Everyone should read this report

[BuzzPhreed]

http://www.rand.org/content/dam/rand/pubs/research_reports/RR600/RR650/RAND_RR650.pdf

For the TL;DR challenged a brief summary:

• Despite increase in opt-out states, supervision rates are increasing
• A female anesthesiologist is significantly more likely than a male anesthesiologist to be employed by a single facility and work in a single facility.
• Female anesthesiologists are paid less. They are also working fewer hours to accommodate personal responsibilities or are choosing to work with pediatric patients because of a passion for children. The accompanying pay differences may be an acceptable trade-off for flexibility and job satisfaction.
  
• The average anesthesiologist delivers anesthesia personally on approximately half of his or her cases and supervises other anesthesia providers on the remaining cases.
• The vast majority of western anesthesiologists supervise non–anesthesia providers on 10 percent or fewer of their cases. (i.e. most work independently)
  
• In the Northeast and South, group-employed anesthesiologists spend a larger percentage of their cases than facility-employed anesthesiologists in the same regions supervising (41% vs. 33% in the Northeast, and 57% vs. 47% in the South).
• The data on variation in hours worked by gender suggest that female anesthesiologists work an average of six fewer hours per week than their male counterparts.
• The West and Midwest appear to have the greatest proportions of states in shortage of anesthesiologists.
• Our best estimate using these models is that, anchoring the national shortage in 2007 at around 2,000 FTE anesthesiologists (aligned with estimates in Schubert, Eckhout, Ngo, et al., 2012); in 2013, that shortage has been erased, and, in effect, there is an equilibrium (a small surplus of around 300 FTE anesthesiologists).

But...

• However, although we find roughly an equilibrium nationally at present, this does not imply that each state is in equilibrium.
• The supply of anesthesiologists is expected to peak in 2017 and then decrease.
• In the short run, we see that the supply of anesthesiologists is projected to increase more quickly than demand, so the anesthesiologist workforce will experience a small surplus.
• However, by 2018, as retirements increase, demand will surpass supply and the workforce will be in shortage.
  
• By 2025, projections indicate that there will be a shortage of approximately 3,000 anesthesiologists.

Fascinating stuff.

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[womp]

Supervision rates are increasing because there are more CRNAs to supervise.

Surprised male anesthesiologists work on average 57 hours a week. That's almost as high as private practice surgeons.

 

[BuzzPhreed]

A shortage of 3000 anesthesiologists in 2025 does not seem like a large number. Predicting anything past 10 years with ACO coming is a fool's errand.

They did use some robust projection methodology in the report. And I wouldn't worry too much about the current state of the ACA remaining intact as it currently stands. Plus, the 2007 report was pretty much spot-on and has played out as predicted.

 

[BuzzPhreed]

Womp, also look at page 81 and 82. They discuss possible scenarios where there could be a shortage or surplus.

 

[BuzzPhreed]

Supervision rates are increasing because there are more CRNAs to supervise.

(You have to look at the graph on page 44.)

The point was about "opt-out" states.

------------------------------------------------------------

The Percentage of Time Spent Supervising Has Increased Despite States Opting Out of Supervision Requirements

• We find that the three states that opted out of the regulation between 2007 and 2013 have anesthesiologists who are much less likely to spend time supervising nurse anesthetists than personally delivering anesthesia. This is largely driven by California and Colorado, western states where few facilities use both anesthesiologists and nurse anesthetists. The tendency of facilities to use anesthesiologists as the sole providers of anesthesia in the western United States may mean that there are substantial barriers to the movement of nurse anesthetists into western facilities. On the other hand, it may be the case that nurse anesthetists are used in western facilities where anesthesiologists are not employed, and the practice of these nurse anesthetists would not be accounted for, given that the survey focuses only on data provided by anesthesiologists.

------------------------------------------------------------

Yes, there are more CRNAs. And they recognize that they may not be capturing the CRNA-only practices. But, the point was that anesthesiologists are still spending more time directing/supervising than in 2007 in spite of the increase in opt-outs (which would intuitively lead one to speculate that all of those new CRNAs would be running to CRNA-only practices to avoid having to work with us).

 

[punkedoutriffs]

Huh... as a med student graduating in 2017 and potentially finishing training in 2021-22, this is good news, if I'm interpreting it right.

 

[BuzzPhreed]

Huh... as a med student graduating in 2017 and potentially finishing training in 2021-22, this is good news, if I'm interpreting it right.

It's a projection. But, yes, if they're correct there will be plenty of jobs. Unless the greedy fatcat grayhairs decide to continue to sit on their asses until they're 75-years-old and just sign the CRNA's charts at the end of the day. That's really what we have to fix in our specialty.

And apparently go West young man to seek thy fortune.

