Dept Chair of Anesthesiology at Jefferson makes a ruling: ignore the red response

[MirrorTodd]

I'm posting this up not to fuel the MD vs CRNA debate or start bashing CRNA's. This is purely for situational awareness. I'm a newly minted Anesthesiologist and I already have a very negative view regarding the strength of the ASA and their ability to lead and to advocate for physicians across the US. It is very refreshing to see someone in the leadership of Anesthesiology standing up for what is right in the practice of medicine and to make a real leadership decision for his department. That is all.

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[Mehd School]

Very proud of Dr. Mahla for taking a stand against this B.S. He showed great leadership and we should support him because he is going to have to deal with an unfair amount of backlash over something so obvious. We need more people like this and less people taking the route of least resistance.

 

[Blockit]

Good for this courageous chairman. And may the Almighty rain damnation down on whatever tool posted the comments in red.

 

[coffeebythelake]

Good. Now ASA and professional societies need to grow some balls and follow suit.

 

[GassYous]

Fire all those idiots. They didn't go to medical school, they didn't go to an anesthesiology residency and they're not an anesthesiologist. They are just taking advantage of the current personnel crunch to advance their agenda.

SMH at all the weak anesthesiologists that let these jokers do lines, blocks and tee. You let this happen. Physician only.

 

[deleted126335]

Good. Now ASA and professional societies need to grow some balls and follow suit.

Equally important- Employers of CRNAs need to do the same.

 

[coffeebythelake]

"Speaking of anesthesia politics,"

CRNAs are nurse anesthetists. That is what they are, this is what they are known as. No matter how much these militant nurses bitch and complain about it they aren't doctors and they aren't anesthesiologists. These nurses and their corrupt parent organization the AANA wants to gaslight the public by changing their name and calling themselves anesthesiologists, for no other reason than to obfuscate. To pretend to be real doctors without the real training. So these weak sauce nurses should grow up and stop portraying themselves with this victim complex when they are called out for being frauds

 

[secretasianman]

Mahla 2024. Also, I would let them walk if they want to, weeds out the non team players. And they being the most sensitive to any perceived slight would likely cause more trouble down the line. They can be like the antivax nurses who quit just because of "freedumb" or "muh beliefs." The public is served better if they just make themselves unhireable in the future.

 

[coffeebythelake]

Mahla 2024. Also, I would let them walk if they want to, weeds out the non team players. And they being the most sensitive to any perceived slight would likely cause more trouble down the line. They can be like the antivax nurses who quit just because of "freedumb" or "muh beliefs." The public is served better if they just make themselves unhireable in the future.

Agree. These nurses can go practice independently in bum**** nowhere

 

[ambiturner]

This was a refreshing read. It’s a dangerous move given how dependent academic groups have become on CRNAs, but best to do now before it gets any worse.

I wish the AANA would tone it down and feel bad for the crnas that aren’t militant and don’t actually support this stuff. But the AANA wouldn’t do this stuff if the less militant crnas told them to shut up, and every day they stay quiet they are complicit in the bickering too.

 

[Airway]

Good for him but did you read point 3? How long until board of nursing says you can call your self a nurse anesthesiologist etc.

 

[GassYous]

Good for him but did you read point 3? How long until board of nursing says you can call your self a nurse anesthesiologist etc.

That's the next step after getting "doctorates", becoming "board certified", american association of "nurse anesthesiology" etc. etc.

 

[DocMcCoy]

That's the next step after getting "doctorates", becoming "board certified", american association of "nurse anesthesiology" etc. etc.

And then drop the “nurse”

 

[deleted941485]

And then drop the “nurse”

I thought about gas as a potential field. There is so much tension on medicine I don't think I could deal with day to day colleagues that I am forced to work with believing deep down that not only can they do what I do but that they don't even really need me around and should just be called anesthesiologists themselves.

 

[DocMcCoy]

I thought about gas as a potential field. There is so much tension on medicine I don't think I could deal with day to day colleagues that I am forced to work with believing deep down that not only can they do what I do but that they don't even really need me around and should just be called anesthesiologists themselves.

