Disturbing article in TIME mag

[MissMDUniverse]

http://www.time.com/time/magazine/article/0,9171,1531329,00.html

The article is entitled, "Who's Putting You Under"...have any of you guys read this? I'm worried that only 45% of cases requiring sedation, etc. are being handled by anesthesiologists. And some of my attendings are warning me that anesthesiology will eventually become obsolete as technological advances lead to fewer and fewer intrusive surgical procedures. Will the need for our expertise be utimately eliminated by CRNs and/or medical advances?? Will we have jobs 10 -15 years from now? I'm writing this because I'm contemplating a change in career...I may just become a stripper and forget this whole doctor gig. Just kidding of course...or am I?

-MissMDUniverse

---

Members don't see this ad.

 

[UTSouthwestern]

Dewey defeats Truman!!!

 

[Bertelman]

 

[cfdavid]

http://www.time.com/time/magazine/article/0,9171,1531329,00.html

The article is entitled, "Who's Putting You Under"...have any of you guys read this? I'm worried that only 45% of cases requiring sedation, etc. are being handled by anesthesiologists. And some of my attendings are warning me that anesthesiology will eventually become obsolete as technological advances lead to fewer and fewer intrusive surgical procedures. Will the need for our expertise be utimately eliminated by CRNs and/or medical advances?? Will we have jobs 10 -15 years from now? I'm writing this because I'm contemplating a change in career...I may just become a stripper and forget this whole doctor gig. Just kidding of course...or am I?

-MissMDUniverse

We must have gotten opposite messages from the same article. I read that as a big positive towards the field of anesthesia.

1) They gave the floor to anesthesiologists
2) They mentioned the ever increasing roles of that of an anesthesiologist
3) They pointed out the reasons for having very skilled people administer the drugs.

What else did you want to hear?

 

[aredoubleyou]

I'm worried that only 45% of cases requiring sedation, etc. are being handled by anesthesiologists. And some of my attendings are warning me that anesthesiology will eventually become obsolete as technological advances lead to fewer and fewer intrusive surgical procedures. Will the need for our expertise be utimately eliminated by CRNs and/or medical advances?? Will we have jobs 10 -15 years from now?

-MissMDUniverse

There will always be a need general practitioners...have fun!

 

[LostTommyGuns]

Since I can't tell if you're serious or not:
Let's not forget this is from Time magazine, not world renowned for its accuracy. Besides there are a couple of key points that the casual glance might gloss over:

- Enormous increase in less drastic procedures (So what? This means nothing to Anesthesiology)
- Stories of people dying from Midazolam administration further the notion that trained professionals are important.
- There has been a dramatic increase in total quantity of surgeries, since there has not been a magical rise in Anesthesiologists, physicians have come up with ways around having to have an Anesthesiologist present (again this deals with minor cases)
- It's a "rough guess" that 45% of sedation is handled by non-Anesthesiologists. I'll hazard a "rough guess" that salaries will increase by 45% in the next 4-5 years. (Yeah... random statistics that people refer to as rough guesses are exactly that.)

 

[flowerss]

I was just talking with a fourth year resident in Anesthesia and we talked about the future of anesthesia. The big question I have is "Autonomy". Do CRNA's have it and will they get it. I am not being disrespectful or mean I just want to know. The resident stated that if they recieved autonomy there would be war. I too worry about the future at times and want to know what others think. All thoughts on the subject would be welcomed. Any other information for good discussion is welcomed.

 

[LostTommyGuns]

My thoughts are thusly: Ask 10 average patients whether they want to have a doctor knock them out or a nurse - I think you'll find your answer.

 

[MacGyver]

My thoughts are thusly: Ask 10 average patients whether they want to have a doctor knock them out or a nurse - I think you'll find your answer.

The more relevant question is:

1) Do patients make surgical decisions based on who is delivering anesthesia?

The answer to that is a resounding NO. People choose surgeries based on who the surgeon is, not who is running the gas. They could care less about that.

 

[LostTommyGuns]

I agree with you that people pick Surgeons more stringently than Anesthesiologists. My point though was whether Anesthesiology as a profession will be eliminated by technology and paraprofessionals and I think the answer is no. Until the word "doctor" holds little or no weight Anesthesiology will continue to be an important profession.

