doom and gloom for anesthesiology? Maybe not....

[Mman]

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every time I read a post about the future of the specialty, I am remember that these discussions have been going on for decades.

is the future really that bleak? (ether thought we'd be getting paid $250K to supervise 7:1 by now)

 

[Consigliere]

Im routinely doing 4-6 level fusions on patients with multiple problems, 400 pounders with bad airways, busy oral surgery svc who have frx jaws as their bread/butter they are getting their mouth wired shut.. CRNAs who routinely giving too much opiates.. try doin that 15x per day and letting the crnas dictate your plan..
The endos i do are all bleeders with hemoglobins in the 4-6 range who are still actively bleeding.
this is in addition to the other rooms i do.

Dude your job sucks.

 

[narcotics999]

Im routinely doing 4-6 level fusions on patients with multiple problems, 400 pounders with bad airways, busy oral surgery svc who have frx jaws as their bread/butter they are getting their mouth wired shut.. CRNAs who routinely giving too much opiates.. try doin that 15x per day and letting the crnas dictate your plan..
The endos i do are all bleeders with hemoglobins in the 4-6 range who are still actively bleeding.
this is in addition to the other rooms i do.

How much are you paid for that? A million?

 

[chocomorsel]

I hate supervising. I hate call. I hate it all.
I need to retire.

 

[deleted50478]

every time I read a post about the future of the specialty, I am remember that these discussions have been going on for decades.

is the future really that bleak? (ether thought we'd be getting paid $250K to supervise 7:1 by now)

How much corporate practice of medicine resulting from selling out to private equity carpetbaggers was there in the 90s?

 

[Consigliere]

I hate supervising. I hate call. I hate it all.
I need to retire.

There's a support group for that - it's called everybody. They meet at the bar Friday night. See you there!

 

[Mman]

How much corporate practice of medicine resulting from selling out to private equity carpetbaggers was there in the 90s?

I was still in college back then so I have no idea, I do know that for decades the doom and gloom predictions of future salary and work conditions have always ended up being overly pessimistic. And my older colleagues confirm that the doom and gloom talk has been around as far back as the 1970s.

 

[deleted171991]

I was still in college back then so I have no idea, I do know that for decades the doom and gloom predictions of future salary and work conditions have always ended up being overly pessimistic. And my older colleagues confirm that the doom and gloom talk has been around as far back as the 1970s.

And a good part of it has come true. Big Health is here to stay. 30-40% of healthcare employees are now useless parasitic bean counters, sucking the blood of hard-working physicians, due to all the regulations and red tape created with the explicit purpose of destroying independent physician practices and small hospitals. That's why healthcare costs are so high, because of all these parasitic middlemen, whether hospital systems, insurance companies or management corporations. It's a racket.

It's ridiculous that a professional (or a group of professionals) cannot survive independently, in 2019, because of all the sweetheart deals these regionally monopolistic big corporations have, with all the corrupt and bought politicians just watching and doing nothing, except inventing more regulations. This has been ongoing at least since the 80's. The CRNA/midlevel scourge has been just the frosting on the cake, just another symptom of the LBO era in healthcare. And the big defender of the American workers is sitting on his small hands in the White House, doing nothing to reverse the trend.

 

[Mman]

And a good part of it has come true. Big Health is here to stay. 30-40% of healthcare employees are now useless parasitic bean counters, sucking the blood of hard-working physicians, due to all the regulations and red tape created with the explicit purpose of destroying independent physician practices and small hospitals. That's why healthcare costs are so high, because of all these parasitic middlemen, whether hospital systems, insurance companies or management corporations. It's a racket.

It's ridiculous that a professional (or a group of professionals) cannot survive independently, in 2019, because of all the sweetheart deals these regionally monopolistic big corporations have, with all the corrupt and bought politicians just watching and doing nothing, except inventing more regulations. This has been ongoing at least since the 80's. The CRNA/midlevel scourge has been just the frosting on the cake, just another symptom of the LBO era in healthcare. And the big defender of the American workers is sitting on his small hands in the White House, doing nothing to reverse the trend.

and yet despite all that, salaries are still higher than imagined and supervision ratios have not budged and work hours are not worse

 

[deleted126335]

and yet despite all that, salaries are still higher than imagined and supervision ratios have not budged and work hours are not worse

For many of us these metrics have all changed for the worse.

 

[Laryngophed]

Not to mention that a great many patients are extubated every day in ICUs without physician immediate presence.

Sometimes it’s even intentional.

 

[Mman]

For many of us these metrics have all changed for the worse.

if you are earning less than $200K per year, I'd be amazed. And the percentage of docs supervising at a > 4:1 ratio is miniscule.

