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I knew I shouldn't have gone to medical school. But the other options were worse
confused about anesthesia
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It's easy and common to feel that way early on. You've bought your ticket but haven't paid for it yet with the blood & tears of residency or the sweat of post-tax dollars earmarked for student loans.I come from a very humble background and will likely marry a girl from a humble background. I don't think financial expectations will be too high
I don't mean to be dismissive of your idealism or the work you've done or the sacrifices you've made so far, really I don't.
There's a similar recurring theme over in the military medicine forum, amongst those of us who owe time instead of money for med school. Lots of bright eyed idealistic pre-meds and med students in the warm tender womb of the classroom, living poor and frugal but basically happy, who think $100K is a lot of money to earn and 7-9 months in the desert ain't no thing. That feeling always changes.I live pretty simple, married a country girl who doesn't want furs or a ferrari, but I wouldn't be cool with $100K/year for what I do.
I don't believe it will ever come to that for anesthesiologists. Realistically, if we all end up working for AMCs and the government, I think the floor isn't likely to be lower than current government (military) pay ... which is around $250K/year for a early-mid career anesthesiologist. I could be wrong. I don't have any special insight to what the future holds.
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It's easy and common to feel that way early on. You've bought your ticket but haven't paid for it yet with the blood & tears of residency or the sweat of post-tax dollars earmarked for student loans.
I don't mean to be dismissive of your idealism or the work you've done or the sacrifices you've made so far, really I don't.
I live pretty simple, married a country girl who doesn't want furs or a ferrari, but I wouldn't be cool with $100K/year for what I do.
I don't believe it will ever come to that for anesthesiologists. Realistically, if we all end up working for AMCs and the government, I think the floor isn't likely to be lower than current government (military) pay ... which is around $250K/year for a early-mid career anesthesiologist. I could be wrong. I don't have any special insight to what the future holds.
You're right. My perspective will change and I'm sure my view of life will also. I can't predict how I will feel in 10 years. Luckily my debt will be just over 100k and I plan to live on peanuts my first years out of residency. 250K with no debt doesn't sound too terrible. And yes, residency will be hard in gas but probably not nearly as hard or as long as a gen surg residency. Only time will tell...
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I know I run the risk of oversimplifying, and maybe I am doing so, but I suppose it's the tension between the heart and the head, between youth and age, between passion and prudence. Even if I am oversimplifying, maybe it'll still at least be somewhat useful to frame it like this. By the way, I'm not saying one is right, and the other wrong. Ideally there'd be an appropriate balance between the two.
Heart/youth/passion: I love anesthesiology as a field. There's little else that's cooler.
* The mastery of physiology, pathophysiology, and pharmacology in an acute setting. You don't have to wait days like on the wards to write an order for the nurse to carry out to see if your patient gets better. No, it's your call, you just do it yourself, and you see what happens in seconds or minutes.
* The fact that you have a wide breadth in the type of medicine you deal with. You're not a subspecialist who has forgotten general medicine. No, you're able to deal with kids, adults, the elderly. You're able to provide anesthesia for neurosurgery, heart surgery, bowel surgery, transplantations, obstetrics, and on and on and on. The variety of cases in which you're competent with is staggering.
* Tons of cool gadgets and toys to play with, and tons of procedures. Everything from all sorts of monitors, tubes, IVs, catheters, nerve blocks, etc. In a sense it's a mix between the medical and the surgical - without of course implying anesthesiologists are surgeons.
* There's no clinic, no listening to a laundry list of medical and non-medical (e.g. social) problems from patients, no constant rounding, not a lot of onerous paperwork or notes to scribe, no chronic care where you have to constantly follow up even on the most ridiculous requests, etc. No, anesthesia is just pure, unadulterated medicine.
* Unless you're on call, your time is your own. When you're on, you're on, but when you're off, you're off. It's nice not to have to carry the burdens of patient care. There's nothing like the feeling of not needing to worry about your patients even if you're already at home or otherwise away from the hospital. They're not constantly in the back of your mind when you're with friends or family or whatever.
Head/age/prudence: But is it wise to choose anesthesiology as a field considering the context in which it's practiced in the US? Sure, the field itself is awesome if practiced in an ideal setting, but what about everything else around it?
* The norm seems to be ~60 hours per week for most anesthesiologists (attendings). Start early, finish whenever the last case finishes. Sometimes that may be 3pm, other times 3am. I'm sure that's fine when you're young, but I imagine it gets pretty tiring in your later years.
* The OR is a high stress environment. Patients can die in seconds or minutes if you make a mistake or fail to notice something at the right time and intervene. Again, this might be exciting when you're young, but I imagine when you're older, regular outpatient clinics at set hours might not sound too bad.