 

[deleted126335]

They did use some robust projection methodology in the report. And I wouldn't worry too much about the current state of the ACA remaining intact as it currently stands. Plus, the 2007 report was pretty much spot-on and has played out as predicted.

-The Rand Report was first published in 2010, not 2007. It predicted that the significant shortage of anesthesiologists that the marketplace experienced in the mid-late 2000s would continue. How's that going?
-These manpower projections have a history of being perfect contrary indicators. In the mid 90s ASA commissioned a manpower report by Abt Associates. It basically stated that there was and would continue to be a huge excess of anesthesiologists for many years, just before the bull market for anesthesiologist salaries hit around 2000.
-Supervision rates are going up because MD-only anesthesia is going down.
-I do agree that lots of anesthesiologists have their eyes on the exit door or at least cutting back to part time. How many will take the plunge is impossible to say.
-They hedge their predictions quite a bit.

 

[BuzzPhreed]

Good points, doze. But I think the 2007 projections (from what I read) were pretty accurate.

There are really two parts to the report. The first part is a current state of how things are. But yes you're right a lot of it, especially at the end, is projection. They reference their 2007 report, which is what the survey data was probably based on. When it was actually published I don't know. The current report (2013) was published in April 2014.

MD-only anesthesia is going up in Western states. Again the point about the supervision rates going up was that, yes, there are more CRNAs to supervise, but it was in the context that they are not running out to start CRNA-only practices despite their being more opt-out states since the last report (three more to be exact).

 

[anbuitachi]

Wow there is a surplus of anesthesiologists... =( i choose the worst time to go into the field
And how is the report able to predict 10 yrs into the future. Are CRNA projections taken into account? It can't be easy to predict when there's another group trying to take your jobs.
I hope programs don't use this report about having a shortage in 2025 as justification for opening even more residency positions...

 

[BuzzPhreed]

Are CRNA projections taken into account?

"It is important to note that all data on team care in the 2013 wave of the survey were reported by anesthesiologists. For findings from CRNAs, please reference our report on the findings from the previous survey wave (Daugherty et al., 2010)." (pg. 35)

Here's the report they reference:

http://www.rand.org/content/dam/rand/pubs/technical_reports/2010/RAND_TR688.pdf

 

[Mman]

And apparently go West young man to seek thy fortune.

Seek thy fortune in the geographic area with the lowest pay in the country?

 

[BuzzPhreed]

Seek thy fortune in the geographic area with the lowest pay in the country?

California is the lowest. Also the most saturated with CRNAs and anesthesiologists (besides Washington D.C., for some reason).

There are other "western" states (named in this survey) where it is predominately physician practice. Northwest pays 2nd best only to the North Central (aka "fly over" states) and only because no one wants to live in the latter.

High pay + no CRNAs = no brainer

http://www.medscape.com/features/slideshow/compensation/2013/anesthesiology
(Slide 5)

 

[punkedoutriffs]

California is the lowest. Also the most saturated with CRNAs and anesthesiologists (besides Washington D.C., for some reason).

There are other "western" states (named in this survey) where it is predominately physician practice. Northwest pays 2nd best only to the North Central (aka "fly over" states) and only because no one wants to live in the latter.

High pay + no CRNAs = no brainer

http://www.medscape.com/features/slideshow/compensation/2013/anesthesiology
(Slide 5)

This is the updated medscape report (2014). Lots have changed regionally in just one year. Makes me question the validity of these surveys...

 

[BuzzPhreed]

It's a survey. I got it. I answered it truthfully. I don't know why one wouldn't.

 

[deleted126335]

It's a survey. I got it. I answered it truthfully. I don't know why one wouldn't.

These surveys are used to benchmark salaries and workload. If everybody answered that they worked 35 hours/week, with 17 weeks off, and made $500,000 it might be useful to the negotiation process. only half joking. MGMA benchmarks are used in physician contract negotiations all the time. The data to a large extent is self reported.

 

[anbuitachi]

from the 2014 survey, minus northwest region.. it looks like all the other regions are paid pretty similarly. you'd think that flyover states would pay significantly more or something

 

[urge]

Are these the same guys who got totally wrong the projections in the 90's?

 

[deleted171991]

The projections are like any other "research" studies: the results depend on who's paying for them.

 

[BuzzPhreed]

I like the responses and critique to this thread. It reads like a lot of other responses to published studies whose conclusions we don't agree with. Time will tell whether or not it comes to fruition. But taken at face value in this report I'll not only have a job in 10 years, I'll be in demand. That means more $$$ as I approach 50 and the peak of my earning years. Time will tell.

 

[BLADEMDA]

I like the responses and critique to this thread. It reads like a lot of other responses to published studies whose conclusions we don't agree with. Time will tell whether or not it comes to fruition. But taken at face value in this report I'll not only have a job in 10 years, I'll be in demand. That means more $$$ as I approach 50 and the peak of my earning years. Time will tell.