In this field and others I've seen patients tell medical students and residents that they want to see "the real doctor". I've seen them ask for Anesthesiologists instead of CRNAs. Don't underestimate the power of the MD

 

[chicamedica]

I was just talking to a current IM resident who finished med school in Great Britain. He had actually spent a year in anesthesiology residency in GB and switched to IM because he found anesthesiology to be excruciatingly boring. I think part of the issue was that in GB there are no CRNAs to do the bread and butter cases. There and in the rest of Europe, anesthesiology historically has been only a physician's realm (as opposed to the US where in the "cowboy days", nurses and med students were initially the anesthesia providers). The good part of having CRNAs around is to give residents (even CA-1s) the opportunity to train on more interesting & nonroutine cases with potentially unstable patients. It's ironic that usually the most knowledgeable, experienced and mature CRNAs are the ones usually who are not as aggressive about taking over the entire field--i guess maybe not so surprising cause they realize the full scope of anesthesiology and have more insight into potential complications.

I fully agree that the more anesthesiology becomes grounded in scientific/molecular theory and becomes less "empiric" the more it will have to be a physician's field. I am not concerned at all. If the CRNAs want autonomy to do the bread and butter cases, it's fine with me. That'll give me more time in the lab or with the transplant cases or in the ICU. However, CRNA or MD, supervision is never a bad thing, and even routine can become complicated.

 

[chicamedica]

The more relevant question is:

1) Do patients make surgical decisions based on who is delivering anesthesia?

The answer to that is a resounding NO. People choose surgeries based on who the surgeon is, not who is running the gas. They could care less about that.

I disagree with the last statement. Some people dont really give a 2nd thought to who will be running the anesthesia because they dont know that it could potentially not be a doctor. Those who are aware of this possibility DO care. . .a LOT. General anesthesia is a scary scary thought to a lot of people (including me. . .and i'm going into the field). I remember as a kid getting a tonsillectomy, the prospect of anesthesia scared me much more than the actual surgery, and I am far from alone in this feeling as i witnessed many times on my anesthesiology rotations. With anesthesiology being a behind-the-scenes field, it's true, patients dont usually specifically pick out anesthesiologists to put them to sleep, HOWEVER, often surgeons pick out certain anesthesiologists who they want to work with. So, when a patient chooses a specific surgeon they are really choosing a surgeon/anesthesiologist team.

 

[canavarim]

Man , believe me , even if that happen in any point in time ...
then the expected significant increase in mortality will make the surgeons take over the war for us ...
do u think surgeons will accept to do their cases without anesthesiologists around ???
believe me , we have other problems to worry about , this is low in the list...

 

[LostTommyGuns]

I think chica and and canavarim make very good points. Medicine like most other fields is very cyclical. Each field has its high points and low points be it malpractice, a baby boom, increasing technology, media scare tactics or dozens of other factors.

In the same way that it is difficult to predict what the weather will be like in 10 days it is difficult to say where any profession might be in 5-10 years. However I can be fairly confident that there WILL be weather in 10 days I feel confident that their will be Anesthesiologists providing care for patients.

 

[SleepIsGood]

Few points

1)Is the threat of CRNAs real? Well not that TIME magazine is 'scientific' at all, but you all did see the part in which the plastic surgeon used his girlfriend to administer anesthesia. Now using someone's gf is probably a rare, extreme case scenario. But let's keep in mind, more and more surgeons are starting to use CRNAs. They're cheaper! Infact, a PGY4 surgery resident told me this just this year. I think more and more, surgery residents are being told CRNAs=Anesthesiologists and are cheaper. Remember, what these guys are told in residency is probably what they'll latch on to as attendings.

For the run of the mill breast implant and other cosmetic surgeries or even minor elective procedures, surgeons want to offer a 'competitive' price. How do they do that? Knock out the anesthesiologist and pay a nominal fee for the CRNA. Dont believe me? Look through some of the threads on here, I think MilMD and some others commented on this. It's scary.

2) Yes, procedures are becoming more less and less invasive, resulting in less "general anesthesia". I worked with a pretty well to do ENT surgeon. VERY successful guy who attracted a lot of clients to his office. What was one of his 'catch' phrases? Essentially, "with my minimally invasive procedure, you can have procedure X performed in the office without the risks associated with Anesthesia". You better believe it. Most ppl are scared, as chica mentioned she was as a child, of anesthesia. Surgeons are more and more trying to be less invasive and use 'local' more often. Heard of Pillar Implants? Typically theses were done in the OR, I've seen more of them being performed in the outpt setting.