* Most CRNAs are nice people, but occasionally you'll run into a militant CRNA who thinks they can easily do your job. Depending on your personality, this may or may not bother you. Related, the ACT model is here to stay, and so many if not most future anesthesiologists will be supervising CRNAs. Keep in mind, fairly or unfairly, you can be held legally responsible for their actions or inactions. Again, this may or may not bother you, but I could see how some might prefer not to deal with the stress. Although to be fair some people are natural leaders or at least able to supervise others effectively enough. Are you this sort of a person? Imagine having to do this for most of your career.
* Your colleagues like surgeons and other physicians (e.g. some gastroenterologists) may in general be nice and cordial towards you, but if push comes to shove, guess who wins? They're not your patients after all. You may be told to just do the job for their patient, even though for example canceling a case may in fact be in the best interest of the patient. They're not your patient though.
* AMCs are gobbling up private practices like Thanksgiving turkey, and many older partners are selling practices so they can retire early. So it's quite possible you'll be working for an AMC.
Similarly, you could be directly employed by a hospital. Or you can work in academia. If these practice environments don't bother you to much, then that's probably good news, and you have little to worry about.
However, if there's an increasing trend towards many if not most anesthesiologists becoming employees for AMCs, hospitals, or other entities, then you lose a lot of autonomy. This may or may not bother you. You won't be able to talk to other partners and arrange schedules with them, or arrange whether or not we should negotiate with this or that hospital about this or that contract, etc. As an employee, you'll be told what to do, and when to do it. You're given a salary with expected hours. The organization's execs will be in charge of deciding whether or not you're performing up to par at the end of the year so you get your Christmas bonus rather than how well your group did. On the plus side, you don't have to worry about the ins and outs of managing a business, I suppose.
* Payor mix. It'd be nice if all patients undergoing surgery had the best private insurance with the highest reimbursement rates and so on. But it depends in large part on where you live. Your community. Some may be fortunate, others not so much. See Blade's comments here and following.
* Maybe there will be places in the US left where anesthesiology can be practiced in a more ideal setting. I hope so. But it may also be good to prepare for the worst even if the worst doesn't transpire. If you're prepared to accept the worst, or at least a "worser" eventuality, and still choose anesthesiology, then you'll be going in with both eyes wide open. And that's a good thing.
-
In short, I think the youth shoot for the stars, but the older practice prudence.
Again, I'm not denigrating either. As I said above, a proper balance between both would be ideal.
On the one hand, if we don't shoot for the stars, then we can't reach our dreams. On the other hand, if we fly too high, then we risk (metaphorically) plummeting to our deaths as did Icarus.
Keep the fire alive, but don't get burned.
Heart/youth/passion: I love anesthesiology as a field. There's little else that's cooler.
* The mastery of physiology, pathophysiology, and pharmacology in an acute setting. You don't have to wait days like on the wards to write an order for the nurse to carry out to see if your patient gets better. No, it's your call, you just do it yourself, and you see what happens in seconds or minutes.
* The fact that you have a wide breadth in the type of medicine you deal with. You're not a subspecialist who has forgotten general medicine. No, you're able to deal with kids, adults, the elderly. You're able to provide anesthesia for neurosurgery, heart surgery, bowel surgery, transplantations, obstetrics, and on and on and on. The variety of cases in which you're competent with is staggering.
* Tons of cool gadgets and toys to play with, and tons of procedures. Everything from all sorts of monitors, tubes, IVs, catheters, nerve blocks, etc. In a sense it's a mix between the medical and the surgical - without of course implying anesthesiologists are surgeons.
* There's no clinic, no listening to a laundry list of medical and non-medical (e.g. social) problems from patients, no constant rounding, not a lot of onerous paperwork or notes to scribe, no chronic care where you have to constantly follow up even on the most ridiculous requests, etc. No, anesthesia is just pure, unadulterated medicine.
* Unless you're on call, your time is your own. When you're on, you're on, but when you're off, you're off. It's nice not to have to carry the burdens of patient care. There's nothing like the feeling of not needing to worry about your patients even if you're already at home or otherwise away from the hospital. They're not constantly in the back of your mind when you're with friends or family or whatever.
Head/age/prudence: But is it wise to choose anesthesiology as a field considering the context in which it's practiced in the US? Sure, the field itself is awesome if practiced in an ideal setting, but what about everything else around it?
* The norm seems to be ~60 hours per week for most anesthesiologists (attendings). Start early, finish whenever the last case finishes. Sometimes that may be 3pm, other times 3am. I'm sure that's fine when you're young, but I imagine it gets pretty tiring in your later years.
