesia department says "yes" to everything the administration and the Surgeons ask for. It doesn't have to be that way, and it isn't, in many community settings. The Anesthesia group can be united and powerful in a community setting. I agree that the trend is not in the right direction though.

Depends on the community. If it's a "highly desirable" community, you better do what the powers that be say or they'll find someone that will.

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Members don't see this ad.

 

[deleted171991]

Depends on the community. If it's a "highly desirable" community, you better do what the powers that be say or they'll find someone that will.

Bingo!

 

[Twiggidy]

I hear you overall, but I can tell you that in some areas of the country, all you need to be wiling is to go slightly off the beaten path from the major metropolitan centers. Not a lot, because that can put you in BFE which has problems of it's own, but just a bit out of the metro areas. Maybe 1.25-2+ hours away, into smaller or better, medium sized cities. I know of plenty of practices doing very well, with a good practice environment, reasonable partner track terms, and overall good gigs.

The problem is that many docs feel compelled to live in the large city centers (If this is for family then so be it), and miss these opportunities, and indeed don't even know about many of them.

So, if "being near the opera" is important to you, you are doing yourself a major disservice, because you can just make a little field trip to those cities while enjoying a great career OUT of them.

It's more than just "going to the opera". City living offers different things to different people. I can find something to do everyday that I wouldn't be able to do if I lived 2hrs outside the city. Moreover, the population of where you live plays a part as well. Different people and treated differently (whether consciously or unconsciously) in different areas.

 

[nimbus]

It's more than just "going to the opera". City living offers different things to different people. I can find something to do everyday that I wouldn't be able to do if I lived 2hrs outside the city. Moreover, the population of where you live plays a part as well. Different people and treated differently (whether consciously or unconsciously) in different areas.

Plus I like opera.

 

[flightnurse2MD]

I love what I do in anesthesiology, but only because I have carved out a niche that allows me to rotate to different locations (avoiding local politics and boredom due to regimentation), leave after 8 hours of work (am not chained to an anesthesia machine until death), no nights, no weekends, and do not take call. It wouldn't work for most anesthesiologists because there is no guarantee of employment as a locums, but I have had only two unscheduled days off since November 2016. I sleep at home every night, and have limited travel, but live in a major metro area. Life is good.

Damn...does this world have unicorns too? I want to come and visit.

 

[AdmiralChz]

Forums have really sucked lately. Summer lull?

 

[LunchMD]

@FFP
Med student here looking for the inside scoop of why I should not do anesthesia. Been diing my homework but cant say I fully understand the landscape yet to make an informed decision. What have your negative experiences been?

In my opinion:

Pros:
-Often fast paced work (day goes by quick)
-High stakes decisions that often need to be made over seconds to minutes (adrenaline rush)
-Learn pharmacology and physiology better than most other fields and apply it daily
-Get to learn about all different types of surgeries
-More procedures than most non-surgical specialties
-Airway management is fun
-Basically no social work
-You are training to be the pharmacist, ICU nurse, and doctor for your patient. You are reliant on almost no one to keep the patient alive, safe, and mininal pain.

Cons:
---You have no patients.
-Often have to ask permission from the surgeon to do your job ("you ok with a nerve block on the next guy?" "No? Ok general anesthesia it is")
-You don't really diagnose and treat in the traditional sense
-Often less respect. You are seen as a means to an end. Ppl just want you to do your job fast. Often they don't care if you can avoid the risks of GA by doing a spinal, they just want the pt asleep ASAP so they can cut.
-More vulnerable to mid-level encroachment because we can't just go out and get patients. We are essentially reliant on someone valuing us and hiring us.
-Procedures limited to lines, neuraxial/nerve blocks, various ways of intubating, TEE if you go in to cardiac or ICU. (personally I'd like to do more complex invasive procedures, or procedures that treat disease other than pain)

 

[Twiggidy]

Forums have really sucked lately. Summer lull?

We're getting mostly 4th years who want to make money but don't want to put in the work and get the perception from their surgery rotations that anesthesiologist are these people who come in, put people to sleep, go home at 4, and make bank..........then they become CA-1 and get a wake up call.

 

[Twiggidy]

In my opinion:

Pros:
-Often fast paced work (day goes by quick)
-High stakes decisions that often need to be made over seconds to minutes (adrenaline rush)
-Learn pharmacology and physiology better than most other fields and apply it daily
-Get to learn about all different types of surgeries
-More procedures than most non-surgical specialties
-Airway management is fun
-Basically no social work
-You are training to be the pharmacist, ICU nurse, and doctor for your patient. You are reliant on almost no one to keep the patient alive, safe, and mininal pain.

Cons:
---You have no patients.
-Often have to ask permission from the surgeon to do your job ("you ok with a nerve block on the next guy?" "No? Ok general anesthesia it is")
-You don't really diagnose and treat in the traditional sense
-Often less respect. You are seen as a means to an end. Ppl just want you to do your job fast. Often they don't care if you can avoid the risks of GA by doing a spinal, they just want the pt asleep ASAP so they can cut.
-More vulnerable to mid-level encroachment because we can't just go out and get patients. We are essentially reliant on someone valuing us and hiring us.
-Procedures limited to lines, neuraxial/nerve blocks, various ways of intubating, TEE if you go in to cardiac or ICU. (personally I'd like to do more complex invasive procedures, or procedures that treat disease other than pain)

This is a solid pro/con. I would say take a real strong look at the Cons because the Pros are easy. Fourth years should ask themselves why they decided to go into medicine and become a doctor and compare that reason to the Cons. If those Cons are outweighing the reason someone chose medicine, then they should choose another field.

 

[zero0]

This is a solid pro/con. I would say take a real strong look at the Cons because the Pros are easy. Fourth years should ask themselves why they decided to go into medicine and become a doctor and compare that reason to the Cons. If those Cons are outweighing the reason someone chose medicine, then they should choose another field.

So if 3 of those cons are actually pros for us, we're in good shape right?

 

[IMGASMD]

So if 3 of those cons are actually pros for us, we're in good shape right?

If you spin those cons into pros, more power to you! And you know you’ve made the right choice.

 

[deleted171991]

Also, try to think as a hospital administrator with a big and shiny eM-Be-Ay when looking at those pros and cons.

E.g.:

Pros:
"-Often fast paced work (day goes by quick)" = make them move their butts even faster for more rapid turnovers
"-High stakes decisions that often need to be made over seconds to minutes (adrenaline rush)" = do we really need a doctor for that?
"-Learn pharmacology and physiology better than most other fields and apply it daily" = who cares, as long as the job gets done
"-Airway management is fun" = dinguses now need $20K glidescopes while the previous generations would intubate as well just with a cheap DL and a bougie
"-Basically no social work" = they just waste time in-between cases
"-You are training to be the pharmacist, ICU nurse, and doctor for your patient. You are reliant on almost no one to keep the patient alive, safe, and mininal pain." = that's also what a CRNA does.

