What does MGMA say?
Crna and status quo
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MGMA still doesn't have a great n. I think my region only has 17 practices participating over 4 states. I wonder what those numbers would look like with 38 or 50 groups reporting.
The numbers are interesting because I have a pretty solid idea what the base pay is for attendings at my place and it's pretty low as compared to those numbers. I think something may be awry.
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Depending on your payer mix, OB can be very lucrative. Even AMCs in my area pay ~3500 per call. If you are lucky enough to be at a fee for service PP group, a hand full of epidurals + couple of sections and you are easily looking at 2x that. Folks at my group fight to cover OB. It's funny how incentivizing people changes their attitude towards work.
What does comfortable mean? Do you think you'll be able to live in a $500K-1.o Million dollar home, send your kids (assuming you have 2-3) to private school AND college, while driving status cars (Audi,BMW, Mercedes)? Sorry for the specifics, just I'm just trying to get a sense of what people mean by comfortable. The above is what I would be happy with.
That's good to hear. How far do you practice from the NYC area?
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Dude, IMHO you're part of the problem. You want to pass off the things that you don't like to the CRNA's.
This is what has brought us to where we are now. And clearly you have no clue about how lucrative an OB practice CAN be - if there are interested and motivated anesthesiologists that actually want to practice their profession.Dude, IMHO you're part of the problem. You want to pass off the things that you don't like to the CRNA's.
Relax. No need to get confrontational, keyboard warrior. I am not in anesthesiology, YET, and I am using this forum to get more information about the profession. I am simply asking questions to those that know about the profession to help me figure out what I should do in the specialty. So, you can help me out and be more constructive rather than taking that confrontational tone with me.
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Dude: DON'T go into anesthesia...we want people who are HUNGRY, who can take the work because they want to SHINE and let administrators/community/patients know what anesthesia does. Dudes who start asking about 'status cars' before they've even tasted the juice are tools, start asking about STATUS JOBS and how to make sure you have one... I can already tell if someone asked you if you'd like someone else to do your job while you thumb twiddled in an office somewhere you'd jump at opportunity, become an academic or a hospital employee...although that little dreamboat has too many holes in it now
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We are a fee-for-service PP group. However, our payor mix is very poor. 80%+ Medi-Cal. We do get a small stipend, but mostly it is financially lucrative only because we pool units and compensate ourselves with money from our OR cases. However, the hospital and our OB patients actually pay us little.
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LOL - I never underestimate how militant and idiotic some CRNA's can be. 😉
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I agree with this, of course. For my personal situation, I am more than happy with my overall compensation, even without OB. Also, on rare occasion, I hit 80-90 hours in a work week, so I'm bumping up against the law of diminishing returns.
BTW, I have hit the 2 x $3500 mark. But it is not with a handful of epidurals and sections. I reached it by doing 12 epidurals and 8 sections in 24 hours, and it is essentially by stealing money from OR cases.
I'm motivated by money. Everyone else is too. You'd be lying if you said you weren't. Hell, this thread got started because of the impending threats of CRNAs to anesthesiologists livelihood. Why do you think you want to let people know what anesthesia does? You want a pat on the back? Think that's enough? No, you want to keep getting paid what you think you deserve. Also, I would jump at the opportunity to have someone else do my job while I get paid. That's the benefit of having ownership in a PP or AMC (if possible). However, I'm aware that this doesn't come easy and the only way to get PAID is to convince people to PAY you. And that is by doing procedures that CRNAs can't or won't do.
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I like doing OB anesthesia. They're the only patients who want to be in the hospital, and they universally appreciate what we do.
Location, location, location.
And - if it's an assurance of very high pay in perpetuity you seek, one of the surgical subs might be a better fit for you. I hear spine surgery pays nice.
Location, location, location.
And - if it's an assurance of very high pay in perpetuity you seek, one of the surgical subs might be a better fit for you. I hear spine surgery pays nice.
I'm not looking for high. I'm looking for HIGH ENOUGH. I'm not interested in 7-8hr surgeries. I'm just trying to get a concrete sense of what to expect. People say "comfortable" but that means different things to different people. The median salary I've seen is $300-400K. I'm just not sure if folks are bitter because they think that is too low or if they are actually happy with the $300-400K range but are concerned that range will get significantly lower in the future. If folks are bitter because they expected to make $500K or $1M, I want to know that. I believe that if I continue to make that much ($300-400K) in perpetuity, then I will be able to get what I stated previously.