* The OR is a high stress environment. Patients can die in seconds or minutes if you make a mistake or fail to notice something at the right time and intervene. Again, this might be exciting when you're young, but I imagine when you're older, regular outpatient clinics at set hours might not sound too bad.
* Most CRNAs are nice people, but occasionally you'll run into a militant CRNA who thinks they can easily do your job. Depending on your personality, this may or may not bother you. Related, the ACT model is here to stay, and so many if not most future anesthesiologists will be supervising CRNAs. Keep in mind, fairly or unfairly, you can be held legally responsible for their actions or inactions. Again, this may or may not bother you, but I could see how some might prefer not to deal with the stress. Although to be fair some people are natural leaders or at least able to supervise others effectively enough. Are you this sort of a person? Imagine having to do this for most of your career.
* Your colleagues like surgeons and other physicians (e.g. some gastroenterologists) may in general be nice and cordial towards you, but if push comes to shove, guess who wins? They're not your patients after all. You may be told to just do the job for their patient, even though for example canceling a case may in fact be in the best interest of the patient. They're not your patient though.
* AMCs are gobbling up private practices like Thanksgiving turkey, and many older partners are selling practices so they can retire early. So it's quite possible you'll be working for an AMC.
Similarly, you could be directly employed by a hospital. Or you can work in academia. If these practice environments don't bother you to much, then that's probably good news, and you have little to worry about.
However, if there's an increasing trend towards many if not most anesthesiologists becoming employees for AMCs, hospitals, or other entities, then you lose a lot of autonomy. This may or may not bother you. You won't be able to talk to other partners and arrange schedules with them, or arrange whether or not we should negotiate with this or that hospital about this or that contract, etc. As an employee, you'll be told what to do, and when to do it. You're given a salary with expected hours. The organization's execs will be in charge of deciding whether or not you're performing up to par at the end of the year so you get your Christmas bonus rather than how well your group did. On the plus side, you don't have to worry about the ins and outs of managing a business, I suppose.
* Payor mix. It'd be nice if all patients undergoing surgery had the best private insurance with the highest reimbursement rates and so on. But it depends in large part on where you live. Your community. Some may be fortunate, others not so much. See Blade's comments here and following.
* Maybe there will be places in the US left where anesthesiology can be practiced in a more ideal setting. I hope so. But it may also be good to prepare for the worst even if the worst doesn't transpire. If you're prepared to accept the worst, or at least a "worser" eventuality, and still choose anesthesiology, then you'll be going in with both eyes wide open. And that's a good thing.
-
In short, I think the youth shoot for the stars, but the older practice prudence.
Again, I'm not denigrating either. As I said above, a proper balance between both would be ideal.
On the one hand, if we don't shoot for the stars, then we can't reach our dreams. On the other hand, if we fly too high, then we risk (metaphorically) plummeting to our deaths as did Icarus.
Keep the fire alive, but don't get burned.
Working for the government may turn out differently than you think. Where I live (Ontario Canada) the average billings for an anesthesiologist in 2012 were $435,000. Most people are in private practice and bill the Ministry of Health directly. It's taxed heavily but anesthesiologists are doing pretty well under a single payer system.
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This
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What's so bad about being a supervisor? The MD becomes more of an executive while the NP does the legwork. Aren't all fields in medicine becoming like this? Pretty sure Gutonc said NPs see all his oncology patients who aren't new and he just reviews/signs the order. Derm, psych, pmr are like this too.
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Also bashwell brought up a very good point : the nature of the work. Anesthesia is very unique and what may be a financial drawback (not owning your patients) is a huge plus in terms of peace of mind. You will take care of a patient and once the immediate peri-procedural period has passed, it remains the surgeon's. Incessant rounding, following up on x lab or imaging result, potential and actual complications, clinic time, coordination of care,etc. You couldn't pay me enough to deal with that. And even though a surgeon may have NPs,PAs, residents to take care of that on a daily basis, he remains responsible. Once you operate on someone, it becomes your patient forever. You can't base it all on economics.
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Beautiful post. Thank you so much. Every med student considering gas should read this. I've never read the pros and cons of anesthesiology outlined so well in one post.
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Are you kidding me? People don't go into medical school to watch other, lesser trained people do their job and be responsible for all their mistakes as well. When you watch over midlevels, you're not an executive. You're a useless middle manager whose sole purpose is to shoulder the blame. The only good thing about the job is interacting with patients and watching them get better. The prestige, the money, the autonomy, the respect are all going away
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Except you missed the point where midlevels are calling for complete independence.
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Complete independence where physicians have zero supervision role or liabilty would be fine. I think it's this having your cake and eating it too garbage that is so infuriating.