Cons:
"---You have no patients." = why do I keep these expensive guys who don't bring us any business, and are just an expense?
"-Often have to ask permission from the surgeon to do your job ("you ok with a nerve block on the next guy?" "No? Ok general anesthesia it is")" = the surgeons keep complaining that these guys cancel cases and don't do what they are told.
"-You don't really diagnose and treat in the traditional sense" = why does one need a doctor just to put people to sleep? There is already a doctor in the room.
"-Often less respect. You are seen as a means to an end. Ppl just want you to do your job fast. Often they don't care if you can avoid the risks of GA by doing a spinal, they just want the pt asleep ASAP so they can cut." = the CRNAs don't need A-lines, nerve blocks and other time wasters.
"-More vulnerable to mid-level encroachment because we can't just go out and get patients. We are essentially reliant on someone valuing us and hiring us." = see above.
"-Procedures limited to lines, neuraxial/nerve blocks, various ways of intubating, TEE if you go in to cardiac or ICU. (personally I'd like to do more complex invasive procedures, or procedures that treat disease other than pain = the insurance companies pay so little for anesthesiology procedures that we should just train midlevels to do them.

 

[IMGASMD]

Also, try to think as a hospital administrator with a big and shiny eM-Be-Ay when looking at those pros and cons.

E.g.:

Pros:
"-Often fast paced work (day goes by quick)" = make them move their butts even faster for more rapid turnovers
"-High stakes decisions that often need to be made over seconds to minutes (adrenaline rush)" = do we really need a doctor for that?
"-Learn pharmacology and physiology better than most other fields and apply it daily" = who cares, as long as the job gets done
"-Airway management is fun" = dinguses now need $20K glidescopes while the previous generations would intubate as well just with a cheap DL and a bougie
"-Basically no social work" = they just waste time in-between cases
"-You are training to be the pharmacist, ICU nurse, and doctor for your patient. You are reliant on almost no one to keep the patient alive, safe, and mininal pain." = that's also what a CRNA does.

Cons:
"---You have no patients." = why do I keep these expensive guys who don't bring us any business, and are just an expense?
"-Often have to ask permission from the surgeon to do your job ("you ok with a nerve block on the next guy?" "No? Ok general anesthesia it is")" = the surgeons keep complaining that these guys cancel cases and don't do what they are told.
"-You don't really diagnose and treat in the traditional sense" = why does one need a doctor just to put people to sleep? There is already a doctor in the room.
"-Often less respect. You are seen as a means to an end. Ppl just want you to do your job fast. Often they don't care if you can avoid the risks of GA by doing a spinal, they just want the pt asleep ASAP so they can cut." = the CRNAs don't need A-lines, nerve blocks and other time wasters.
"-More vulnerable to mid-level encroachment because we can't just go out and get patients. We are essentially reliant on someone valuing us and hiring us." = see above.
"-Procedures limited to lines, neuraxial/nerve blocks, various ways of intubating, TEE if you go in to cardiac or ICU. (personally I'd like to do more complex invasive procedures, or procedures that treat disease other than pain = the insurance companies pay so little for anesthesiology procedures that we should just train midlevels to do them.

@DrMdSoon

There. Also saved for myself as future reference.

 

[deleted171991]

Btw, I am not trying to be negative here. I just want trainees to think about the specialty in terms of:

"Why would they hire me, and not a CRNA, or just let the proceduralist do his own sedation? What am I bringing to the table? How can I make that bean counter see the difference between me and a CRNA in a MEASURABLE way? How can I make them see me as an asset, and not as an EXPENSE?"

 

[shepardsun]

"Why would they hire me, and not a CRNA, or just let the proceduralist do his own sedation? What am I bringing to the table? How can I make that bean counter see the difference between me and a CRNA in a MEASURABLE way? How can I make them see me as an asset, and not as an EXPENSE?"

This, and the preceding one, is such a good quote, because the reality of the situation is that ultimately nothing we do matters unless we can, in the words of my chair, "tell our own story better" to the people who at the end of the day make the decisions in the hospital. You know there's a difference between our training and our capabilities, I know there's a difference, but how to we better convey that to the only people who really count- administrators with often zero clinical experience?

In my extremely limited experience, I've come to appreciate that people are (relatively) hard to kill, that there's many ways to skin a cat, and a sloppy anesthetic (whether given by a CRNA or MDA) will probably get the job done 99 times out of a 100 (exaggerating slightly, of course). Do those (rare at a majority of healthcare delivery organizations across the country) complex 3s and 4s make up enough of the financial pie? And what do we do if they don't?

This is largely a rhetorical question- most people here seem to think both the ACT and the perioperative surgical homes are too-little too-late reactions to the loss of ground the specialty has already incurred to midlevels. Statistics and the literature will never convince an administrator, even if there were extremely compelling studies to suggest extreme variance in care (which to my limited knowledge, there aren't). Does this really come down to a lobbying and PR issue, and if so, have we already lost?

 

[T-burglar]

I would recommend anesthesia if you plan to do peds, cardiac, or transition to CCM.

There will always be a need for physicians for the most complex anesthetics in little ones and frail elderly getting Cardiothoracic and vascular interventions.

Places that are serious about these patient populations understand the importance of solid staff for these cases.

 

[Twiggidy]

Btw, I am not trying to be negative here. I just want trainees to think about the specialty in terms of:

"Why would they hire me, and not a CRNA, or just let the proceduralist do his own sedation? What am I bringing to the table? How can I make that bean counter see the difference between me and a CRNA in a MEASURABLE way? How can I make them see me as an asset, and not as an EXPENSE?"

You’re just giving people the info they need to make an informed decision. I wish I had the same info when I a student. Anesthesiology would’ve still been high on the list but I would’ve thought hard.

 

[DrMdSoon]

You’re just giving people the info they need to make an informed decision. I wish I had the same info when I a student. Anesthesiology would’ve still been high on the list but I would’ve thought hard.

Tbh even more confused than before getting on sdn to research.
Seems like everyone here is saying CRNAs are gonna be a growing threat, that working for hospital is gonna only get worse in terms of pay, that working in outpatient is career suicide.

Also learned that the most you can make in NYC while working 10 hrs a day 7-5pm 5 days a week with 2 24 hour calls/mth is a cieling of +\- 375ish.

Please correct me if I am wrong about any of these impressions

 

[deleted171991]

You're not (at least not significantly).

The good news is that, in NYC (or any other highly sought-after market), you will be paid peanuts (when compared to the best-paid areas in the country) in EVERY single specialty, unless you are a rockstar and the patients flock to you. It's a matter of supply vs demand, which in anesthesia is also complicated by the midlevel encroachment.

You wanna make double what you'd make in NYC? Go work in Alaska, or other BFE locations (until the CRNAs catch up - they are legally advantaged in rural areas in ways anesthesiologists are not).

I honestly hope you're not choosing a specialty mostly based on the income, because you'll end up regretting that, big time. Choose a specialty with a decent pay (almost all of them), and a decent lifestyle (many of them - some would include anesthesia, some wouldn't), which you are PASSIONATE about, and become the best doctor you can.

