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Discussion in 'Anesthesiology' started by wtyson, Mar 25, 2014.
They can. Inpatient with (many) overnight calls.
I know this was tongue in cheek, but I'll answer it anyway.
First I would say, "If you want to do this without an anesthesiologist, that's fine, as long as you have sedation privileges. But just know that you can't give propofol with a nurse."
Then after he gave his response, whatever that may be, I would explain that is what I thought he wanted because he wrote an order and only nurses take orders from the order sheet. Then I would explain why propofol isn't the best drug for the procedure…unless for this particular patient, it is.
As I said, this wouldn't happen in my facility. The psychiatrists have a lot of respect for us and what we can do. So much so, it is bordering on awe. Remember, these are guys who sit in an office, talking and prescribing meds all day. When they come to do their ECT's, they see us dealing with apnea, tachycardia, hypertension, etc, like it is nothing to us. They haven't done that kind of medicine in many years, when they were med students.
Because he has vaginal hubris.
Sorry to bump this thread but what prevents hospitals/administration from increasing the CRNA to anesthesiologist ratio, especially in states that have already opted out, in order to save money? Wouldn't the recent increase in the past few years of residency training spots also make it harder for graduates to find a job as well in the upcoming years?
Most hospitals don't actively manage anesthesia. The group/AMC agrees to provide coverage and does so more or less however they want.
Yes. It is hard to find a job now and will be even more so in the future. Best of luck to all future anesthesiology residents.
This may seem naive of me but what about the increasing need for more physicians across all specialties ? The aging of the US population requiring more surgical interventions ? Does anybody account for that ?
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Multiple market forces are working against anesthesiologists. Perhaps the greatest is Medicare choosing to reimburse crna's 100% in opt out states. This is a movement toward the "pseudo equalization" of anesthesia providers. Imagine if 80+ anesthesiologists graduated annually in one state alone. It would decimate the job market. Now combine the Crna and anesthesiology graduates in TN alone annually. It has to approach 100. AMC's want the cheapest common denominator allowed by law (patient care be damned). Whether or not you consider rural areas desirable, every position filled is one less available. It eventually trickles down.
I got a solution. How about some of you old timers (I'm talking 55+) retire? I know y'all are sitting on several million dollars of savings and a few beach houses with a bentley out front. S&P500 is at all time highs so don't tell me you're waiting for a market rebound. Sell now and retire so us young bucks have a shot at a decent job. Also retire because you guys are the reason we have so many CRNAs out there. Us young bucks will fight for the future of the specialty cause we have no other choice.
People not retiring is only a very small part of the problem, the real issue is the uncertainty about the future of reimbursement under the new value based purchase system.
No one can predict how things are going to be 2 years from now and how hard reimbursement is going to fall.
This is why groups, AMCs and hospital administrators are trying to run as bare bones as possible.
I'll be able to retire in a few years but I will keep working because I'm healthy and still have a lot of energy. I love my work. It is one of the best things I do.
You have an entitled attitude. If you keep it up you will never be content. We are not the cause of your problem. There are larger forces at work. I'm sorry the timing looks bad you. The anesthesia job market has always had ups and downs.
Ps....no Bentley or beach house, but that's why I could retire.
Way to go.
What future? Anesthesiology is dead. AMCs will rule the earth:
I don't think this is accurate. You are talking about this situation in a vaccuum. Hospitals are familiar with the medicolegal aspects of medicine more than we could ever imagine. They know by employing a higher quantity of CRNA/AA's they are assuming more risk. At major centers with high case complexity (yes, this is monitored), you are absolutely not going to see ratios go much higher, nor will you see the independent practice within higher ASA case stratifications. The real damage is going to be in those elective and low complexity cases -- we can pretty much say "buh-bye" to providing direct care to low complexity cases and can say "hello" to high supervision ratios in this context. This will absolutely be maximized, because the hospital will likely view this as a low-risk population. Just extrapolating what I've seen on rotations and in military medicine with midlevel providers... YMMV, take it for what it's worth.
Damn, Consigliere. You've got your finger on the pulse. How do you pull out this stuff as its happening!
While they may be familiar with medico legal risk, hospitals will weigh that risk against improved profit margins. How many "risky" surgeons do we see that butcher patients and keep their priveleges because they generate revenue for the hospital. I fear you are giving these businesses more credit than they deserve.
I agree. You are giving them way too much credit about understanding such distinctions. You're making the fundamental attribution error: a mistake that they know and understand what you know and understand.
This is Lee Iaccoca and the Ford Pinto all over again. Nothing more.
Hospital administrators care only about saving money and that liability issue is at the very bottom of their list of priorities.
More to the point, are the hospitals even exposed to very much of that liability? I would think that most of that risk is effectively offloaded to the individual's liability insurance carrier.
What are you talking? You are a perennial anesthesiology basher. Are you this negative in all aspects of your life or only in regards to the future of anesthesiology?
Secondly, if these kinds of transactions are a sign of the death, then it is not only anesthesiology. This is happening across the board to many specialties including radiology and surgery.