D
deleted171991
So here's the unavoidable part about being the surgeon's bitch:
Surgeon books facelift case for 4 hours, despite knowing very well that he NEVER does them in 4, not even in 6. Takes 90 minutes just till incision. Case takes 8 hours. Patient gets to the PACU after 3 pm. You sit there in the ASC like his bitch till 6 pm, recovering only his patient (all other patients gone by 4:30 pm), while he's been gone for 3 hours minding his business and making more money. That's anesthesia and "periop surgical home" for you! Who in their right mind would sign up for this ****, unless you like playing Anthony Hopkins in The Remains Of The Day? And this is the nice mommy track.
Now imagine if it were the opposite, if you took double the time an average professional takes for the task. You'd be fired in 2 weeks.
P.S. Oh, and he managed to give his patient a corneal abrasion, too, because he was too lazy to tape and untape the eyes as needed. And this is the typical "master" you serve, you and the rest of the OR "staff".
You are not a doctor, regardless what's written on your badge. You are "anesthesia". You will be more respected as a doctor during your medical internship than almost anytime as an anesthesiologist (and that includes the grateful patients, who very rarely understand the extent of what you have done to/for them). Still confused?
Surgeon books facelift case for 4 hours, despite knowing very well that he NEVER does them in 4, not even in 6. Takes 90 minutes just till incision. Case takes 8 hours. Patient gets to the PACU after 3 pm. You sit there in the ASC like his bitch till 6 pm, recovering only his patient (all other patients gone by 4:30 pm), while he's been gone for 3 hours minding his business and making more money. That's anesthesia and "periop surgical home" for you! Who in their right mind would sign up for this ****, unless you like playing Anthony Hopkins in The Remains Of The Day? And this is the nice mommy track.
Now imagine if it were the opposite, if you took double the time an average professional takes for the task. You'd be fired in 2 weeks.
P.S. Oh, and he managed to give his patient a corneal abrasion, too, because he was too lazy to tape and untape the eyes as needed. And this is the typical "master" you serve, you and the rest of the OR "staff".
You are not a doctor, regardless what's written on your badge. You are "anesthesia". You will be more respected as a doctor during your medical internship than almost anytime as an anesthesiologist (and that includes the grateful patients, who very rarely understand the extent of what you have done to/for them). Still confused?
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So here's the unavoidable part about being the surgeon's bitch:
Surgeon books facelift case for 4 hours, despite knowing very well that he NEVER does them in 4, not even in 6. Takes 90 minutes just till incision. Case takes 8 hours. Patient gets to the PACU after 3 pm. You sit there in the ASC like his bitch till 6 pm, recovering only his patient (all other patients gone by 4:30 pm), while he's been gone for 3 hours minding his business and making more money. That's anesthesia and "periop surgical home" for you! Who in their right mind would sign up for this ****, unless you like playing Anthony Hopkins in The Remains Of The Day? And this is the nice mommy track.
Now imagine if it were the opposite, if you took double the time an average professional takes for the task. You'd be fired in 2 weeks.
P.S. Oh, and he managed to give his patient a corneal abrasion, too, because he was too lazy to tape and untape the eyes as needed. And this is the typical "master" you serve, you and the rest of the OR "staff". Still confused?
Idk why, maybe I'm an idiot, but none of what was posted above really bothered me...
D
deleted171991
It won't bother you the first few times. When it happens the 100th time, it will, trust me.
You are in love with an idea, like some kids dream about being in the military. Until they go to war... Then reality hits.
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I can see that. I don't disagree that I am an extremely naive snott nosed med student at this point.
I can see this bothering me after the 100th time...maybe. However, it definitely would bother me a lot less than the 100th time that I had to see an afternoon clinic with 20-30 patients, or the 100th time that I had to come in and round on patients on weekends, or the 100th time that I had to write an endless H&P, or the 100th time that I had to serve as a patient's social worker, or the 100th week that I had to work 100 hours, or the 100th time that I had to counsel a patient on smoking cessation, weight loss, or diabetes. This is just my personal feelings, not to say many wouldn't take those scenarios over the one you highlighted.
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In the USA the "Govt" pays an Anesthesiologist around $200K for 50 hours per week doing 100% CMS cases solo. So, your Ministry of Health may pay $435,000 but our Emperor only pays $200K and we are taxed heavily as well plus we get the Malpractice issue with big premiums.
D
deleted171991
Because 30 endoscopy patients in 3 CRNA rooms are a pleasure.
Just wait till you have to dig through tons of pre-existing notes to figure out just exactly how sick your patient is, and to make sure you are not missing anything. Oh, and all that in 5-10 minutes, because the surgeon can't wait.
You ain't seen Medicaid clinic patients in the OR.
Because the average anesthesiologist works like 60-70, and the average surgeon not much more. Whoever works 100 hours probably makes 50% more than them.