Scary stuff certainly for us. Again, I think sitting back on this issue is definitely not productive. WE, are the future of anesthesiology. Realistically, individuals say >40 yrs of age in our field are likely well established already. All of us younger physicians will unfortunately feel the greatest impact if we aren't proactive about this.

 

[LostTommyGuns]

Perhaps we need to go back to the days when Anesthesiology was more dangerous - that would bring the people back to us... There's a certain truth in that as well, the fact that we have made Anesthesia so safe over the past few decades makes what we do look easier.

Another question that has to be answered is how else would you deal with the increased quantity of surgeries? If you have the same number of Anes. and more surgeries, it makes staffing them very difficult and the production and usage of CRNAs increases. That doesn't make it good or bad just true.

I think Sleep's point that being proactive is smart is totally reasonable. Proper planning prevents poor performance sounds like an applicable motto. The question is what IS the next step? The truth is this issue doesn't scare me a whole lot and I'm pretty good at seeing things for what they are but I'd be a fool to not hedge my bets

Lead on Sleep.

 

[Gern Blansten]

The more relevant question is:

1) Do patients make surgical decisions based on who is delivering anesthesia?

The answer to that is a resounding NO. People choose surgeries based on who the surgeon is, not who is running the gas. They could care less about that.

The real answer is that patients that have a working knowledge of how the system works absolutely try to choose their anesthesia provider. If you were having surgery, and you knew which anesthesiologists you thought were good or bad, do you think you would have an opinion? In most situations, the lay public is not aware they have a choice in who delivers their anesthetic. Often, there is not a mechanism in place to allow a choice. The truth is, the lay public has no idea how good surgeons really are and base a lot of their decisions on word of mouth and reputation. I have seen people brag on how good a surgeon is when all of that surgeon's colleagues think they are terrible. They know about as much about how to choose a surgeon or anesthesiologist as I do about how to choose a mechanic.
BTW, I believe the phrase, "could care less" states the opposite of your intended meaning and I am not sure what "running the gas" means, but it comes across derogatory.

 

[SleepIsGood]

..... In most situations, the lay public is not aware they have a choice in who delivers their anesthetic. Often, there is not a mechanism in place to allow a choice. The truth is, the lay public has no idea how good surgeons really are and base a lot of their decisions on word of mouth and reputation. I have seen people brag on how good a surgeon is when all of that surgeon's colleagues think they are terrible. They know about as much about how to choose a surgeon or anesthesiologist as I do about how to choose a mechanic.
BTW, I believe the phrase, "could care less" states the opposite of your intended meaning and I am not sure what "running the gas" means, but it comes across derogatory.

Gern I think you are absolutely right. I know that in my experiences so far the surgeons that are known to be the 'best' are indeed seen by their collegues to be the worst (ie when they're on consult in the hosp they will not call back, or if they do they will refer the pt to another service). The lay public perceives who the 'best' is by reading magazines in their hometown. We all have seen these magazine front covers with, "City X's Top Doctors" etc glorified in the front. For the most part, these "Top Doctors" are on those covers because they were 1)politically connected 2) knew how to sell themselves or 3) are really good. I think for the most part it's because they are both #1 or #2 that they get on those mags.

Absolutely right. Hopefully, this TIME article will increase the public interest in asking for an Anesthesiologist. Nevertheless, we all know that CRNAs will likely be able to fly under the radar by calling themselves "anesthesist" which to the lay public is the same thing. Perhaps TIME needs to publish a new article on this issue. Bottom line, we can moan and groan about the fact that TIME is not a 'scientific' journal, but unfortunately that's the sort of literature the public reads and that's how they get their info.

 

[BIS]

Bottom line there is no place in this coutry that CRNA's are taking jobs from Anesthesiologists. In my city there are many jobs for both. The MD's are begging us as CRNA students to work for them. Things are good and for the most past salaries and job prospects look pretty good here for both. Work is plentiful, overtime is abundant and everyone in making money. Lets just lobby together for once and try to stop the decreases in reimburstment.