Which sucks because gas itself is awesome. The politics not so much

 

[Lecithin5]

I thought about gas as a potential field. There is so much tension on medicine I don't think I could deal with day to day colleagues that I am forced to work with believing deep down that not only can they do what I do but that they don't even really need me around and should just be called anesthesiologists themselves.

Not only do they think they are as good, but that they are *better* (ie they have a ‘nurse’s touch’/compassion etc that us cold physicians don’t have)

 

[D P356]

Put bullet points 1-3 in future employment contracts.

 

[Neopolymath]

I thought about gas as a potential field. There is so much tension on medicine I don't think I could deal with day to day colleagues that I am forced to work with believing deep down that not only can they do what I do but that they don't even really need me around and should just be called anesthesiologists themselves.

Then add a sprinkling of ***** surgeons to the mix that largely dictate both your income and quality of work day as well...

 

[vector2]

Excellent letter. Here it is for sharing purposes without the idiotic CRNA response in red

 

[<(^_^)>]

I thought about gas as a potential field. There is so much tension on medicine I don't think I could deal with day to day colleagues that I am forced to work with believing deep down that not only can they do what I do but that they don't even really need me around and should just be called anesthesiologists themselves.

I can’t think of a field of medicine that doesn’t have less educated people claiming equivalence. Surgery has been most isolated, but rest assured, they’re coming for that too. It’s not a coincidence they’re co-opting a lot of the same terms such as “surgical residency” and “fellowship”. In some states there is nothing preventing PAs from performing surgery independently and in (rare) circumstances they actually do operate independently. Radiology “extenders” and AI continue to put pressure on productivity/justify further reimbursement cuts.

Bottom line is these issues effect everyone in medicine, and since physicians are so divided competing interests have gained a lot of ground. Hopefully there is pushback before it is too late.

 

[Planktonmd]

OK, I truly admire this chairman's courage and willingness to stick his neck out, but this is unfortunately going to be used against him and against the whole specialty as another proof that we are trying to limit their ability to function at the "top of their certification".
It's refreshing to see someone taking the heat for all of us when no one else is willing to do so, but he is just a department chairman and he is as replaceable as any one else.
The problem with this specialty is deeper than this, the problem is that many of us have come to this specialty precisely for the implied promise of getting away with doing minimal work while getting paid top dollars. These anesthesiologists are unfortunately everywhere now and they keep proliferating.
It's sadly too late to change this deplorable reality since even the new graduates now function and think like shift workers not like physicians.
This is not another doom and gloom opinion but my view of the current state of affairs in anesthesiology.
The fact that we have to fight nurses for turf is the ultimate proof of how miserable this specialty has become and how bleak the future of anesthesiology in the US is looking. I am happy that our colleagues in the rest of the world did not follow our footsteps and they kept this field of medicine alive.

 

[dabears505]

Live simple and save. 250k in 10 years for us.

 

[nimbus]

OK, I truly admire this chairman's courage and willingness to stick his neck out, but this is unfortunately going to be used against him and against the whole specialty as another proof that we are trying to limit their ability to function at the "top of their certification".
It's refreshing to see someone taking the heat for all of us when no one else is willing to do so, but he is just a department chairman and he is as replaceable as any one else.
The problem with this specialty is deeper than this, the problem is that many of us have come to this specialty precisely for the implied promise of getting away with doing minimal work while getting paid top dollars. These anesthesiologists are unfortunately everywhere now and they keep proliferating.
It's sadly too late to change this deplorable reality since even the new graduates now function and think like shift workers not like physicians.
This is not another doom and gloom opinion but my view of the current state of affairs in anesthesiology.
The fact that we have to fight nurses for turf is the ultimate proof of how miserable this specialty has become and how bleak the future of anesthesiology in the US is looking. I am happy that our colleagues in the rest of the world did not follow our footsteps and they kept this field of medicine alive.