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From what ive read over the years.. some attendings thing the salaries peaked probably 10 yrs ago. CRNA "independence" becoming more prevalent, will cause MDs and CRNAs to work "collaboratively" causing a lot of MD jobs to be converted to CRNA jobs, ACA decreasing reimbursement, AMC's buying up all the PPs and academic salaries already so low. Basically in the future some predict no jobs, low salary (~200k, they hope) maybe longer hours, having to address Dr. CRNA. .basically = scroomed.
Im not sure what year you are, Im a third yr med student, Im very interested in anesthesia, most likely will go into it regardless of what is said here. Youll have to make your own decision and live out the repercussions. I cant see myself doing anything else. If the choice is between jumping off a bridge midway through a surgical residency, or being happy in gas which pays half of todays salaries, well that shouldnt be that hard of a choice.
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I don't know. I readily admit that my perspective is probably skewed because I never had any educational debt, and I have a government pension to look forward to. My ~25th %ile by MGMA data salary from the Navy plus a bit of moonlighting on the side is enough money, especially living out in the sticks.
Anesthesiologist pay in the $500K - $1M range is an historic anomoly. It can't last. I hope those earning at that level have many more years of making hay while the sun shines, but it can't last. On the bright side, I honestly don't see average anesthesia pay dropping below $250K/y even in the worst imaginable scenario. Pediatricians aren't starving miserably, and neither will you if you go into anesthesia.
Annual income twenty pounds, annual expenditure nineteen pounds nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery. Overquoted trite cliche sure, but it's the truth.
Anesthesiologist pay in the $500K - $1M range is an historic anomoly. It can't last. I hope those earning at that level have many more years of making hay while the sun shines, but it can't last. On the bright side, I honestly don't see average anesthesia pay dropping below $250K/y even in the worst imaginable scenario. Pediatricians aren't starving miserably, and neither will you if you go into anesthesia.
Annual income twenty pounds, annual expenditure nineteen pounds nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery. Overquoted trite cliche sure, but it's the truth.
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I read this article http://www.brightcopy.net/allen/csab/62-2/index.php#/12 in the CSA Bulletin not too long ago. Economic arguments are spot on. Offers advice at the end to those here who might be interested. Enjoy
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Southpaw, I wish you well in your practice and personal life. You post the truth for those coming up behind you; it seems just like yesterday you were an intern.
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"DO A FELLOWSHIP" (page 16). Guess who has been posting that same opinion since 2008? The article is worth reading but the part about regular nurses sedating patients in the O.R. is a pipe dream. The horse has left the barn on redefining the anesthesia model.
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Many of you are in the early stages; I understand that fact as that was me in'07-'10. I've moved on to "acceptance" these days which is a much better place to be.
Which subspecialty is most resistant to CRNA encroachment? Cardiac? Regional? Critical Care?
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Peds, critical care, and pain. Though critical care gives more power to their NPs than is probably smart. But their model is already one attending physician and 20+ patients. And "Pain Specialist CRNAs" are out there.
I think Peds is a good bet because most of the big cases and high volume are in large specialty hospitals already. A management company can't just conjure up 30 or 50 or 100 adequately trained peds people to poach these contracts, and most are affiliated with academic centers anyway, so unless they change the education and research part of the mission, they're locked out. We don't train CRNAs to be independent and we limit what they do. They can go to some conferences and call themselves a regional or OB expert, but neonates, craniofacial, Pedi regional, fetal cases, transplant, congenital cardiac, big tumors in little kids, pediatric difficult airways, etc. takes real on the job training and skills they don't have and can't get taught in their shady CRNA mills. That's what we do every single day. And parents are not likely to buy into unsupervised non physicians taking care of their bundles of joy when a fully trained and boarded alternative exists just down the road, at the real Children's Hospital.
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Given that the OP is a med student, I'd simply say to choose a different field.
What gets overlooked in the fellowship debate is a question of whether you want the case mix that the fellowship will prepare you to do. Love cardiac surgery? Great, do cardiac fellowship. Love taking care of sick kids? Great, do pedi. But you either like those cases or you don't. If you don't, I'd argue that it's better to do something else (either be a generalist or train in a different field) than to wake up every day dreading going to work.