 

[shepardsun]

One of the current top threads on the radiation oncology board basically states that there are not enough jobs for the graduates the residency programs are producing, and the few that are available are in the middle of nowhere geographically and horribly reimbursed. For a specialty that was pretty hot and in demand when I was graduating med school, that's a pretty incredible turn of circumstances.

I think it's sometimes valuable for us trainees or new grads to step back and realize that there are other fields that have it much, much worse, and while the glory days of the 90s may be gone we will still never really struggle finding a job that at least puts food on the table. Don't think that means we can get complacent or not advocate for our specialty, but at least it's a little perspective.

 

[IMGASMD]

I honestly hope you're not choosing a specialty mostly based on the income, because you'll end up regretting that, big time.

@DrMdSoon
There is another thread about ROAD to happiness you should take a quick read too.

Kevinmd had an article “A case for paying doctors more”. Maybe that can provide some additional thoughts.

Tl;dr. For amount of effort you’re putting into this career, with the end goal of making money; there are other paths that may be better and easier to get that cool mil.

 

[deleted171991]

One of the current top threads on the radiation oncology board basically states that there are not enough jobs for the graduates the residency programs are producing, and the few that are available are in the middle of nowhere geographically and horribly reimbursed. For a specialty that was pretty hot and in demand when I was graduating med school, that's a pretty incredible turn of circumstances.

I think it's sometimes valuable for us trainees or new grads to step back and realize that there are other fields that have it much, much worse, and while the glory days of the 90s may be gone we will still never really struggle finding a job that at least puts food on the table. Don't think that means we can get complacent or not advocate for our specialty, but at least it's a little perspective.

It's a natural cycle, of supply and demand, as with everything. A low demand for specialty decreases the number of people who get into it, which in turn decreases the supply disproportionately, and the few remaining cannot even keep up with the demand, and get to write their own checks.

Anesthesia was exactly the same. There was the desert of the 80s-90s (too many anesthesiologists and poor reimbursements, with salaries dropping to 100K), then they found oil in the desert and in the 2000s they all became sheikhs, then the locusts CRNAs invaded the market with cheap alternatives.

Every cycle is different, and usually worse than the previous. In the 80s, medicine went to hell because of the HMOs and other insurance companies, now it's the big hospitals and healthcare corporations who suck our blood.

Unless they get midlevels in rad onc (or radiation therapy falls into disfavor), that specialty will probably bounce back big time in a decade or two. It's very much like the stock market: smart (not just any) contrarian investors can make a windfall by going against the current conventional wisdom. Going for a specialty that's making big bucks now is almost a guarantee for poor returns in a decade or so, unless that specialty has a very high entrance moat (e.g. long residency with continuously insufficient number of residency grads). Because these kinds of things are difficult to predict, best to do what one's passionate about.

 

[dannyboy1]

It's a natural cycle, of supply and demand, as with everything. A low demand for specialty decreases the number of people who get into it, which in turn decreases the supply disproportionately, and the few remaining cannot even keep up with the demand, and get to write their own checks.

Anesthesia was exactly the same. There was the desert of the 80s-90s (too many anesthesiologists and poor reimbursements, with salaries dropping to 100K), then they found oil in the desert and in the 2000s they all became sheikhs, then the locusts CRNAs invaded the market with cheap alternatives.

Every cycle is different, and usually worse than the previous. In the 80s, medicine went to hell because of the HMOs and other insurance companies, now it's the big hospitals and healthcare corporations who suck our blood.

Unless they get midlevels in rad onc (or radiation therapy falls into disfavor), that specialty will probably bounce back big time in a decade or two. It's very much like the stock market: smart (not just any) contrarian investors can make a windfall by going against the current conventional wisdom. Going for a specialty that's making big bucks now is almost a guarantee for poor returns in a decade or so, unless that specialty has a very high entrance moat (e.g. long residency with continuously insufficient number of residency grads). Because these kinds of things are difficult to predict, best to do what one's passionate about.

Supply is not going anywhere. There are far more applicants for residency positions than there are positions available (when including FMG’s) every residency program will be filled. The only question is the quality of those filling them.

 

[coffeebythelake]

You think this is an issue with the field of Anesthesiology? Medicine as a whole is becoming doom and gloom. Too much work, eroding respect from the public and by hospital administrators, increasing encroachment by fly-by-night online NP schools and militancy from nursing organizations = burn out. Health care in America is all about $$$. You have ego-driven mid levels and profit-driven executives conspiring to screw the patients. To them it is not about patient care or safety. It is about how to get away with doing the least possible to make the most possible.

 

[pgg]

It's a natural cycle, of supply and demand, as with everything. A low demand for specialty decreases the number of people who get into it, which in turn decreases the supply disproportionately, and the few remaining cannot even keep up with the demand, and get to write their own checks.

Anesthesia was exactly the same. There was the desert of the 80s-90s (too many anesthesiologists and poor reimbursements, with salaries dropping to 100K), then they found oil in the desert and in the 2000s they all became sheikhs, then the locusts CRNAs invaded the market with cheap alternatives.

It's different now. I don't think we'll ever see that bust boom cycle again. The 2000s boom was a result of anesthesiology residencies going unfilled in the 90s. Med school graduation numbers have far outpaced residency growth. There will be somebody to fill every spot.

In the 90s the programs half filled with marginal US candidates, many FMGs and IMGs. Already the FMGs and IMGs are getting squeezed out, and the growing DO graduate pool is feeling the pinch too.

I think we'll never again see a shortage of anesthesiologists caused by a 90s-like training dip. The pipeline will be full, forevermore.

 

[deleted171991]

It's different now. I don't think we'll ever see that bust boom cycle again. The 2000s boom was a result of anesthesiology residencies going unfilled in the 90s. Med school graduation numbers have far outpaced residency growth. There will be somebody to fill every spot.

In the 90s the programs half filled with marginal US candidates, many FMGs and IMGs. Already the FMGs and IMGs are getting squeezed out, and the growing DO graduate pool is feeling the pinch too.

I think we'll never again see a shortage of anesthesiologists caused by a 90s-like training dip. The pipeline will be full, forevermore.

You're preaching to the choir. That's the main reason I don't recommend anesthesia anymore, except to masochists. It will only get worse, with a low probability of things ever getting significantly better. The docs in the Western half of the country are disputing this the same way one's brain would be in denial that one's body has a slowly-evolving, but already metastatic, cancer.

 

[GA8314]

I think the Pro of not having to deal with excessive social work issues is a huge plus. We see these train wrecks, take care of them acutely, and that's about it. We don't deal with all of the myriad BS which comes with managing a mental or physical train wreck of a human being. This is not to sound uncaring, but our population is not doing very well from my, admittedly skewed, viewpoint. Imagine having to deal with all of that day in and day out........

Also, in anesthesia, mostly, the call burden can be spread out much better than many other professional groups (think OB...). So, the lifestyle really is not too bad.

We get to see instant results of our work. This is a big deal. We DO something.