Because as an anesthesiologist you will not tell your patient that he should go and have that cardiac workup he was too lazy to have before surgery, because he has like 10-15 PVCs a minute. That's just an example from today.
This is just an exchange of opinions. But while yours are personal dreams, mine are personal reality.
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Let me summarize:
Canadian Health care for Anesthesiologists: $450K and you get to do your own cases
USA Socialized Health care (100% Medicare Option) for Anesthesiologists: $200-$250K and you get to supervise 4 know it all CRNAs.
Canadian Health care for Anesthesiologists: $450K and you get to do your own cases
USA Socialized Health care (100% Medicare Option) for Anesthesiologists: $200-$250K and you get to supervise 4 know it all CRNAs.
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http://forums.studentdoctor.net/thr...-the-future-of-anesthesiology-for-mds.931292/
It's time for you boys and girls to read this thread. Once you read through the posts and links feel free to state your thoughts.
Blade
It's time for you boys and girls to read this thread. Once you read through the posts and links feel free to state your thoughts.
Blade
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Great thread Blade. Thanks! Your posts on that thread are extremely knowledgeable and informative. I definitely have a better understanding of all the issues.
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In general, do anesthesiologists like anatomy? Or do those folks become surgeons?
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I'm not an anesthesiologist, I'm a med student going into gas but the only anatomy that I like is CV/Pulm anatomy...and that's because I love the physiology behind it. Most anesthesiologist I know love pharmacology and physiology...anatomy, not so much.
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also a med4.... def have to be fond of anatomy.. will be doing regional blocks, placing lines, other procedures in pain...intubating pts with faces have been sawed off.. cant forget that anatomy
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Good anesthesiologists love anatomy. It's part of what makes the job fun and interesting.
D
deleted171991
Anesthesiologists like physiology.
You don't need to know a lot of anatomy to be a good anesthesiologist. Definitely not the level you need for surgical practice.
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I'm just a medical student, but I think the fact that gas docs don't have ownership of the patient is a huge factor in life satisfaction. I prefer short, intense patient interactions. You don't think about patients anymore once you're home. Now this may translate to less autonomy/respect/bargaining power but most surgeons I've spoken to admit that nobody respects them -- from the hospital, to patients, to the average layperson. You don't do surgery for the accolades nowadays. I don't see gas salaries going under 250K. All it takes is for a few major lawsuits for CRNAs to be given strict regulations on their SOP.
D
deleted171991
In 5 years, we will pay dearly for that lack of ownership. Mark my words.
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I've been saying for years that Canada is a valid alternative when the music stops and we are left holding our Laryngoscope handle.
Another advantage of fellowship training.
Another advantage of fellowship training.
D
deleted171991
ACGME-approved fellowship training, to be precise. As in only the subspecialties which currently have boards. Not OB, regional, neuro, ambulatory, periop, ortho etc.
Also, if you want Canada, now is the time. When the exodus begins, it will be too late.
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To present a different side of the coin, I work in an all-MD private practice setting. We are well-respected by our hospitals, and in fact have leadership positions at all the facilities we serve. While nothing is ever guaranteed, we are well-insulated from both the AMC and CRNA issues. Every job has its trade-offs, but I look forward to going to work every morning.
I think that, for the motivated resident, good jobs are certainly out there. I also think that the days of Joe Slacker sailing through residency and then scoring a cush job in a nice area without even trying are over. You have to earn it nowadays.
Anatomy? Yes, you have to know anatomy. The ultrasound revolution is here, and you must know what the hell you're looking at to be good at it.
I love my job. There is nothing else in medicine I could do and be happy. The actual practice of anesthesiology in a good setting is fantastic.
So it's well worth listening to the doom and gloom, because the AMC threat is a real game changer. But there do exist places where the specialty is thriving. If you love anesthesiology the way I do, you can find happiness somewhere.
I think that, for the motivated resident, good jobs are certainly out there. I also think that the days of Joe Slacker sailing through residency and then scoring a cush job in a nice area without even trying are over. You have to earn it nowadays.
Anatomy? Yes, you have to know anatomy. The ultrasound revolution is here, and you must know what the hell you're looking at to be good at it.
I love my job. There is nothing else in medicine I could do and be happy. The actual practice of anesthesiology in a good setting is fantastic.
So it's well worth listening to the doom and gloom, because the AMC threat is a real game changer. But there do exist places where the specialty is thriving. If you love anesthesiology the way I do, you can find happiness somewhere.
D
deleted171991
So you went to Hawaii because of the great practice opportunity?
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Can you elaborate on any possible disadvantages you see in an all-MD practice setting? Do such jobs exist in nearby suburbs of major cities?
