First post on Anes forum-question about FAQ post

[neolium]

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[Planktonmd]

This is a nice post by Tenesma and it basically reflects the current view the ASA has of the future of Anesthesiology.
The future according to the ASA is about practicing perioperative medicine instead of being confined to the practice of surgical anesthesia.
It's an ambitious view but it has no plan of action to support it and is based on assumptions that are far from reality.
If we assume that our future is going to be in practicing perioperative medicine then we are also assuming that the other specialists that are currently doing that are going to let us share their territory, This means we have to compete with Hospitalists, Pulmonologists, Intensivists, Internists.....
If we can't compete with nurses how are we going to compete with other physicians?
It is really sad that our professional organization has already decided that the practice of surgical anesthesia is not our exclusive domain and nurses can do it under the supervision of any physician while we try to find our new identity.

 

[neolium]

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[GassiusClay]

Shortage is the key to high reimbursement currently. Hopefully, it holds up for the next 15 years or so.

I wonder if there is any new predictions on when the supply will meet demand.

 

[Jeff05]

neo, i'm starting my last year of anesthesiology training.

the issues affecting anesthesiology are much more global and really are issues that affect all of medicine. the compensation will continue to decline, autonomy will continue to dwindle, satisfaction will continue to wither.

medicare and medicaid are OUT of control. they will bankrupt this country and the only way the system will survive (no matter how much we don't want this to happen) is to cut reimbursement to physicians/providers at all levels (along with cutting lots of other things). a tipping point will be reached until a TRUE 2 tiered system develops (physicians who opt out of government programs and most insurance and those who accept them) - most physicians will attempt to enter the private sector (higher tier) and the lower tier will be staffed by midlevels and foreign medical grads (only providers that the government will be able to afford). this will become the norm and demand for american trained physicians will dwindle. since americans don't know any better (American adults in general do not understand what molecules are (other than that they are really small). Fewer than a third can identify DNA as a key to heredity. Only about 10 percent know what radiation is. One adult American in five thinks the Sun revolves around the Earth, an idea science had abandoned by the 17th century. http://www.nytimes.com/2005/08/30/s...47200&en=631977063d726261&ei=5070&oref=slogin)
they will accept this without a fight.

american medical schools will pump out elite physicians for the private sector and the military.


just like medicine is NOTHING like what it was 30 years ago, the future is going to be NOTHING like the present.

having said that, as a well trained, competent clinician you will always have a job, always make a living, and, if you want - really connect with and help your patients.

 

[amyl]

i don't think that to fix medicare and medicaid the only answer is to cut physician salaries... perhaps the answer is that health care is not a right....and that people should have to make some decisions. I have spoken with a medicaid mother who told me she didn't have the money for her childs antibiotics as she whipped out her chanel lipstick and estee lauder compact. the priorities of many of the citizens of this country are seriously warped....because they have the excuse that health care is a right and thus something they shouldn't have to pay for....something that they are ENTITLED too....it is this perception that must be changed first and foremost.

 

[lord_jeebus]

I think that if any industrialized nation with nationalized healthcare was willing to put the amount of per capita spending that we put into healthcare, their doctors would make more than us.

In any system, money ultimately goes from the people to the providers (and equipment, etc.). Our system is horribly inefficient (more bureacracy, corruption, and waste involved in our private system than anything a government could come up with) but because we spend so much more than everyone else, doctors are still making quite a bit.

Regarding the state of anesthesia, what I don't get (besides how residents are cheaper labor than CRNAs) is why we still have so many training spots for anesthesiologists if the ACT model is going to reduce the need for them while employing scores of nurse anesthetists.

 

[Planktonmd]

the issues affecting anesthesiology are much more global and really are issues that affect all of medicine.

Anesthesiology is affected by the global issues in addition to the more specific issues that only affect anesthesiology.
There is no other specialty where the leadership is convinced that they should let mid level providers practice the specialty while the physicians become consultants!
This would be equivalent to the leadership of Gastroenterologists saying: let's teach the nurses to do Endoscopic procedures so we can sit in the office and do H&P's!

 

[scotchnwater]

i don't think that to fix medicare and medicaid the only answer is to cut physician salaries... perhaps the answer is that health care is not a right....and that people should have to make some decisions. I have spoken with a medicaid mother who told me she didn't have the money for her childs antibiotics as she whipped out her chanel lipstick and estee lauder compact. the priorities of many of the citizens of this country are seriously warped....because they have the excuse that health care is a right and thus something they shouldn't have to pay for....something that they are ENTITLED too....it is this perception that must be changed first and foremost.

👍👍👍 I couldn't agree more.

 

[jwk]

medicare and medicaid are OUT of control. they will bankrupt this country and the only way the system will survive (no matter how much we don't want this to happen) is to cut reimbursement to physicians/providers at all levels (along with cutting lots of other things). a tipping point will be reached until a TRUE 2 tiered system develops (physicians who opt out of government programs and most insurance and those who accept them) - most physicians will attempt to enter the private sector (higher tier) and the lower tier will be staffed by midlevels and foreign medical grads (only providers that the government will be able to afford). this will become the norm and demand for american trained physicians will dwindle. .

I hope by "other things" you mean hospitals, drug and equipment costs, etc. The physician/provider percentage of overall healthcare costs is relatively small compared to everything else.

 

[Jeff05]

in 2004, 29% of private insurance healthcare dollars went to physician compensation (1). That is not a minor percentage. I agree, however, that a useless mass of administration has to go.

1.Blue Cross/Blue shield, Reference Guide, 2007.

 

[Leverage]

I think that if any industrialized nation with nationalized healthcare was willing to put the amount of per capita spending that we put into healthcare, their doctors would make more than us.

In any system, money ultimately goes from the people to the providers (and equipment, etc.). Our system is horribly inefficient (more bureacracy, corruption, and waste involved in our private system than anything a government could come up with) but because we spend so much more than everyone else, doctors are still making quite a bit.

Regarding the state of anesthesia, what I don't get (besides how residents are cheaper labor than CRNAs) is why we still have so many training spots for anesthesiologists if the ACT model is going to reduce the need for them while employing scores of nurse anesthetists.

You realize our government is over nine trillion in debt??