I agree we largely did it to ourselves, more from greed than laziness. Some of us have been lucky enough (and it’s pure luck) to do our own cases for our entire careers. I haven’t worked with a CRNA in over 20 years. I have a friend who recently moved from CA to FL. He says he’s probably gonna just retire if he can’t adjust to the supervision pace. Totally different jobs. In his case, supervision is much busier and more intense. He says he doesn’t even have time to check his stocks during the day.

 

[Zekchar]

I agree we largely did it to ourselves, more from greed than laziness. Some of us have been lucky enough (and it’s pure luck) to do our own cases for our entire careers. I haven’t worked with a CRNA in over 20 years. I have a friend who recently moved from CA to FL. He says he’s probably gonna just retire if he can’t adjust to the supervision pace. Totally different jobs. In his case, supervision is much busier and more intense. He says he doesn’t even have time to check his stocks during the day.

It's less about the stocks. I know you say that tongue-in-check, but it also does nothing to move the discussion along. Just feeds into the perceived image of the lazy anesthesiologist.

It comes down to the practice of medicine, billing, and being a liability sponge. In doing 4:1 supervision, you cease to function as a physician. You are a fire-fighter that is there to put out "fires" and to absorb medical malpractice liability. Once you are capped out, you leave to go to the VA since your funds have been "exhausted."

In 4:1 supervision, you are essentially signing your name and lying because you cannot in good conscience argue that you are doing a thorough pre-op, obtaining proper consent, being present at induction, emergence, and immediately avilable. You are officially available, but in essence you are availing yourself to put out the most pressing fire.

You spend so much time in residency becoming a terrific anesthesiologist. Then you completed your training and watch 4 less-educated, less-caring, and less-qualified nurses do an inferior job. You watch and pray that nothing goes wrong or that you are able to run in and fix it when it does. Sometimes you salvage the situation. Other times the patient gets hurt. Then you hope and pray that injury didnt not happen to someone you care about. A sad state of affairs.

 

[MirrorTodd]

Excellent letter. Here it is for sharing purposes without the idiotic CRNA response in red


View attachment 345988

Thank you, I had trouble finding an unedited picture online.

 

[JDMcNugent]

Live simple and save. 250k in 10 years for us.

When people make these salary predictions, is this across the board for all anesthesiologists regardless if fellowship-trained or not (exclude chronic pain)?

 

[CHARLESTONMMM]

Live simple and save. 250k in 10 years for us.

No it will be $450k but at the same time floor nurses will make $175k and CRNAs will make $399k.

 

[Blockit]

dabears advice still rings true…inflation will decimate the value of that 450k.

 

[vector2]

You spend so much time in residency becoming a terrific anesthesiologist. Then you completed your training and watch 4 less-educated, less-caring, and less-qualified nurses do an inferior job. You watch and pray that nothing goes wrong or that you are able to run in and fix it when it does.

When I try to explain this to med students and tell them supervisory anesthesia isn't all that it's cracked up to be, and that if they do anesthesia then they should get an MD only job, they look at me like I just killed their puppy and then proceed to assume I'm exaggerating and/or lying.

 

[Neopolymath]

When I try to explain this to med students and tell them supervisory anesthesia isn't all that it's cracked up to be, and that if they do anesthesia then they should get an MD only job, they look at me like I just killed their puppy and then proceed to assume I'm exaggerating and/or lying.

Most med students are dweebs who have never had a job before. It's unsurprising and looking back at how dumb some of my classmates were outside of their ability to memorize a PowerPoint I can see why we as a profession are in this mess. We select for yes-man strivers, predominantly. This means they can't understand how medicine the career is different than medicine the training bubble of academia.

 

[Southpaw]

When I try to explain this to med students and tell them supervisory anesthesia isn't all that it's cracked up to be, and that if they do anesthesia then they should get an MD only job, they look at me like I just killed their puppy and then proceed to assume I'm exaggerating and/or lying.