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The major disadvantages are straightforward. One is financial- you leave money on the table by staffing every little ditzel case with a physician. The corollary is that you will occasionally find yourself sitting the stool for some straightforward case and be frankly bored.
However, I'd rather be bored and in complete control than deal with supervising militant or incompetent CRNAs. The peace of mind that comes with doing your own cases is very valuable, at least to me.
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I know that on SDN everyone is brilliant and handsome (or beautiful) with a keen eye for business ... It sure seems a lot of statements are predicated on the assumption of what a top 10%-er's choices and options are.
"Just do ENT" or "just do derm" isn't realistic advice for most people. The kind of board scores that got most of us into anesthesia wouldn't cut it for some of these destiny-controlling wealth specialties. Likewise, "run a lean efficient profitable practice at an ASC doing just boob cases" isn't where most general surgeons wind up.
Yeah, if your step 1 is 250 and you don't really love any particular specialty you don't have to settle for a field with "issues" and if you're rich and handsome you don't have to settle for a chick with six fingers and a lisp, either. There are vanishingly few specialties left that don't have "issues" with midlevel encroachment or declining reimbursement.
I know more unhappy surgeons than unhappy anesthesiologists. Ours is a great specialty. I love my job, and from reading this forum, it appears I'm living an absolute horror movie of a life: practicing alongside pseudo-independent CRNAs, making government pay somewhere around the 25th %ile MGMA. Maybe less depending on what region I look at. If you're one of the 10%'ers who could make it big in ENT, odds are you won't be scraping around the bottom of the anesthesia world either. If you're not one of them, well, do the options of the elite really have an impact on your decision?
Cue the coulda been an i-banker posts.
I agree with this post 100%. I NEVER set out to be a "hot shot" in medicine or surgery. I wanted to do anesthesia for a lot of reasons. I knew full well that anesthesia had some "issues". I knew that there were challenges. I also knew (and know) that so does just about every other field of occupation both in AND out of medicine.
Is it the best field in all of MD/DO-dom? I don't know. It depends on the type of practice. The culture of your institution. The culture of your group. The relationships with the CRNAs/AA's (in ACT models). There are LOTS of variables.
I'm having a blast for the most part, as a new attending in an ACT model. MOST days I have an opportunity to feel as if I did something meaningful and rewarding. For now, I'm well compensated for what I do. I have decent hours, but when we work we work. Call isn't so bad. We employ the CRNAs (which for sure helps but isn't that great financially). I can't complain. I love being an anesthesiologist. I really do.
Will all of the above be my reality in 10 years? Who the f.ck knows. Will I work to minimize the risk that it changes drastically? Yes. Will I prepare for change, mentally, financially, and by never lettering my skills down? Yes, of course.
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In the 4:1 model, who is liable if there are two emergencies simultaneously and the firefighter anesthesiologist can only extinguish one case? How often does this happen?
D
deleted171991
The liability always lies with the anesthesiologist of record. And the group, of course.
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Look guys, the following was posted in another thread about physician burn out. It's not just anesthesiology. You thought surgery or a surgical subspecialty can save you from the corporate garbage and becoming a bitch? Think again. Do what you love, live within your means, and invest wisely. At least then we'll all be (somewhat) happy bitches
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"A little story I just heard that illustrates the sad state of medicine today. An ophthalmologist friend practicing out in the midwest for one of the better known corporate medical groups was called into the office of the big honcho number cruncher..."it takes you 15 - 17 minutes to do a cataract. Dr. X, your colleague, can do the same surgery in only 10-12 minutes. If you can't speed up, we will make sure that all the primary care doctors in the group only send their surgical patients to Dr. X. You will no longer be allowed to do surgery".Look guys, the following was posted in another thread about physician burn out. It's not just anesthesiology. You thought surgery or a surgical subspecialty can save you from the corporate garbage and becoming a bitch? Think again. Do what you love, live within your means, and invest wisely. At least then we'll all be (somewhat) happy bitches
WOW, I'm glad Gas doesn't have to deal with this garbage (or so I'd like to believe). And what about docs whose reimbursement is contingent upon the extent to which they make their constituent population "healthier"? My medical school's health policy course says this is the future. Again, sounds like Gas would be immune to such bull***t.
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Cool stuff about anesthesia.
Get to do some cool procedures. Get to practice LIFE SAVING skills every day. See immediate results. Treat hemodynamics with meds that you personally push and even draw up yourself. Treat pain (I'm talking acute) with all sorts of cool nerve blocks. Use some really cool technology. USE the technology yourself. Have and maintain skills (this is key for us ACT folks) which has a MINIMUM income greater than most people achieve unless at the VP level in corporate America. Even if the sky falls down on top of our profession one day, the demand for anesthesia will be high. The number and quality of CRNA students/grads isn't sufficient. I foresee a premium for an MD/DO no matter what happens though in the future it could be a tighter gap. Regardless, it's a fun specialty and there are WAY worse ways to earn a living.