This is a dynamic process. Your income depends on the govt/CMS and the state of the overall health care system. Will the ACA be in place? Will President Clinton modify the ACA/healthcare exchanges to include the Medicare option? Will anesthesia be part of a bundled reimbursement system? So, this isn't a strictly MD vs CRNA issue or who is sitting on the stool.

What about AMCs? Market share continues to increase and some projections show they could have 85% of the market place in 10 years. Where does that leave your salary and job satisfaction?

 

[Tuohy]

It's a projection. But, yes, if they're correct there will be plenty of jobs. Unless the greedy fatcat grayhairs decide to continue to sit on their asses until they're 75-years-old and just sign the CRNA's charts at the end of the day. That's really what we have to fix in our specialty.

And apparently go West young man to seek thy fortune.

You mean the same a**holes that are indefinitely board certified and do not need to do MOCA re-cert? These guys need MOCA the most. I give lectures to private practice grayhairs and it is downright scary! I would not let half of them put any family member to sleep-their knowledge is so antiquated once you talk to them re: clinical cases/conundrums...

 

[deleted126335]

Some of those gray hairs have forgotten more than you will ever know.
One day your hair will also be gray.

 

[Carbocation1]

A breath of fresh air from the gloom and doom regarding the future of gas.

 

[deleted171991]

A breath of fresh air from the gloom and doom regarding the future of gas.

If you pay me (too) enough, I (too) will sing you hymns about the glorious future of anesthesia.

 

[Carbocation1]

If you pay me (too) enough, I (too) will sing you hymns about the glorious future of anesthesia.

I'm considering literally every specialty there is but the fact that gas docs don't have to put up with much of the BS that other docs do is a huge plus.

 

[gasdoc77]

I'm considering literally every specialty there is but the fact that gas docs don't have to put up with much of the BS that other docs do is a huge plus.

Paging Consigliere

 

[Sirach38]

I'm considering literally every specialty there is but the fact that gas docs don't have to put up with much of the BS that other docs do is a huge plus.

Uh oh, this might get ugly...

 

[Mman]

You mean the same a**holes that are indefinitely board certified and do not need to do MOCA re-cert? These guys need MOCA the most. I give lectures to private practice grayhairs and it is downright scary! I would not let half of them put any family member to sleep-their knowledge is so antiquated once you talk to them re: clinical cases/conundrums...

You realize that absolute worst are old academic attendings that have barely done any cases outside their little area in decades, right?

 

[deleted171991]

I hope s/he also realizes that academia is many times (but not always) the refuge of the lazy and/or incompetent. Those who can, do; those who can't, teach.

 

[Consigliere]

Paging Consigliere

Sorry, I was too busy banging the hot nurses to answer immediately........anywho....wow. I don't think there is any means to quantify how clueless you are - re: (I'm considering literally every specialty there is but the fact that gas docs don't have to put up with much of the BS that other docs do is a huge plus).

I've neither the time nor the desire to explain to you on how many levels you are wrong. Anesthesiologists have to deal with CRNAs and that puts our BS quotient light years ahead of any other physician.

 

[Tuohy]

You realize that absolute worst are old academic attendings that have barely done any cases outside their little area in decades, right?

Trust me-I know what you are saying...I see that in action regularly!

 

[Tuohy]

I hope s/he also realizes that academia is many times (but not always) the refuge of the lazy and/or incompetent. Those who can, do; those who can't, teach.

I teach and do-I like to think of myself as a private practicioner in an academic body!

 

[Spinach Dip]

...snip...

• By 2025, projections indicate that there will be a shortage of approximately 3,000 anesthesiologists.

Given all the gloom and doom I've seen...combined with the attitudes of those going into med school towards this specialty...I would be stunned if the shortage was as small as 3000 in 10 years.

 

[deleted171991]

I would be stunned if there were any shortage.

Let me put it this way: where there is a real shortage, salaries would be climbing significantly and continuously.

 

[pgg]

I would be stunned if there were any shortage.

Let me put it this way: where there is a real shortage, salaries would be climbing significantly and continuously.

That's exactly what happened in the 2000s after the gloom and doom of the 1990s.

Granted, the gloom and doom of the 2010s seems unlikely to produce the same effect in the 2020s though, because residencies didn't fill in the 1990s, and they will absolutely continue to fill now.

The only prediction I make is that the patient population will keep getting older and more dependent on government insurance, and the government will keep expanding its debt and reducing its ability to pay, and managing middlemen will get bigger and bigger slices of a shrinking pie. Even if there is a shortage of anesthesiologists in 2025, there's only so much supply and demand can do in the face of that.

My long term financial planning is based on the expectation of stagnant or decreasing real wages for the rest of my career. I hope to be pleasantly surprised.