Even supervising, we do quite a bit of hands on work. It could be so much worse and less gratifying.

Nobody is respected the way they used to be.

Patients can't even pronounce dexmedetomidine let alone have any inkling of WTF we do. So, they aren't likely to come to you having just spent 3 hours on WebMD trying to tell you how to do your job.

Anesthesia must be given at the point of care. It can't be done remote. Not anytime soon (and please don't fool yourself on this one...).

CRNA relations outside of major city centers are much better than I've seen in the tertiary care arena. There, you have more "hotshot" wannabe's. Even in a mid-sized town, and especially if you employ the CRNA's (becoming more common), relationships are much better. You can't help but develop a positive working environment when you see the same folks day in and day out. This is in great contrast to where many people train (large/very large hospitals). It's just different in PP.

The above applies to surgeon relationships also. A big plus.

Yes, there are drawbacks. But, you could do far worse than anesthesia.

I can't even believe how good my gig is and it's not that unique from what I can tell in our general market.

 

[Twiggidy]

Tbh even more confused than before getting on sdn to research.
Seems like everyone here is saying CRNAs are gonna be a growing threat, that working for hospital is gonna only get worse in terms of pay, that working in outpatient is career suicide.

Also learned that the most you can make in NYC while working 10 hrs a day 7-5pm 5 days a week with 2 24 hour calls/mth is a cieling of +\- 375ish.

Please correct me if I am wrong about any of these impressions

i'm not worried about CRNAs. Some people on this forum may balk at this, but I (and others) are specialty trained anesthesiologists, ie, fellowship trained. Most of us have skills the can't be matched by any current or in training CRNA. That's not to say our non-fellowship trained colleagues aren't skilled, as many are highly skilled. I was just taught that when the gauntlet does fall one day it will be nice to have a resume that says cardiac (or ped, or pain, or whatever) anesthesiologist with TEE certfication vs anesthesiologist. That's an argument for another thread (which if you search the threads has already happened)

Also, it's not just NYC, but fill in the blank any major metro "desirable" city, and I say it in quotes because some people don't like living in big cities, and the pay will generally reflect how much you work, but there is a base. An academic institution in NYC is gonna start you at close to 250k, maybe 300k if you're fellowship trained. That's just how academics roll and you can maybe increase that number if you start taking more calls. In private practice the number may be higher at base level but to get up to the big numbers you have to work for it. To pull 500k you need to be taking at least 4 calls a month and working 7-5 or later days and maybe post call days. That's just how the "desirable" areas work. Why? Because if you don't like the pay, they will find someone who will, because quite honestly there is a line of people who want to work in these cities. On the other hard, if you very 2-3 hours outside of a city as @GA8314 will tell you, you can easily find a well paying job with a more reasonable call schedule mainly because you have to entice more people to go that far outside of the cities. It's just not for everyone while similarly living in the city isn't for everyone.

So yeah, the scenario you drew up is about correct for NYC and that's just the way it is. If 500k is what you want in NYC, you better add about 4 calls to that schedule and work in PP and be ok working post call.

 

[Twiggidy]

It's different now. I don't think we'll ever see that bust boom cycle again. The 2000s boom was a result of anesthesiology residencies going unfilled in the 90s. Med school graduation numbers have far outpaced residency growth. There will be somebody to fill every spot.

In the 90s the programs half filled with marginal US candidates, many FMGs and IMGs. Already the FMGs and IMGs are getting squeezed out, and the growing DO graduate pool is feeling the pinch too.

I think we'll never again see a shortage of anesthesiologists caused by a 90s-like training dip. The pipeline will be full, forevermore.

But I also think this is part of the problem, especially with the mentality of residency programs. I mean, we discuss on here all the time how many residencies are less about education and more about being a sweatshop. Anesthesiology seems to always get the leftovers and washouts and these booming numbers dilutes the field and sadly dilutes it with mediocre and subpar doctors. We get those that just want to "put them to sleep and cash a check". I honestly think our field would be better off with less residents (I sound like Jerry Maguire).

Now obviously I know my scenario wouldn't work because that just means less rooms running and longer days on the schedule, which is good (money) and bad (lifestyle). So maybe that's the answer to our problem.....make it so anesthesiology IS NOT a lifestyle specialty.

 

[shepardsun]

I honestly think our field would be better off with less residents (I sound like Jerry Maguire).

As long as a resident is the cheapest way to staff a room (which at my academic institution it is, by far, with what the CRNAs make and the perks they get with overtime etc), that'll never happen.

 

[LunchMD]

But I also think this is part of the problem, especially with the mentality of residency programs. I mean, we discuss on here all the time how many residencies are less about education and more about being a sweatshop. Anesthesiology seems to always get the leftovers and washouts and these booming numbers dilutes the field and sadly dilutes it with mediocre and subpar doctors. We get those that just want to "put them to sleep and cash a check". I honestly think our field would be better off with less residents (I sound like Jerry Maguire).

Now obviously I know my scenario wouldn't work because that just means less rooms running and longer days on the schedule, which is good (money) and bad (lifestyle). So maybe that's the answer to our problem.....make it so anesthesiology IS NOT a lifestyle specialty.

It's not an issue of lifestyle or that people just want the money. I mean frankly, you think all those AOA derm applicants are doing it because they have such a passion for treating dermatits and acne? F no, they want good lifestyle, good money. But they are still hard working and smart.

I honestly think what turns people off the most (what turns me off the most at least) is 2 things:

1. No ownership of patients. We are the only clinical specialty that has no ownership of our patients. MD= Makes decisions, but this fact severly impacts our ability to make decisions. Most people who go to medical school do it to have their own patients and make the decisions.

2. Only clinical specialty that doesn't have robust diagnose and treat in our scope of practice.

So you have to find the subset of medical students that want a clinical specialty, but don't mind having minimal ownership of patients and don't mind doing minimal diagnosis and treatment. That's a pretty small group. Also the specialty tends to backfill with good students who didn't match their first choice, but can't bear to be internists or general surgeons.

I'll say it again, but in my novice opinion, we as a specialty need to take more ownership of patients, and be willing to do more dx and tx out of the OR, do more procedures out of the OR. We need more ownership in pre-op. We should be doing the stress tests, echo, etc and giving clearance. Airway management we need to own 100%, even front of neck access. TEE throughout the hospital. Run codes on the floor, being more involved in ICU and closed ICUs, and MICUs. These aren't crazy. I know of different academic centers doing 1 or 2 of each of these things. We just need to bring it all together. To future applicants, you can often tell the strength of an anesthesia program based ironically on their out of OR presence. Is anesthesia doing all the trauma airways? Do they have a strong presence in closed ICUs? Strong perioperative clinic? Anesthesiology isn't about just sitting cases anymore, and personally I think that's a great thing.

 

[LunchMD]

As long as a resident is the cheapest way to staff a room (which at my academic institution it is, by far, with what the CRNAs make and the perks they get with overtime etc), that'll never happen.