This is because most med students who seriously consider anesthesia are lazy and entitled.

 

[Neopolymath]

This is because most med students who seriously consider anesthesia are lazy and entitled.

Eh, I don't know about that. It seems like most people pick anesthesia not because they are lazy but because other areas of medicine are terrible. It would be ideal for people to pick anesthesia because they actively love the field but if you aren't competitive for ophtho or ENT, do you really relinquish your life to the hell that is internal medicine just so somebody on the internet doesn't say you are a sellout?

Is that lazy???

 

[Urzuz]

When I try to explain this to med students and tell them supervisory anesthesia isn't all that it's cracked up to be, and that if they do anesthesia then they should get an MD only job, they look at me like I just killed their puppy and then proceed to assume I'm exaggerating and/or lying.

To this day I'll never understand why anyone would actively seek out a supervisory role except for the $$$. Why go through all that training if you actively dislike doing the job? Either that or they're incompetent and want to hide in the shadows while collecting a paycheck.

 

[Neopolymath]

To this day I'll never understand why anyone would actively seek out a supervisory role except for the $$$. Why go through all that training if you actively dislike doing the job? Either that or they're incompetent and want to hide in the shadows while collecting a paycheck.

Probably want to live in a place already solely offering supervision jobs so they just bite the bullet.

 

[Neopolymath]

And then these same people become “leaders” in academic medicine who outcast those who aren’t “yes men.” Medicine is ran by weak, incompetent people.

It's basically politics in a nutshell. Largely, anyone who would be a good politician or teacher (in medicine) is already busy doing something productive with their lives so the only people filling these positions are morally bankrupt or incompetent or both.

 

[nimbus]

Its basically politics in a nutshell. Largely, anyone who would be a good politician or teacher (in medicine) is already busy doing something productive with their lives so the only people filling these positions are morally bankrupt or incompetent or both.

I’ve seen this first hand. One of the most miserable, below average surgeons I ever worked with once ran for Congress. At the time, he actually told me one of the reasons he was running was because of the lifetime pension.

 

[deleted126335]

OK, I truly admire this chairman's courage and willingness to stick his neck out, but this is unfortunately going to be used against him and against the whole specialty as another proof that we are trying to limit their ability to function at the "top of their certification".
It's refreshing to see someone taking the heat for all of us when no one else is willing to do so, but he is just a department chairman and he is as replaceable as any one else.
The problem with this specialty is deeper than this, the problem is that many of us have come to this specialty precisely for the implied promise of getting away with doing minimal work while getting paid top dollars. These anesthesiologists are unfortunately everywhere now and they keep proliferating.
It's sadly too late to change this deplorable reality since even the new graduates now function and think like shift workers not like physicians.
This is not another doom and gloom opinion but my view of the current state of affairs in anesthesiology.
The fact that we have to fight nurses for turf is the ultimate proof of how miserable this specialty has become and how bleak the future of anesthesiology in the US is looking. I am happy that our colleagues in the rest of the world did not follow our footsteps and they kept this field of medicine alive.

Does anybody know how this was received @jefferson?

 

[IMGASMD]

Does anybody know how this was received @jefferson?

This guy has gigantic balls!! Thanks Dr. Mahla.

Not sure about Jefferson. Found this.

From PSA

“PSA received a report from a hospital in the Commonwealth of Pennsylvania that CRNAs are holding themselves out as nurse anesthesiologists and have mentioned starting a department of nurse anesthesiologists. PSA believes CRNA’s may not use the title “nurse anesthesiologist” based on Section 3 of Act 60 of 2021.

This is a serious issue because it means CRNAs are classifying themselves as physicians. PSA members may consider reporting Act 60 title violations to the State Board of Medicine.

Please let us know if this action has occurred in your hospital or facility. PSA will help guide you on the proper legal action to take to stop this flagrant violation.”