 

[deleted875186]

Large academic institution on the east coast settled with a very large payout for a post op kid who larygospasmed and developed NPPP and anoxic brain injury after a nurse extubated post T&A.

Is this a place that routinely brings kids to the PACU intubated for the PACU nurse tk extubate, or was it just someone with delayed emergence brought to the PACU?

 

[deleted126335]

if you are earning less than $200K per year, I'd be amazed. And the percentage of docs supervising at a > 4:1 ratio is miniscule.

Hourly rates are down for many.
Supervisory ratios are up. Lots of practices are routinely 1:3-1:4 (including mine) all day when they would only hit that for terminal rooms a decade ago.

 

[nimbus]

Hourly rates are down for many.
Supervisory ratios are up. Lots of practices are routinely 1:3-1:4 (including mine) all day when they would only hit that for terminal rooms a decade ago.

In your case is this driven by an AMC?

 

[jwk]

Hourly rates are down for many.
Supervisory ratios are up. Lots of practices are routinely 1:3-1:4 (including mine) all day when they would only hit that for terminal rooms a decade ago.

1:3 and 1:4 is perfectly manageable with the right planning and mix of cases. We do it every day, and have been for all of the nearly 40 years I've been in practice, even before the maximum ratios were mandated.

 

[BLADEMDA]

There is a BIG difference between 1:3 and 1:4 coverage. The former is "reasonable" while the latter pretty much sucks over a long career. Of course, the money generated from 1:4 is significantly better for the company. I'm not sure it's worth it though because the burnout factor is much higher at 1:4 which may shorten your career. I use the word "may" because just like everything in life there are outliers who can handle this stress much better vs. his/her colleagues for 4+ decades.

I did it for many years and honestly can't say that type of coverage makes for a better work day than just doing your own room/cases.

 

[kidthor]

FWIW I do 1:3 coverage sometimes in an optho outpatient center (I'm in ivory tower academia). It's a mix of mostly sedation but with some GA - patients are usually very sick adults. I did 1:4 once there and it was almost untenable. 1:3 is annoying, but I can manage it...

Each room typically has 6-12ish cases. My day's pay for this is $1100. The overlords take a lot off the top.

 

[dhb]

The overlords take a lot off the top.

Huge understatement
I make that for one room

 

[dannyboy1]

Like everything in life, it depends. My shop has a lot of routine cases on healthy people. Covering 1:4 is no big deal when 2 of your cases are long plastics cases are on healthy patients. Another room of robotic gyn stuff and maybe sedation cases in Cath lab. That’s my usual day and it’s pretty easy. Of course in anything funny is going on in one of my rooms the other rooms will be ignored.....
But I work with CRNAs that are reasonably competent.....

 

[dannyboy1]

FWIW I do 1:3 coverage sometimes in an optho outpatient center (I'm in ivory tower academia). It's a mix of mostly sedation but with some GA - patients are usually very sick adults. I did 1:4 once there and it was almost untenable. 1:3 is annoying, but I can manage it...

Each room typically has 6-12ish cases. My day's pay for this is $1100. The overlords take a lot off the top.

How long is your day. I hope you are leaving at noon or you are getting screwed...

 

[PieOHmy]

Both ENT and Anesthesia were served.

Seriously, what kinda ***wipe do you have to be to think that you shouldnt be there for extubation or even worse leaving a kid post t a in the pacu and let the pacu nurse extubate. do you know what a nurses criteria for extubation in the pacu, he is bucking.

 

[pgg]

1:3 and 1:4 is perfectly manageable with the right planning and mix of cases. We do it every day, and have been for all of the nearly 40 years I've been in practice, even before the maximum ratios were mandated.

Whether or not it's "manageable" isn't the issue. It's still miserable **** work to have to supervise. Money may make it tolerable. It's still miserable having to keep tabs on 4 people who may or may not be good at their jobs.

You're an AA, not an anesthesiologist. Of course your job is great. You do one patient at a time and there's always a physician there to help. Now imagine 3 of your colleagues are terrible militant occasionally dangerous hacks who are proud members and $ donors to an organization dedicated to the deliberate destruction of their supervisory safety net? How would you like to "manage" that flock of seagulls?

 

[Rich91]

I looked around to see if anyone else posted this. I couldn't find it - so sorry if it is a re-post.

https://www.anesthesiologynews.com/PRN-/Article/07-18/Looming-Anesthesiologist-Shortage-Fuels-High-Market-Demand/55607

Anesthiologist shortage, engineer shortage, all mean the same thing, there's a shortage of DocA's willing to take insulting offers creating a shortage

 

[anbuitachi]

Both ENT and Anesthesia were served.

Did the nurse extubate the patient without ENT/anes telling nurse to? or was it a planned nurse extubation?