The way you stop this from happening is with ACGME regulations on how many of X procedure/case/whatever each resident needs. That stops the riffraff with poor educational experience opening up a residency just to staff rooms cheaply.

 

[shepardsun]

The way you stop this from happening is with ACGME regulations on how many of X procedure/case/whatever each resident needs.

Agreed, that's realistically the main thing keeping most programs from expanding. And the numbers are kind of a little low in my opinion to begin with. 40 epidurals, 10 bypass cases, 20 major vascular, 20 life threatening pathology, etc. I'll surely exceed all of those by the end of CA2 year, but that's nowhere near enough for me to feel like I would be comfortable being an attending with that bare minimum.

 

[UnoMas]

It's not an issue of lifestyle or that people just want the money. I mean frankly, you think all those AOA derm applicants are doing it because they have such a passion for treating dermatits and acne? F no, they want good lifestyle, good money. But they are still hard working and smart.

I honestly think what turns people off the most (what turns me off the most at least) is 2 things:

1. No ownership of patients. We are the only clinical specialty that has no ownership of our patients. MD= Makes decisions, but this fact severly impacts our ability to make decisions. Most people who go to medical school do it to have their own patients and make the decisions.

2. Only clinical specialty that doesn't have robust diagnose and treat in our scope of practice.

So you have to find the subset of medical students that want a clinical specialty, but don't mind having minimal ownership of patients and don't mind doing minimal diagnosis and treatment. That's a pretty small group. Also the specialty tends to backfill with good students who didn't match their first choice, but can't bear to be internists or general surgeons.

I'll say it again, but in my novice opinion, we as a specialty need to take more ownership of patients, and be willing to do more dx and tx out of the OR, do more procedures out of the OR. We need more ownership in pre-op. We should be doing the stress tests, echo, etc and giving clearance. Airway management we need to own 100%, even front of neck access. TEE throughout the hospital. Run codes on the floor, being more involved in ICU and closed ICUs, and MICUs. These aren't crazy. I know of different academic centers doing 1 or 2 of each of these things. We just need to bring it all together. To future applicants, you can often tell the strength of an anesthesia program based ironically on their out of OR presence. Is anesthesia doing all the trauma airways? Do they have a strong presence in closed ICUs? Strong perioperative clinic? Anesthesiology isn't about just sitting cases anymore, and personally I think that's a great thing.

Just a lowly 4th year applying to Anesthesiology in less than 2 months. I know I have always wanted to do Anesthesiology ever since I was just a lowly 1st year, kept my eyes wide open during 3rd year, talked to as many attendings and residents as I could. All told me that Anesthesiology is still a great choice with good prospects and a good fit for my personality. These include: ACS Surgeon, CT Surgeon, OBs, Anesthesiologists, Interventional Cardiologist, Internists. Talked to them extensively about the CRNA issues, especially the surgeons, the oldest among them, a CT surgeon (probably in his 60s) told me he heard the same thing when he was going through the process, yet here we are and he appreciates having a competent Anesthesiologist in his room all the time and wouldn't have it any other way. All told me compensation is going down but it's not an issue exclusive to Anesthesiologists. I have no reason to doubt any of them lied to me, they have no reason to and we discussed both the perceived ups and downs.

I flirted with the idea of IM --> Cardiology but I hate rounding, social work and clinic with a passion. I also met an Internist-turned-Anesthesiologist who told me she was doing more IM during her Anesthesiology residency than she did for the entire 3 years of her IM residency. So happy with the specialty switch.

Anyway, the reason I am quoting your post is because I personally know at least 2 of my close friends who were deciding between IM and Anesthesiology, ended up picking IM because of the things they read on here and they are worried about not having a job in the future due to the CRNA takeover. Bright people with great board scores, hate rounding, continuity of care and social work but willing to compromise for 3 years to get into fellowships. Knowing them, I think they won't be happy at all if somehow they got stuck doing IM. While I appreciate reading all about the pros and cons regarding the field so I can go in with my eyes wide open, I think we need more positive guidance instead of just doom-and-glooming, which at times feels like fear-mongering. Your words have a much bigger impact on impressionable medical students than you think. You can't attract the good ones if you actively try to scare them away. In addition, medical students often have very little exposure to the specialty unless they actively try to get involved more. I hate it so much when my classmates tell me "you guys don't do anything, the CRNA does all the work," my comeback usually is "well, same **** in IM/EM/Neurology, the NP/PA does everything."

Anyway, for me, it's full-speed-forward for Anesthesia. 100% will be doing CT/Peds/CCM fellowship to satisfy the Canadian 5 year requirement. I have no geographical constraints and will move where the best jobs are. If the sky ended up finally falling, I am ok with working for CRNA salary for their 36-40 hours work-week with similar responsibilities or better yet move to Canada or Australia. I have no desire to own any patients, get involved with any continuity of care, getting paged while off-duty, I am fine with call as long as the pay reflects that. I am absolutely ok being just a consultant

 

[shepardsun]

Anyway, the reason I am quoting your post is because I personally know at least 2 of my close friends who were deciding between IM and Anesthesiology, ended up picking IM because of the things they read on here and they are worried about not having a job in the future due to the CRNA takeover. Bright people with great board scores, hate rounding, continuity of care and social work but willing to compromise for 3 years to get into fellowships.

Well then the residency pool just shrunk by two! We're well on our way, LunchMD!

Joking aside, if they made that choice despite all of their reservations with medicine, as you mentioned, mainly because of things they read on SDN and not as part of a more personal introspective and cost/benefit analytic process, then perhaps they did themselves a disservice, and are ultimately responsible for any unhappiness they may subsequently endure.

 

[IMGASMD]

It's not an issue of lifestyle or that people just want the money. I mean frankly, you think all those AOA derm applicants are doing it because they have such a passion for treating dermatits and acne? F no, they want good lifestyle, good money. But they are still hard working and smart.

I honestly think what turns people off the most (what turns me off the most at least) is 2 things:

1. No ownership of patients. We are the only clinical specialty that has no ownership of our patients. MD= Makes decisions, but this fact severly impacts our ability to make decisions. Most people who go to medical school do it to have their own patients and make the decisions.

2. Only clinical specialty that doesn't have robust diagnose and treat in our scope of practice.

So you have to find the subset of medical students that want a clinical specialty, but don't mind having minimal ownership of patients and don't mind doing minimal diagnosis and treatment. That's a pretty small group. Also the specialty tends to backfill with good students who didn't match their first choice, but can't bear to be internists or general surgeons.

I'll say it again, but in my novice opinion, we as a specialty need to take more ownership of patients, and be willing to do more dx and tx out of the OR, do more procedures out of the OR. We need more ownership in pre-op. We should be doing the stress tests, echo, etc and giving clearance. Airway management we need to own 100%, even front of neck access. TEE throughout the hospital. Run codes on the floor, being more involved in ICU and closed ICUs, and MICUs. These aren't crazy. I know of different academic centers doing 1 or 2 of each of these things. We just need to bring it all together. To future applicants, you can often tell the strength of an anesthesia program based ironically on their out of OR presence. Is anesthesia doing all the trauma airways? Do they have a strong presence in closed ICUs? Strong perioperative clinic? Anesthesiology isn't about just sitting cases anymore, and personally I think that's a great thing.

