Employment options for anesthesiologists

Discussion in 'Anesthesiology' started by scutdoc, 09.27.14.

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  1. scutdoc

    scutdoc ASA Member 2+ Year Member

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    Apologies if the following is an ignorant or dumb question. I just thought it might be helpful for med students like me who are considering anesthesiology so we can have a lay of the land for what to expect beyond residency and thus head into anesthesiology with our eyes as wide open as possible if we do choose to go this route. Basically, I'm wondering if what I've written below about employment options for new anesthesiologists is more or less accurate please?

    My understanding is anesthesiologists have five main employment options (in no particular order):

    1) Locums
    2) Private Practice
    3) Hospital
    4) AMC
    5) Academia

    All of these can have varying degrees of good and/or bad depending on what a person values and prioritizes in their life.

    I would think for most people locums aren't usually ideal mainly because they're temporary. That said, perhaps locums can be tacked on as supplementary rather than primary income.

    Many if not most anesthesiologists would presumably prefer to be a partner in private practice. But this is apparently becoming increasingly rare, and an increasing number of private practices are no longer hiring people for partnership tracks but only as employees. There are still private practices with a fair and reasonable path to partnership out there, but again they're decreasing, and perhaps rapidly decreasing, and most of these good ones are available in "undesirable" locales (though this is somewhat subjective since many people may prefer to live in these areas).

    However, if an anesthesiologist works for a hospital, AMC, university, or evidently an increasing number of private practices, then they will be an employee of the hospital, company, university, or group.

    If all this is true, and nothing changes like private practices for whatever reason(s) decide to start hiring people for partnership tracks again, then fundamentally speaking it looks like the future for anesthesiologists is going to be mainly as employees.

    Of course, employment as an employee can differ significantly from employer to employer. Some groups, hospitals, universities, or AMCs may pay a fair and reasonable salary for work done, others not so much. It's a bit hard to generalize.

    But if we had to generalize, then it looks like $250-$350K per year (before taxes) for 60-65 hours per week of work (on average) plus call roughly once per week is what a newly minted anesthesiologist can expect to make as an employee of a hospital, AMC, university, or many private practices.​

    Is this about right? Or am I way off?

    Thanks in advance.
     
    Last edited: 09.27.14
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  3. gasdoc77

    gasdoc77 2+ Year Member

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    I have worked in all of the aforementioned models except locums. You pretty much summed up the options. That being said, there is one major factor that warrants consideration. In a private practice, you are in some ways a maker of market forces. In every other model, you are completely subject to market forces with little to no recourse. Why does this matter? As the government tries to increase "access", they continue to expand the scope of practice of midlevels. The free market will encourage all providers to practice to the full extent that is allowed. If midlevels are granted the full scope of anesthesiologists (as has happened in some states), than the collaborative model is going to become a real threat. At that point, it is only a matter of time before employed (read "non-partner") MD's will be considered expensive compared to other providers. The CRNA floodgates are open and the oversupply will continue to put downward pressure on their wages, making that gap even greater. At least as a partner, you will have as much security as the guy next to you. In such a case, as people retire, you can slowly adapt your model if necessary but the cuts will be spread evenly across the group. Unfortunately, you will find that patient care is not a consideration of institutions. They feel that the liability will rest with the physicians, or whatever provider that CMS considers adequate. Beyond that, it's all about the bottom line and they fully recognize staff as their biggest expense.
     
  4. BuzzPhreed

    BuzzPhreed

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    This is okay. The anesthesiologists just have to not be there to bail them out if they get into trouble. Eventually there will be enough sentinel events in those practices that it will no longer be an issue. Even the near misses will get noticed. Surgeons will complain, etc.

    The problem now is when the midlevel gets in trouble they call us and we bail them out. If we aren't there, they will have to then call one of their other non-physician colleagues. Nurses eat their young. It's inherent in their profession. When enough senior CRNAs get called to bail out the junior ones, they'll get a taste of what we go through. The difference is that the junior CRNAs will not be protected like they are now. They will be skewered.

    The key to this is just turning them loose. I think eventually physician-only practices will be sought after in that environment, or the surgeons will at the very least demand an anesthesiologist-led team. The collaborative model will only survive for those who want to work in that. Most surgeons don't want a "consult" from a CRNA. Even in the CRNA dominant practice that I left this was true.

    So, I think there will be some very, very strong CRNAs who will lead these groups. But they will have a hard time finding people to work by them who have the same mettle that they do. And they will be banging their heads against the wall much like we are now trying to cover and fill in the gaps for the weaklings. I say, let 'em have it. They have no idea what they are actually in for.
     
  5. bashwell

    bashwell SDN Bronze Donor Bronze Donor 2+ Year Member

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    That's a really interesting idea to turn them loose. But it sounds like there's a risk if they're turned loose? If patients, surgeons, hospitals etc don't complain enough to make a difference about how bad CRNAs are when they're let loose, or if turning CRNAs loose ends up weeding out all the bad or weak CRNAs but keeping in tact all the good or strong CRNAs and there are a lot more strong CRNAs than we expect, or if surgeons/hospitals/patients are't otherwise as vocal as we might think they would be about CRNAs, then there won't be any going back, no turning back the clock, right? I mean it seems like we can't "unloose" what we've already let loose? I'd love to see what you say actually happen by turning CRNAs loose, but what if it doesn't happen? Then were doubly ****ed.
     
  6. BuzzPhreed

    BuzzPhreed

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    They're already "loose" in many states. The problem is that physicians (not just anesthesiologists) bail them out when they get in trouble. So while they claim that they are practicing independently, they're really not. They are in essence having their cake and eating it. That's the difference. If we could have some solidarity and agree not to get involved in their bad decisions - at all - then the tide of public sentiment would change. But there also might be a "why didn't you help them" backlash too.
     
  7. gasdoc77

    gasdoc77 2+ Year Member

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    My concern is that often the periop complications don't truly come home to roost. They are attributed to some nebulous "reaction to anesthesia", and most of these charts don't end up scrutinized by an expert witness. The family is simply given the usual song and dance by the institution. It's really kind of tragic.
     
  8. scutdoc

    scutdoc ASA Member 2+ Year Member

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    Thanks, everyone! All this is really eye-opening, to say the least.
     
  9. Noyac

    Noyac ASA Member SDN Advisor 10+ Year Member

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    Here in Colorado ( and I'm sure in other states as well) we are working on a mandatory sentinel event reporting system. All hospitals should already have "triggers" that require them to report events. I'm sure, as you eluded, some get over looked but there will be some reporting of these events.
    Unfortunately, it's like calling the cops after you went above the speed limit to report yourself for speeding. Nobody does it. The trick is to make these events mandatory and to base funding on it. So in a sense a poor hospital will lose funding if they report events and if they don't. Hell, that should be right up the governments alley.
     

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