Also, as others have pointed out, if all CRNAs everywhere got total autonomy, there will STILL be extra $ available to staff things like 24 hour OB, to take call, weekends, holidays.
Nobody in anesthesia who is remotely good has a thing to worry about in their career unless you live like a jackass and forget some basic financial principles. Be conservative like a small business owner having some good years but whom isn't SURE if they will be so great in 10 years or if things will get harder. Invest and save. Pay off debt while you can. YOU CAN DO ALL OF THIS.
Country Clubs and multiple homes? Personal planes? Those days are probably gone for most of us. Good thing I never counted or cared about that anyway.
If your goal is to make a good living in a fun specialty, and can handle the politics, change, and being a SERVICE specialty, then this is a good choice for you.
I'm about to go do an overnight OB shift for a good amount of $$. It's extra call I'm opting to take while I can take it. I get to think about maternal fetal physiology and being good at what I do matters when a parturient needs me most. Ain't a bad way to make a living.....
Get to do some cool procedures. Get to practice LIFE SAVING skills every day. See immediate results. Treat hemodynamics with meds that you personally push and even draw up yourself. Treat pain (I'm talking acute) with all sorts of cool nerve blocks. Use some really cool technology. USE the technology yourself. Have and maintain skills (this is key for us ACT folks) which has a MINIMUM income greater than most people achieve unless at the VP level in corporate America. Even if the sky falls down on top of our profession one day, the demand for anesthesia will be high. The number and quality of CRNA students/grads isn't sufficient. I foresee a premium for an MD/DO no matter what happens though in the future it could be a tighter gap. Regardless, it's a fun specialty and there are WAY worse ways to earn a living.
Also, as others have pointed out, if all CRNAs everywhere got total autonomy, there will STILL be extra $ available to staff things like 24 hour OB, to take call, weekends, holidays.
Nobody in anesthesia who is remotely good has a thing to worry about in their career unless you live like a jackass and forget some basic financial principles. Be conservative like a small business owner having some good years but whom isn't SURE if they will be so great in 10 years or if things will get harder. Invest and save. Pay off debt while you can. YOU CAN DO ALL OF THIS.
Country Clubs and multiple homes? Personal planes? Those days are probably gone for most of us. Good thing I never counted or cared about that anyway.
If your goal is to make a good living in a fun specialty, and can handle the politics, change, and being a SERVICE specialty, then this is a good choice for you.
I'm about to go do an overnight OB shift for a good amount of $$. It's extra call I'm opting to take while I can take it. I get to think about maternal fetal physiology and being good at what I do matters when a parturient needs me most. Ain't a bad way to make a living.....
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Look guys, the following was posted in another thread about physician burn out. It's not just anesthesiology. You thought surgery or a surgical subspecialty can save you from the corporate garbage and becoming a bitch? Think again. Do what you love, live within your means, and invest wisely. At least then we'll all be (somewhat) happy bitches
We're ALL somebody's bitch. CEO's have massive pressure from investors. Small business owners whom feel their lack of diversification in their sphincter daily need BP meds when their biggest accounts threaten to leave. One of our very good ortho surgeons just got back from a 2 week sabbatical in court after being sued for some bullish.t. How about that general surgeon who now has to deal with a threatening patient after a ventral hernia repair with mesh having now chronic pain, blaming him.....
The VP of sales who's subject to flat out dismissal if his quarters don't look the way the president wants them to look...... It goes on and on.
The lawyer who constantly has to deal with people bitching about a simple email exchange that he/she billed the client for. Clients expecting him to somehow not charge when they call frantically over the weekend.....
How about the CPA who does a great job trying to cultivate relationships with longstanding clients only to have some succession person come in and act like their 15 year history was nothing and says "I need a better price. The guys down the street say they can do this for 20% less."
Sometimes I think we're a spoiled bunch of bitches ourselves. What other profession do people call you DOCTOR on a daily basis, mostly with respect. Patients deferring to you as you walk in the halls in your scrubs and with your badge....
Making pretty great money for the headaches that we DO indeed put up with.
But, there's no free lunch in this life. Do your job, do it well, and have a good attitude. Yes, this is trying at times. Our group is currently very stable. I may be singing a different tune were it otherwise. But, then there would be a MARKET for groups or leadership to facilitate such a culture, or to instigate a cultural change. Yikes, this board gets depressing at times.