I will ask a lot of rhetorical questions, and believe me I am not argumentative by any means.

What do we do with all these super partners, who is at the dusk of their careers and they either want to just supervise or push propofol? These are also the people who have sold or thinking about their last push to sell before anesthesia really just become a service of corporate America?

Is there a CRNA or not a CRNA problem? Are we going to embrace it? Are we resisting? Are we embracing AA? What are we doing when the hospital or other surgical centers breath down our necks and scream we don’t have enough anesthesiologists? Do we have the balls to push back? Do we have “any” ammunition to push back? Even here recently we have Anesthesiologists singing ACT is a better model than solo md in a room.

Some people choose anesthesia, for exact reasons that you suggest that we should fight against. Take on more responsibilities, “own” the patient, be at the forefront of critical care. I remember when ASA started to push for periop surgical home, I asked one of my mentor at that time, is this really going to work? He said, he didn’t know, but asa had tried something like that in the years past, didn’t think it really sticked. I asked my chairman, if we are seeing all these patients for PAT, how do their primary physician feel about it? He shrug, didn’t really care. I saw some cardiologists coming to OR to do TEEs, because that’s part of THEIR stream of revenue and they’re not ready to give that up. Then what?

Like I said, I obviously don’t have any answers. All I know is there are many many problems as physicians we are fighting, as anesthesiologists we are fighting, and we are not gaining any grounds. I remember a few years ago asa practice management meeting were mostly Anesthesiologists, now just all AMCs all the time. Went to PGA’s session on pitfall for new grads. They had one academic professor, one Sheridan regional Vice President who is a MD. The best advice I got was, maybe I should develop better hobbies and there are lives outside of anesthesia. That’s the message and advice they’re giving out these days, can we really blame these students asking is anesthesia as cush as they say?

Am I angry? Hell yea. Unless most of us are united, not much is going to change.

 

[dannyboy1]

It's not an issue of lifestyle or that people just want the money. I mean frankly, you think all those AOA derm applicants are doing it because they have such a passion for treating dermatits and acne? F no, they want good lifestyle, good money. But they are still hard working and smart.

I honestly think what turns people off the most (what turns me off the most at least) is 2 things:

1. No ownership of patients. We are the only clinical specialty that has no ownership of our patients. MD= Makes decisions, but this fact severly impacts our ability to make decisions. Most people who go to medical school do it to have their own patients and make the decisions.

2. Only clinical specialty that doesn't have robust diagnose and treat in our scope of practice.

So you have to find the subset of medical students that want a clinical specialty, but don't mind having minimal ownership of patients and don't mind doing minimal diagnosis and treatment. That's a pretty small group. Also the specialty tends to backfill with good students who didn't match their first choice, but can't bear to be internists or general surgeons.

I'll say it again, but in my novice opinion, we as a specialty need to take more ownership of patients, and be willing to do more dx and tx out of the OR, do more procedures out of the OR. We need more ownership in pre-op. We should be doing the stress tests, echo, etc and giving clearance. Airway management we need to own 100%, even front of neck access. TEE throughout the hospital. Run codes on the floor, being more involved in ICU and closed ICUs, and MICUs. These aren't crazy. I know of different academic centers doing 1 or 2 of each of these things. We just need to bring it all together. To future applicants, you can often tell the strength of an anesthesia program based ironically on their out of OR presence. Is anesthesia doing all the trauma airways? Do they have a strong presence in closed ICUs? Strong perioperative clinic? Anesthesiology isn't about just sitting cases anymore, and personally I think that's a great thing.

Umm... what. How is our specialty supposed to do all of this. Any anesthesiologists out there know how to perform and interpret a stress test? What happens when it’s positive, will we do a cath as well?? All the TEE’s most TEE’s are refereed as an outpatient to cardiology. Will all inpatients suddenly get referrals to anesthesia? Most anesthesiologists are not cardiac trained. Front of neck access??? I have never done one and don’t know any attending that has. Now we are supposed to be the service that all tracheostomy referrals go to?? Gen surg and ENT do this just fine. How can we train residents do do things that we can’t do ourselves. How would you structure a residency program for all residents to become competent in these things. Add on another year or maybe 2? Who will teach them?? Most importantly why would the typical anesthesia department try to take on these tasks when no one from the hospital administration is asking for it, nor are they offering compensation. They want us churning out cases with minimal to no drama. That’s all.

 

[dannyboy1]

I will ask a lot of rhetorical questions, and believe me I am not argumentative by any means.

What do we do with all these super partners, who is at the dusk of their careers and they either want to just supervise or push propofol? These are also the people who have sold or thinking about their last push to sell before anesthesia really just become a service of corporate America?

Is there a CRNA or not a CRNA problem? Are we going to embrace it? Are we resisting? Are we embracing AA? What are we doing when the hospital or other surgical centers breath down our necks and scream we don’t have enough anesthesiologists? Do we have the balls to push back? Do we have “any” ammunition to push back? Even here recently we have Anesthesiologists singing ACT is a better model than solo md in a room.

Some people choose anesthesia, for exact reasons that you suggest that we should fight against. Take on more responsibilities, “own” the patient, be at the forefront of critical care. I remember when ASA started to push for periop surgical home, I asked one of my mentor at that time, is this really going to work? He said, he didn’t know, but asa had tried something like that in the years past, didn’t think it really sticked. I asked my chairman, if we are seeing all these patients for PAT, how do their primary physician feel about it? He shrug, didn’t really care. I saw some cardiologists coming to OR to do TEEs, because that’s part of THEIR stream of revenue and they’re not ready to give that up. Then what?

Like I said, I obviously don’t have any answers. All I know is there are many many problems as physicians we are fighting, as anesthesiologists we are fighting, and we are not gaining any grounds. I remember a few years ago asa practice management meeting were mostly Anesthesiologists, now just all AMCs all the time. Went to PGA’s session on pitfall for new grads. They had one academic professor, one Sheridan regional Vice President who is a MD. The best advice I got was, maybe I should develop better hobbies and there are lives outside of anesthesia. That’s the message and advice they’re giving out these days, can we really blame these students asking is anesthesia as cush as they say?