I think if you want to make bold statements like "anesthesiology is dead" then you should generalize more to include every other specialty that is going through changes (= every single one). Say "medicine is dead" if you want to be more accurate.
Also, if "anesthesiology is dead" means we won't be making 600k like those who came 10-20 years before us, then no need to post. We already know that. If you are miserable with your job and money is your only motivator then I feel bad for you. Find a new position or go back to residency.
Yes! This is correct.
They expect that quality you provide is inherent in what you do, no matter whether or not you have the resources or equipment to provide it. Their assumption is that you took the job because you can do the job. Liability is therefore not even on their regular radar screen. And when situations happen where it comes onto their radar screen, it is mainly your problem not their problem.
Yes. This is more accurate. There are very few niches left where autonomy reigns. And most troubling is that these corporations expect you to put your medical license on the line for their profits.
This is going to blow up in everyone's face within the next 3-5 years. This "fix" is not sustainable.
Just look at the sh*tstorm the VA is going through in the public eye right now. Are any of you surprised or shocked about what they are reporting?
FWIW Buzz is going into lockdown mode.
I'm saving every penny I can. I'm trying to reposition myself at my new/old job into more a managerial role. I'm going to get my MBA. I'm planning my exit strategy.
When the bean counters finally win, if they win, I'm out. I'm either going to join them or go do something else with my life. But right now we're outnumbered, disorganized, and can't agree what's best for our profession. So plan your exit and make sure you have enough money in your **CK-YOU account to be able to walk away.
That's what all the fatcat grayhairs who are selling out our profession are doing.
Damn right. This is a bubble like the Nasdaq in 1999 or real estate/housing in 2006. Now is the time to sell as WallStreet is greedy to buy
Give me a call when you've got some hair on your nuts, kid.
I know what you meant... but am wondering what you'll do when he presents his hairy balls.
Just remember CRNAs aren't going to work for pennies either. Why work as CRNA when they can easily make 100K as ICU nurse with no debt? and better hours and more days off.
CRNAs are trained to do "shift work". If you adjust their salaries towards the average 50-55 hours the MDs do, CRNAs will be making around 250-300K.
And many CRNAs don't want to work those hours.
What's stopping you from getting an executive MBA and selling out?
Dude......step away from the leaking sevo vaporizer. Since when does an executive MBA grant you the ability to do anything other than waste your time and $35k+?!?
Then forget the MBA. What's stopping you from selling out by weaseling your way into administration?
Why are you so against the guy's opinion? He is only trying to voice his opinion so that medical students will learn about all aspects of practicing Anesthesiology before they sign up for it.
I'd be pretty upset if I happen to train in Anesthesiology and find out when I'm done that it's not as great as it is made out to be.
Probably because almost all his posts are extreme doom and gloom.
He wants to make money, there's nothing wrong with that. I want to know why he won't take steps toward becoming a hospital or AMC administrator.
As if it's just as easy as deciding "hey, I'd like to become a hospital or AMC administrator" and voila! it's done. I have absolutely no experience doing anything administrative nor do I have any desire to.
Or extreme reality; interpret as you will. Admittedly, my posts are intentionally pessimistic, but, I'd like people to see the other side of anesthesiology as well.
It’s a recession when your neighbor loses his job; it’s a depression when you lose your own.”
― Harry S. Truman
I love the anesthesia forum and its posters, but I felt it was time for this.....again:
The sky has fallen.
I guess it's easier to complain about it on the internet than it is to actually do anything about it.
Thanks for the responses above. So to summarize, most of you would go to Tufts ortho vs. MGH anesthesia as a new resident?
Wharton has an executive MBA, is that a waste of time and money as well? Though it runs about $160k.
If you're going to get an MBA, remember that reputation is FAR more important than in medical school, and the difference between prospects at top 10 programs and your local university are night and day.
If you want to do ortho.
Yes and most of the students are sponsored by their employers. Try to get an anesthesia group to do that.
It is, and on an even greater scale.
Well that's the key to opening the door of corporate medicine to you if you are not interested in practicing medicine anymore.
I'm not sure why you don't see that. Though you wouldn't be starting off as the COO...
You already have the medical background. Now you need to learn about business, that's what business school does.
The advantage of the executive MBA, assuming you don't go to the University of Phoenix, is that you can transition your career while working full time and then leave when you get a business job.
My observation has been that what opens the administrative doors for physicians is being a revenue generator for the hospital. The relationships are built when the hospital is working closely to keep you there and appease you. Then you slowly transition your role to more administrative duties and less clinical responsibility. This appears to be a pathway that is less available to an anesthesiologist (seen as a liability on a spreadsheet) as opposed to a surgeon or a cardiologist (who is seen as an asset). I am sure that exceptions exist, but it seems this is a more common route. It's not what you know but who you know.
Probably impossible but why don't anesthesia groups team up with surgical groups to become a larger more negotiable force? Each side of the drape collects their fees and gets what they want. Essentially two smaller factions operating as a large combination group. If the OR is the cash cow of the hospital, then the combo may be able to dictate a little more.
I wasn't referring to internal management jobs.