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I couldn't agree with this more. Thanks GA8314. Live is hard. Period. Regardless of your job. But it can also be extremely fun and gratifying at times. Life is a journey full of ups and downs but it's a great journey to embark on.
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Not sure if this has been posted elsewhere but this scares the **** out of me: http://www.stahq.org/index.php/download_file/view/356/184/.
"Winning the War"
"• Aggressive legislative & regulatory efforts by AANA with goal
of dismantling MD-led ACT
• Need to prove our role in preventing mortality & major
morbidity as leaders of the ACT
• Definitively prove our role by showing value added in patient
outcomes
• Concern for welfare of patients should AANA achieve its long
sought after goal of independent practice"
Can we get Blade to lead the ASA? We need leaders like him in all medical fields, not just anesthesiology.
"Winning the War"
"• Aggressive legislative & regulatory efforts by AANA with goal
of dismantling MD-led ACT
• Need to prove our role in preventing mortality & major
morbidity as leaders of the ACT
• Definitively prove our role by showing value added in patient
outcomes
• Concern for welfare of patients should AANA achieve its long
sought after goal of independent practice"
Can we get Blade to lead the ASA? We need leaders like him in all medical fields, not just anesthesiology.
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What about the guy/gal who takes 80 minutes to do a cataract? or 3 hours to do a typical one hour procedure? Should we all eat the loss in revenue because that person has poor surgical skills? I'm willing to bet that cataract is really well over an hour as surgical times less than 20 minutes is considered excellent.
D
deleted171991
You're probably right. I still see surgeons doing every cataract with a retrobulbar block, 30 minutes just till incision. They are private and nobody can do anything about it. The hospital loves them because of the higher facility fees for longer surgeries. The same goes for some plastic surgeons who take double the time their private counterparts do.
I can see this becoming a problem in the era of bundled payments, when the hospitals won't get extra facility money for the extra surgical time.
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Let them practice independently, I have no interest in supervising anybody. Perhaps I'm naive, but I wouldn't have a problem working side by side with independent CRNA's as long as I'm not signing charts for cases that I'm not involved with. I would be working along side of independent CRNA's at one of the two jobs I'm seriously considering. The other job is an all MD/DO group which is well established and as of now, doesn't take a subsidy. They take a loss for uninsured patients and providing services that are poorly compensated such as having staff available for remote sites, cath lab etc. But it allows them to function autonomously and I would argue, makes it difficult for an AMC to take over unless they could negotiate insurance rates that would allow the AMC to pay a "kick back" to the hospital. But even then, the hospital and surgeons are very happy with this group so it doesn't seem likely that the hospital would take on an AMC unless there was a significant kickback involved.
Despite my significant student loan debt (~$300K), I'd rather make less and do my own cases. Had I not gone into anesthesiology, I would have done IM/Pulm or FP and it doesn't seem likely that our salaries could fall much below pulm and they should stay well above FP. Remember, CRNA's don't cost less, the whole point of "opt out" is that they are able to bill CMS independently in 17 states. The bill is the same whether it's an MD or nurse doing the case. The independent CRNA's I know make the same salary as anesthesiologists in their area. There should be plenty of good jobs available for those who are personable, hard working, and highly skilled. Maybe not for the lazy, out of practice folks who want to sit around, sign charts and drink coffee while flirting with the circulators and scheduling clerks. As reimbursement continues to decline, we'll all feel the squeeze including surgical specialties. Eventually the costs of attending medical school may exceed the benefits but we're not there yet IMO. Medicine seems like a pretty good gig overall. All of the anesthesiologists I know are happy and have a decent income, none of them are in the hellish situations I read about on SDN, at least for now.
In terms of ACO's and bundled payments, take a look at the pioneer ACO's. Most of them aren't doing well and it doesn't seem like a viable practice model. The current system isn't sustainable either, so clearly something needs to change. I'm already in too deep, I have no choice but to work hard, live conservatively, pay down my debt and ride it out. I was miserable working in a lab before medical school, I couldn't imagine doing that for the rest of my life. My engineering friends seem bored and unsatisfied with their work and they aren't making the killer salaries you see quoted on SDN. Every one of them is looking for their exit plan with hopes of eventually landing a job that pays >$120K.
I love anesthesiology and I can't think of another job that I'd be more excited to do each day. Even as a resident, I enjoy waking up and coming into work most days. It's Christmas Eve and I'm on an elective rotation. I could have slept in but instead I came in to work for a few hours this morning so the pre-OB call person can have the day off and the OB call person can sleep in. I worked the OB floor while my wife and kids were sleeping and I have the rest of the day and tomorrow to spend with my family. I would never volunteer to go see FP clinic patients on a day off. That to me is the difference between doing a job vs. a career you enjoy.