Am I angry? Hell yea. Unless most of us are united, not much is going to change.

nothing is going to change because the powers that be don’t want any change. All they want is that their anesthesia “service” is affable, available, and cheap. They are perfectly happy with an AMC model that delivers that and they would probably be OK if the hospital janitor delivered the anesthesia( if they could get away with it ). The key to happiness in anesthesia is to view it as a JOB. it is not your passion or even a career. I am pretty happy in anesthesia because I discovered that I really don’t want to be a doctor. What I mean by that is I am not interested in people’s problems, nor their long term health. I am perfectly happy to go with the surgical flow as long as it will not kill the patient in the OR or PACU. A boing day of routine procedures on ASA 1 and 2 is perfectly fine by me. Once you adopt this attitude you will realize that you are actually overpaid because all you are is a glorified respiratory therapist. Then you will find happiness

 

[mmag]

Umm... what. How is our specialty supposed to do all of this. Any anesthesiologists out there know how to perform and interpret a stress test? What happens when it’s positive, will we do a cath as well?? All the TEE’s most TEE’s are refereed as an outpatient to cardiology. Will all inpatients suddenly get referrals to anesthesia? Most anesthesiologists are not cardiac trained. Front of neck access??? I have never done one and don’t know any attending that has. Now we are supposed to be the service that all tracheostomy referrals go to?? Gen surg and ENT do this just fine. How can we train residents do do things that we can’t do ourselves. How would you structure a residency program for all residents to become competent in these things. Add on another year or maybe 2? Who will teach them?? Most importantly why would the typical anesthesia department try to take on these tasks when no one from the hospital administration is asking for it, nor are they offering compensation. They want us churning out cases with minimal to no drama. That’s all.

NP's do perform and interpret stress tests. NPs can cath as well. If the financial incentives are there, the cardiologists will teach it as they have done for NP's. It's only a political question of whether the cardiologists will let us do it on a privileging level and the insurance schemes reimburse for it.

https://www.researchgate.net/public...ress_Testing_Is_a_Safe_and_Effective_Practice
Performing cardiac stress test. | allnurses
Medscape: Medscape Access

 

[dannyboy1]

NP's do perform and interpret stress tests. NPs can cath as well. If the financial incentives are there, the cardiologists will teach it as they have done for NP's. It's only a political question of whether the cardiologists will let us do it on a privileging level and the insurance schemes reimburse for it.

https://www.researchgate.net/public...ress_Testing_Is_a_Safe_and_Effective_Practice
Performing cardiac stress test. | allnurses
Medscape: Medscape Access

Explain the logistics of this: you see a patient in pre - op who needs a stress, instead of sending him to the cardiology run stress Lab you send him to the anesthesia run stress lab? Who is staffing this place? How is it being reimbursed? Will performing and interpreting stresses become a core competency of Anesthesiology? If so, who will teach it, the current boarded anesthesia docs who don’t know how to do it themselves? Will residency be extended to accommodate teaching of stress and echo (and maybe cath?!). What benefit is there to the surgeons? Why will cardiologists willingly give away business ? Why will current (mostly employed) anesthesia docs want to do this when it will not pay any extra and it is much easier to just “refer to cards”

 

[AdmiralChz]

this has been said ad nauseum (autocorrects to nauseated, fitting since I’m tired of saying it), but if you are choosing against this specialty to get away from a “CRNA takeover” then you’re in for a world of disappointment when you get to practice. If you don’t think NP/PAs are pushing into literally every specialty then you are not paying attention. The corporate ED jobs are becoming more and more NP/PA “supervision” oh, I’m sorry, “collaboration.”

Pick a specialty you ENJOY. Because you never know what will happen down the pipe with salaries etc... you’ll find yourself always chasing the Joneses if you’re just in it for the money. Next think you know you’re a neurospine surgeon making close to $1 mil but splitting it with 3 wives, operating 5 days a week and paying child support for 4 kids. Dude is miserable, and nearly always says he envies my position.

 

[LunchMD]

Just a lowly 4th year applying to Anesthesiology in less than 2 months. I know I have always wanted to do Anesthesiology ever since I was just a lowly 1st year, kept my eyes wide open during 3rd year, talked to as many attendings and residents as I could. All told me that Anesthesiology is still a great choice with good prospects and a good fit for my personality. These include: ACS Surgeon, CT Surgeon, OBs, Anesthesiologists, Interventional Cardiologist, Internists. Talked to them extensively about the CRNA issues, especially the surgeons, the oldest among them, a CT surgeon (probably in his 60s) told me he heard the same thing when he was going through the process, yet here we are and he appreciates having a competent Anesthesiologist in his room all the time and wouldn't have it any other way. All told me compensation is going down but it's not an issue exclusive to Anesthesiologists. I have no reason to doubt any of them lied to me, they have no reason to and we discussed both the perceived ups and downs.

I flirted with the idea of IM --> Cardiology but I hate rounding, social work and clinic with a passion. I also met an Internist-turned-Anesthesiologist who told me she was doing more IM during her Anesthesiology residency than she did for the entire 3 years of her IM residency. So happy with the specialty switch.

Anyway, the reason I am quoting your post is because I personally know at least 2 of my close friends who were deciding between IM and Anesthesiology, ended up picking IM because of the things they read on here and they are worried about not having a job in the future due to the CRNA takeover. Bright people with great board scores, hate rounding, continuity of care and social work but willing to compromise for 3 years to get into fellowships. Knowing them, I think they won't be happy at all if somehow they got stuck doing IM. While I appreciate reading all about the pros and cons regarding the field so I can go in with my eyes wide open, I think we need more positive guidance instead of just doom-and-glooming, which at times feels like fear-mongering. Your words have a much bigger impact on impressionable medical students than you think. You can't attract the good ones if you actively try to scare them away. In addition, medical students often have very little exposure to the specialty unless they actively try to get involved more. I hate it so much when my classmates tell me "you guys don't do anything, the CRNA does all the work," my comeback usually is "well, same **** in IM/EM/Neurology, the NP/PA does everything."

Anyway, for me, it's full-speed-forward for Anesthesia. 100% will be doing CT/Peds/CCM fellowship to satisfy the Canadian 5 year requirement. I have no geographical constraints and will move where the best jobs are. If the sky ended up finally falling, I am ok with working for CRNA salary for their 36-40 hours work-week with similar responsibilities or better yet move to Canada or Australia. I have no desire to own any patients, get involved with any continuity of care, getting paged while off-duty, I am fine with call as long as the pay reflects that. I am absolutely ok being just a consultant

Look, first of all I'm a resident and have no idea what attending life is like. Maybe I should be making this disclaimer on all of my posts. Second, I actually am not anti-anesthesia. It's a cool field, and I picked it for a reason. We all see issues with our chosen "team" so to speak, and I simply want to point them out and help fix them.

I know I'm saying provocative things with little in the way of plans or how it would actually work. But there is almost no voice for this stuff on this forum, and that's why I'm saying it. It should be part of the discussion, because many anesthesiologists think this way. Maybe some of it is dumb, but I know some of it is not because large academic departments are doing it currently. Maybe doing ALL of it would just be too much for a single department, I don't know. But my favorite example is at Miami the anesthesiologists have a percutaneous tracheostomy consult service, they see, evaluate, and do the procedure. Most of these procedures aren't rocket science, but they are very valuable. What would have happened if we just gave up and said "we aren't cardiologists, we can't do TEE!?" Or what about the first radiologist who decided to do a IVC filter, or carotid stent? If you want to push boundaries, your going to have to be uncomfortable. I could list many other examples within medicine and outside it. Sure, maybe these extended skills would fall under fellowship training, not residency training. For example if you do a perioperative medicine/PSH/whatever you want to call it fellowship, I don't see any reason why you couldn't learn to interpret stress tests.