Either way, i agree with many of above posters. it's still doom and gloom. it just means more work and same pay for many of us who are just cogs. even if there is profit, the higher ups, business peeps, administrators get it, not us unless maybe private practice.

Besides, if medicare for all passes, and/or out of network bill passes, we are screwed, even if we are in 'demand'

 

[anbuitachi]

I was still in college back then so I have no idea, I do know that for decades the doom and gloom predictions of future salary and work conditions have always ended up being overly pessimistic. And my older colleagues confirm that the doom and gloom talk has been around as far back as the 1970s.

and yet despite all that, salaries are still higher than imagined and supervision ratios have not budged and work hours are not worse

For many of us these metrics have all changed for the worse.

Hourly rates are down for many.
Supervisory ratios are up. Lots of practices are routinely 1:3-1:4 (including mine) all day when they would only hit that for terminal rooms a decade ago.

I'm not that old so i dont know how true it is, but was talking to colleague in his 60s, and he said it's not a good time to be starting my anesthesiology career. He said in he started in the 1980s and was making 1m a year working the same amount. 1980s! because of that now he has many properties but he said because salary dropped so much he could no longer afford the same lifestyle. So it sounds like according to him, not only did salary not keep up with inflation it actually SIGNIFICANTLY decreased by >>50%. so i guess to him, the doom and gloom is happening, and he believes will only get worse.


Also funny thing is i work in an academic center covering no more than 2 rooms at a time (resident or CRNA). Work about 50s hours a week, I found out that the CRNA i supervise who work same number of hours as i do, make the same as i do! except i get all the liability

 

[sevoflurane]

Did the nurse extubate the patient without ENT/anes telling nurse to? or was it a planned nurse extubation?

Either way, i agree with many of above posters. it's still doom and gloom. it just means more work and same pay for many of us who are just cogs. even if there is profit, the higher ups, business peeps, administrators get it, not us unless maybe private practice.

Besides, if medicare for all passes, and/or out of network bill passes, we are screwed, even if we are in 'demand'

I don’t remember. I think an attending was giving a break and a code was called in pacu after extubation. Delayed resuscitation if I remember correctly. This was 10+ years ago.

 

[sevoflurane]

Besides, if medicare for all passes, and/or out of network bill passes, we are screwed, even if we are in 'demand'

This is one plausible reason to sell IMO.

Risk transfer.

 

[PieOHmy]

, I found out that the CRNA i supervise who work same number of hours as i do, make the same as i do! except i get all the liability

If that is true... are you still working there?

 

[Mman]

I'm not that old so i dont know how true it is, but was talking to colleague in his 60s, and he said it's not a good time to be starting my anesthesiology career. He said in he started in the 1980s and was making 1m a year working the same amount. 1980s! because of that now he has many properties but he said because salary dropped so much he could no longer afford the same lifestyle. So it sounds like according to him, not only did salary not keep up with inflation it actually SIGNIFICANTLY decreased by >>50%. so i guess to him, the doom and gloom is happening, and he believes will only get worse.

Medicine in the 1980s was unhinged from reality and people got mega rich. Medicare balance billing and insane rates for insured patients meant people were getting PAID. Cataract surgeons used to get $2000-3000 per eye. Do the math on that for 20 cases a day several days a week.

 

[radsisrad]

Medicine in the 1980s was unhinged from reality and people got mega rich. Medicare balance billing and insane rates for insured patients meant people were getting PAID. Cataract surgeons used to get $2000-3000 per eye. Do the math on that for 20 cases a day several days a week.

20 cases a day? Cataracts used to take far longer than they do now - even if you assume 30 minutes per eye, you still need to factor in clinic f/u for the cat patients.

All said, though, ophtho was a money-mill.

 

[Mman]

20 cases a day? Cataracts used to take far longer than they do now - even if you assume 30 minutes per eye, you still need to factor in clinic f/u for the cat patients.

All said, though, ophtho was a money-mill.

Sure, now you can do 40 cases a day.

 

[anbuitachi]

If that is true... are you still working there?

Yes, i found out this week ! And also its a friendly group. But for some reason hospital pays the CRNAs a lot and us not a lot (but still >25% on MGMA for region)

 

[PieOHmy]

Yes, i found out this week ! And also its a friendly group. But for some reason hospital pays the CRNAs a lot and us not a lot (but still >25% on MGMA for region)

Let me understand you. CRNAS are making MORE MONEY than you. Cumulatively, not just per hour basis.

 

[VA Hopeful Dr]

Sure, now you can do 40 cases a day.

Yep. Pre-phaco it would take up to an hour. Now it's more like 10-15 minutes. Ophthalmologist I worked for in college early 2000s did around 30/day two days per week.

And those post-op visits took maybe 10 minutes, scheduled 3 of them total.