What gets overlooked in the fellowship debate is a question of whether you want the case mix that the fellowship will prepare you to do. Love cardiac surgery? Great, do cardiac fellowship. Love taking care of sick kids? Great, do pedi. But you either like those cases or you don't. If you don't, I'd argue that it's better to do something else (either be a generalist or train in a different field) than to wake up every day dreading going to work.
Gotta be realistic. I don't think doing a fellowship is about getting paid more in anesthesia. I think based on recent economic trends, it will be all about maintaining a decent level of income. Is it possible to do a fellowship to be comfortable in specific, difficult cases but as an attending have a fair share of B&B cases? My goal is to have a secure income of $300-400K a year while taking minimal call.
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Anesthesiology is not for you. If you don't understand why, take some time to look sincerely at some of the things you've said in this thread. If you still don't get it, just accept it, and move on to something else. As a practicing anesthesiologist, my advice is that you need to look elsewhere.
I disagree but elaborate why my expectations don't align with anesthesiology.
I personally am choosing anesthesiology for the reasonable work-life balance relative to the pay. I think it's reasonable to desire a good work-life balance and while I have articulated such, you don't have any indication what specifically an optimal work-life balance means for me. I haven't said anything about that. Does it include 4 calls a month? 10 calls/month? No calls? Haven't said. At the same time, I'm becoming increasingly aware that economic trends may catch up to anesthesiology and some of you may be replaced by CRNAs because you don't contribute any more value than they do. Some of you think that because we have the MD and at least 4 years of training after that justifies our higher salaries compared to CRNAs. I don't think extra years of training is enough if there is no visible benefit from them. Some say our training is better once **** hits the fan, but how often does that happen? Does the small likelihood of that happening justify double the salary in some cases? I'm just not sure if that's sustainable.
I think as someone entering anesthesiology, you have to have the passion AND be aware of the economic issues facing the industry. I think too many doctors on here have the former but are now bitter because they didn't consider the latter and have screwed themselves. If doing a fellowship justifies my added value over CRNAs, so be it. I will pursue a fellowship. And the subspecialty I choose will have the optimal work-life balance for me.
I think as someone entering anesthesiology, you have to have the passion AND be aware of the economic issues facing the industry. I think too many doctors on here have the former but are now bitter because they didn't consider the latter and have screwed themselves. If doing a fellowship justifies my added value over CRNAs, so be it. I will pursue a fellowship. And the subspecialty I choose will have the optimal work-life balance for me.
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"...Some say our training is better once **** hits the fan, but how often does that happen? Does the small likelihood of that happening justify double the salary in some cases? I'm just not sure if that's sustainable...."
do yourself a favor and pick another specialty. i understand the whole work-life balance thing but honestly that is not how you come off to me... and others apparently. frankly, we don't need another greedy lazy a** in our profession. study hard in med school, work hard in residency +/- fellowship and no nurse will be able to touch your breadth of medical knowledge and expertise regardless of field. btw, our training is better in EVERY ASPECT and not just better when the **** hits the fan. oh yeah, the next time you or your loved one needs surgery feel free to ask for an independent crna... good luck!
do yourself a favor and pick another specialty. i understand the whole work-life balance thing but honestly that is not how you come off to me... and others apparently. frankly, we don't need another greedy lazy a** in our profession. study hard in med school, work hard in residency +/- fellowship and no nurse will be able to touch your breadth of medical knowledge and expertise regardless of field. btw, our training is better in EVERY ASPECT and not just better when the **** hits the fan. oh yeah, the next time you or your loved one needs surgery feel free to ask for an independent crna... good luck!
Southpaw/Saratoga, if reading this article and following its advice is lazy, then call me lazy. This is the where the future is heading and I'm not going to be left behind.
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They called you lazy because of what you wrote earlier in the thread.
I know what I wrote. I actually want to know what you don't agree with. I think it's reasonable to want minimal call. I actually think they are upset also because I suggested tbat our extra training is not perceived as valuable as they think it is. I'm not going to back off from that, especially when you have an increasing number of states allowing CRNAs to practice independently.
I'll work hard enough during residency to get into a PP with a partnership. I'll also consider a fellowship to master areas with little CRNA encroachment. Then, when saratoga/southpaw get replaced by CRNAs, they can look me up, and work HARD for ME, albeit for lower pay, because I still need to get paid and their training will be worth less.