I personally wholeheartedly disagree with the "just a job" mentality. If you want "just a job", I'm sure there are places for you for now. But that's not what I'm about, and that's not what I work towards in my career. AMCs and now Amazon love that idea though, I'm sure.

Unomas, I applaud your decision. You can rest assured you have done your research, and I think can be confident you are making the right decision.

 

[vector2]

Explain the logistics of this: you see a patient in pre - op who needs a stress, instead of sending him to the cardiology run stress Lab you send him to the anesthesia run stress lab? Who is staffing this place? How is it being reimbursed? Will performing and interpreting stresses become a core competency of Anesthesiology? If so, who will teach it, the current boarded anesthesia docs who don’t know how to do it themselves? Will residency be extended to accommodate teaching of stress and echo (and maybe cath?!). What benefit is there to the surgeons? Why will cardiologists willingly give away business ? Why will current (mostly employed) anesthesia docs want to do this when it will not pay any extra and it is much easier to just “refer to cards”

Ask the university of Utah anesthesia guys. They run their own TTE/stress echo lab and do TEE hospital wide.

Imo, all this "anesthesiology runs a bunch of varied services outside the OR" stuff can really only exist in a tertiary academic center. Community and PP don't have the money, time, staffing, knowhow, or will to do perc trachs or run a comprehensive echo lab or perioperative medicine clinic.

 

[Modanq]

Umm... what. How is our specialty supposed to do all of this. Any anesthesiologists out there know how to perform and interpret a stress test? What happens when it’s positive, will we do a cath as well?? All the TEE’s most TEE’s are refereed as an outpatient to cardiology. Will all inpatients suddenly get referrals to anesthesia? Most anesthesiologists are not cardiac trained. Front of neck access??? I have never done one and don’t know any attending that has. Now we are supposed to be the service that all tracheostomy referrals go to?? Gen surg and ENT do this just fine. How can we train residents do do things that we can’t do ourselves. How would you structure a residency program for all residents to become competent in these things. Add on another year or maybe 2? Who will teach them?? Most importantly why would the typical anesthesia department try to take on these tasks when no one from the hospital administration is asking for it, nor are they offering compensation. They want us churning out cases with minimal to no drama. That’s all.

Yet we go ahead and teach every tom dick and harry CRNA, ED resident, OMFS resident, ENT cross rotator anesthesia and OR skills. Sure lets have this random OMFS resident join our service for 4 months and then go off and practice anesthesia on their own and kill a couple of kiddos with unsuspected laryngospasm out in the office based practice, give them the keys to the billing codes and call it a day. Just the other day a medflight person EMT or someone rudely walked into the OR without introducing themselves to the patient beforehand and announced they need to log an intubation. Try to steal one of my new CA1 residents intubations and inductions. And guess what - I said no - and there is an email in my trash currently unread about rotators and intubation. GTFOH
Why not just have the Anesthesiology residents rotate on ENT, OMFS, Gen Surg and do ~ 50 trachs. Its not that hard. I did half of surgery residency and during my current moonlighting covering surgery and still do them. I am doing my own trachs in the ICU thank you very much and bill for them also. In if all goes to **** well - I am an airway master at least thats what the ABA told me - I can cannulate to ECMO.

 

[dannyboy1]

Yet we go ahead and teach every tom dick and harry CRNA, ED resident, OMFS resident, ENT cross rotator anesthesia and OR skills. Sure lets have this random OMFS resident join our service for 4 months and then go off and practice anesthesia on their own and kill a couple of kiddos with unsuspected laryngospasm out in the office based practice, give them the keys to the billing codes and call it a day. Just the other day a medflight person EMT or someone rudely walked into the OR without introducing themselves to the patient beforehand and announced they need to log an intubation. Try to steal one of my new CA1 residents intubations and inductions. And guess what - I said no - and there is an email in my trash currently unread about rotators and intubation. GTFOH
Why not just have the Anesthesiology residents rotate on ENT, OMFS, Gen Surg and do ~ 50 trachs. Its not that hard. I did half of surgery residency and during my current moonlighting covering surgery and still do them. I am doing my own trachs in the ICU thank you very much and bill for them also. In if all goes to **** well - I am an airway master at least thats what the ABA told me - I can cannulate to ECMO.

OK. first of all ED attendings can SUCK at airways I had to bail out quite a few f them during residency on easy airways. they are supposed t be "jack of all trades" so airway management is part of their scope of practice. Whatever, they can do whatever they like so long as they dont involve me. I have no problem with any physician doing any procedure so long as they are willing to accept responsibility for bad outcomes. The question is how would you incentivize an anesthesia department and a medical system to go along with this expanded scope of anesthesia practice. as more anesthesiologists become employees there really is no incentive to do anything extra. And what need does a medical system have for this arrangement. Are tracheostomy's not being done ? As an aside if part of your plan for a routine tracheostomy involves crashing onto ECMO maybe you should not be doing them.

 

[Modanq]

OK. first of all ED attendings can SUCK at airways I had to bail out quite a few f them during residency on easy airways. they are supposed t be "jack of all trades" so airway management is part of their scope of practice. Whatever, they can do whatever they like so long as they dont involve me. I have no problem with any physician doing any procedure so long as they are willing to accept responsibility for bad outcomes. The question is how would you incentivize an anesthesia department and a medical system to go along with this expanded scope of anesthesia practice. as more anesthesiologists become employees there really is no incentive to do anything extra. And what need does a medical system have for this arrangement. Are tracheostomy's not being done ? As an aside if part of your plan for a routine tracheostomy involves crashing onto ECMO maybe you should not be doing them.

Agree with your post. All valid points. The ECMO part was in sarcasm. read it as another area we should expand into.

 

[anbuitachi]

There is a reason why we are specialties. We have our area of expertise. Usually the area of expertise of the specialist is in the name of the specialty. We are experts of ANESTHESIA. Does that have the word airway in it, or anything close? Not really. We just happen to do a lot of them... ENT is the true master of airways.. that's why we call them for backup when there's an airway concern and if i need a trach, i'd always choose ENT over any other field for it. Same if i need a laryngectomy.

 

[Twiggidy]

There is a reason why we are specialties. We have our area of expertise. Usually the area of expertise of the specialist is in the name of the specialty. We are experts of ANESTHESIA. Does that have the word airway in it, or anything close? Not really. We just happen to do a lot of them... ENT is the true master of airways.. that's why we call them for backup when there's an airway concern and if i need a trach, i'd always choose ENT over any other field for it. Same if i need a laryngectomy.

I agree with about 95% of this post. Anesthesiologist are experts in airway management from least invasive (simply mask) all the way to surgical (cric if need) and I say our expertise in airway is the reason why the later is rarely needed. ENTs are experts in surgical airways. Most can probably do less invasive airway management but it won’t be as pretty as the way we do it.