 

[gasguy]

I actually really enjoyed supervising in my old practice. It was mostly 3:1, but sometimes 4:1 either in the outpatient area of the hospital or our ASC. I do my own cases now which I also love, but I do sometimes miss the “hustle” of supervision. We had a really collegial group of MDs, CRNAs, and AAs. As usual, there were occasional bad apples or less competent midlevels, but we would just schedule them appropriately and it was typically fine. It was honesty quite a bit less boring than sitting my own cases.

 

[BLADEMDA]

No it will be $450k but at the same time floor nurses will make $175k and CRNAs will make $399k.

$400K will be the $250K in just a few years. CRNAs are now at $200K-$210K plus benefits for 40 hours per week. At 50 hours per week many are pulling in $275K+. Hence, I fully expect salaries to stay in the $400K range but be eaten up by Inflation. It isn't the salary that is the big issue it is the fact that anesthesia nurses are more than keeping up with inflation while Anesthesiologists are struggling to do the same. Recently, the market has adjusted upwards for the first time in 5 years. Now, if the job doesn't pay $400k+ the new recruit will seek employment elsewhere. AMCs have kept salaries low by NOT giving raises; that situation changed this year for the better.

 

[deleted126335]

$400K will be the $250K in just a few years. CRNAs are now at $200K-$210K plus benefits for 40 hours per week. At 50 hours per week many are pulling in $275K+. Hence, I fully expect salaries to stay in the $400K range but be eaten up by Inflation. It isn't the salary that is the big issue it is the fact that anesthesia nurses are more than keeping up with inflation while Anesthesiologists are struggling to do the same. Recently, the market has adjusted upwards for the first time in 5 years. Now, if the job doesn't pay $400k+ the new recruit will seek employment elsewhere. AMCs have kept salaries low by NOT giving raises; that situation changed this year for the better.

Agree. I also think that ratio of the hourly rate for a doc to a CRNA will continue to decline.

 

[IlDestriero]

I’ve seen this first hand. One of the most miserable, below average surgeons I ever worked with once ran for Congress. At the time, he actually told me one of the reasons he was running was because of the lifetime pension.

Smart guy!

 

[secretasianman]

$400K will be the $250K in just a few years. CRNAs are now at $200K-$210K plus benefits for 40 hours per week. At 50 hours per week many are pulling in $275K+. Hence, I fully expect salaries to stay in the $400K range but be eaten up by Inflation. It isn't the salary that is the big issue it is the fact that anesthesia nurses are more than keeping up with inflation while Anesthesiologists are struggling to do the same. Recently, the market has adjusted upwards for the first time in 5 years. Now, if the job doesn't pay $400k+ the new recruit will seek employment elsewhere. AMCs have kept salaries low by NOT giving raises; that situation changed this year for the better.

Actually they are at least $240k+ now with sign on bonus being common. Not cheap.

 

[GassYous]

Actually they are at least $240k+ now with sign on bonus being common. Not cheap.

Whoaa

 

[deleted941485]

Whoaa

Keep in mind Jeff pays its hospitalists 200K and many of its Clinic based non procedural specialties are in the same boat 200-300 range.

 

[6svette]

Keep in mind Jeff pays its hospitalists 200K and many of its Clinic based non procedural specialties are in the same boat 200-300 range.

What about anesthesiologists?

 

[deleted941485]

What about anesthesiologists?

I just get my info from Glassdoor like everyone else. The point I was trying to illustrate that at this point why even pretend to be a doctor?

 

[coffeebythelake]

I just get my info from Glassdoor like everyone else. The point I was trying to illustrate that at this point why even pretend to be a doctor?

Ego

 

[deleted126335]

I just get my info from Glassdoor like everyone else. The point I was trying to illustrate that at this point why even pretend to be a doctor?

Because it actually does matter.

 

[deleted941485]

Because it actually does matter.

Jeff Glassdoor

MDA - 274K (Nov 2021)
Hospitalist - 177K-240K (Nov 2021)

If you are a CRNA in Philadelphia your making 170-250K +/- overtime per gaswork. Plus you know some of these people are calling in sick and have second gigs too.