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'... they can look me up, and work HARD for ME, albeit for lower pay, because I still need to get paid...'
i rest my case. now, please spare us your infantile rant. lurking suits you better...
i rest my case. now, please spare us your infantile rant. lurking suits you better...
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So just so we're clear - you want to make as much money as you can and work as little as possible. Does that about sum it up?
You think "minimal call" is reasonable. Then IF you ever make it into anesthesia, you better be looking for an outpatient only gig. Those are the only places that don't have call.
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Good luck with that.
I want an optimal work-life balance. For instance, if obstretrics and cardiac have similar pay, but obstretrics has less call, then obstretrics could potentially be more attractive. However, if there is little difference between an obstretric anesthesiologist and a CRNA in obstretrics, then I will consider cardiac because I want to command good pay in the future. Also, if I can increase my pay by taking more calls, I might consider that too. Got it?
I think people here are getting hung up on my work ethic. That's irrelevant, since I'll only get paid if I work, and I want to get paid. I can always figure out how much work I need to do to get paid enough that I'll be happy. I'm really more concerned about protecting my future income by providing a unique skill (unique to MDs and not performed about CRNAs).
Do you understand now?
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For someone who hasn't done his first case…..you have no idea what you're talking about……for all we know you may hate Anesthesia altogether….it happens.
Some do this because it was a "calling"……it is disturbing to hear someone would do this solely for cash and lifestyle…….when I hear statements like that, it seems to make our case against CRNAs that much harder.
Cheapens the profession IMHO.
The profession is already cheapening because when you were pursuing your "calling", you forgot to notice the lower-paid competitors learning to do exactly WHAT you do. Currently, you have a decent lifestyle, but economic trends suggest that will not continue. I plan not to make that same mistake.
D
deleted171991
I keep reading your posts and try to reconcile it with the fact that you have an MBA from a "top 10 business school" (approximate quote). Then I remember that healthcare is in deep trouble especially since/because EmBeeAy's got involved... and it all starts to make sense.
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You think we "forgot to notice" what mid-levels are doing?
You make it sound like we have 100% control over the healthcare marketplace.
We talk to legislators, we sponsor bills, we encourage legislation, we contribute to our PAC….we're not sitting on our asses watching the world leave us behind.
Im sure Ive spent more time in legislators offices than you…..you come here with an attitude that if we were to follow your path, all would be well.
All politics are local….as well as jobs….all I need to do is prove my worth to the small circle of surgeons I provide my service to…..I get them to keep asking me to staff their rooms, then "economic trends" be damned.
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I can't be the only person who wonders about the status of the OP, can I?
Healthcare is in trouble because it's too expensive. It's about 15-20% of the US GDP which is a significantly higher percentage than the other countries in the G8. Obviously, the government is aware of this and is looking to cut costs. You can continue to be employed by your surgeons but reimbursement will decrease, especially if the same procedures can be performed by CRNAs. Having an MBA makes me increasingly aware of the trend and looking for subspecialties that are more resistant to cost-cutting (those where true value can be demonstrated)
Doesn't seem to be doing you any good though
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You don't seem to understand anesthesia billing.
When they bundle payments, were all going to be taking it in the arse. Even the Wharton grads.
When they bundle payments, were all going to be taking it in the arse. Even the Wharton grads.
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yet you so desperately want to join our ranks despite our insistence for you to look elsewhere... where's the logic in that??
I'm not going to listen to bitter keyboard warriors who have a weak grasp of healthcare economics
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It looks like this one's run it's course.
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My 2 cents
I find it offensive that people suggest that an anesthesiology residency (four yeaars) is just as good a crna education and a fellowship must be obtained to be competitive. This kind of rhetoric will scare off all medical students to the specialty as it should. It just is not true. And if it is true then there are major problems .
A peds fellowship will train you to work at major academic centers doing peds. IF you want to do that, then do a peds fellowship. Reg residency you can do all healthy children. At least it should.
I find it offensive that people suggest that an anesthesiology residency (four yeaars) is just as good a crna education and a fellowship must be obtained to be competitive. This kind of rhetoric will scare off all medical students to the specialty as it should. It just is not true. And if it is true then there are major problems .
A peds fellowship will train you to work at major academic centers doing peds. IF you want to do that, then do a peds fellowship. Reg residency you can do all healthy children. At least it should.
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