Future of Anesthesia (for med school class of 28' and beyond)

[rowsdower88]

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I'm not sure what you mean by "recently", and I can't to speak for aneftp. But work hour restrictions came in 2003, put forth by the ACGME. in 2003, leaders of the ACGME were probably in their 50's. You should thank them in their retirement homes. Prior to that, the first work hour restrictions came in 1987. I'm not sure there are any lurkers on this board that trained before 1987. I can tell you I was an MS-3 in 2003. We weren't picketing for work hours, nor did we celebrate our resident brothers and sisters for fighting the good fight.

The training sucks, but the struggle builds tenacity. Close to 50% of hospitals are actually losing money. Few are "making tons" Either way, we live in a capitalist economy. Hospitals will continue doing what they do until they can no longer recruit medical residents. As long as someone is willing to sign up, there is no incentive for them to change.

But you've got this to look forward to: One day, someone 20 years younger will blame you for the world's problems, too. And you'll get to blame them for all the things that have changed. It's been happening for centuries.

Residents 20 years from now will be able to thank these guys:

Residents Strike, Demonstrate Around Labor Day Weekend

Trainees in Buffalo strike, while those in Philadelphia demonstrate for better pay

www.medpagetoday.com

As far as I know, this strike didn't accomplish it's aims, but progress doesn't happen overnight.

 

[Bertelman]

Lifties in Park City have a better shot at getting what they want.

 

[aneftp]

Residents 20 years from now will be able to thank these guys:

Residents Strike, Demonstrate Around Labor Day Weekend

Trainees in Buffalo strike, while those in Philadelphia demonstrate for better pay

www.medpagetoday.com

As far as I know, this strike didn't accomplish it's aims, but progress doesn't happen overnight.

It could be worst. Srna works for free.

Most places have really cracked down on srna supervision. But with growth of srna programs particularly late 1990s to 2010. Many places loosely supervised srnas.

So much greed especially in Florida with puppy mill srna programs and even the crnas who finished those programs tell
Me it was survival and many poorly trained srnas.

 

[UscGhost]

I'm not sure what you mean by "recently", and I can't to speak for aneftp. But work hour restrictions came in 2003, put forth by the ACGME. in 2003, leaders of the ACGME were probably in their 50's. You should thank them in their retirement homes. Prior to that, the first work hour restrictions came in 1987. I'm not sure there are any lurkers on this board that trained before 1987. I can tell you I was an MS-3 in 2003. We weren't picketing for work hours, nor did we celebrate our resident brothers and sisters for fighting the good fight.

The training sucks, but the struggle builds tenacity. Close to 50% of hospitals are actually losing money. Few are "making tons" Either way, we live in a capitalist economy. Hospitals will continue doing what they do until they can no longer recruit medical residents. As long as someone is willing to sign up, there is no incentive for them to change.

But you've got this to look forward to: One day, someone 20 years younger will blame you for the world's problems, too. And you'll get to blame them for all the things that have changed. It's been happening for centuries.

I agree. Not sure the timeline of everything. Additional restrictions were put in place around 2010-2013 that cause some grumpy older folks to speak out against them.

Incremental gains. Each time, the older docs lament that the newer docs didn't have to go through the same hardships
Instead they should be applauding them.

In terms of hospitals, I believe Medicare pays residencies 150k per position but the avg salary is 61k.

Combine that with the fact that it would easily cost 200-300k per resident, if not more, to replace their labor. An avg residency has 50 anes residents all staffing rooms. How much would replacements cost the hospital?

I agree that residents need hours. But pay them accordingly.

 

[Meyer-Overton]

I went into pain right as the market for general was taking off, and you would have to pay me $2.5 million a year to go back to general anesthesia.

For what reasons do you find pain so much better than OR anesthesia?

 

[mdo1738]

For what reasons do you find pain so much better than OR anesthesia?

I work from 8 am to 4 pm 4 days a week and will make right around 7 figures doing so. I do not work nights, weekends, or holidays. There are zero life-or-death emergencies I have to deal with. I never have to deal with egotistical surgeons. I don’t have to run around from room to room while hoping CRNAs I’m liable for aren’t doing something stupid. I can go to the bathroom whenever I want. Those are all the big reasons that immediately come to mind.

 

[Bryan O’Blivion]

The most well researched projection of the anesthesia market that I’ve been an observer to indicated that there would be a shortage of anesthesia services from 2019-2029, which seems to thus far correlate with the changing job market. I would expect this to correct in about that timeframe, honestly. Lots of nurses are seeing CRNAs make money and are getting the requisite months of ICU experience to apply to nurse anesthetist school, which is going to produce a crop in 5 years. Same with medical students going through residency.

I can’t speak to the cardiology market, the friends and associates that I’ve had who have been in cards have always been in demand, which has been a two edged sword. They’ve always been well compensated, but working constantly. Nothing is perfect.

Anesthesia has been great for me, but I wouldn’t recommend it for everyone.

 

[Coffee PRN]

The most well researched projection of the anesthesia market that I’ve been an observer to indicated that there would be a shortage of anesthesia services from 2019-2029, which seems to thus far correlate with the changing job market. I would expect this to correct in about that timeframe, honestly. Lots of nurses are seeing CRNAs make money and are getting the requisite months of ICU experience to apply to nurse anesthetist school, which is going to produce a crop in 5 years. Same with medical students going through residency.

I can’t speak to the cardiology market, the friends and associates that I’ve had who have been in cards have always been in demand, which has been a two edged sword. They’ve always been well compensated, but working constantly. Nothing is perfect.

Anesthesia has been great for me, but I wouldn’t recommend it for everyone.

I’ve heard that the nadir is projected to be in 5 years.

 

[PainInTheAnes]

I'm not sure what you mean by "recently", and I can't to speak for aneftp. But work hour restrictions came in 2003, put forth by the ACGME. in 2003, leaders of the ACGME were probably in their 50's. You should thank them in their retirement homes. Prior to that, the first work hour restrictions came in 1987. I'm not sure there are any lurkers on this board that trained before 1987. I can tell you I was an MS-3 in 2003. We weren't picketing for work hours, nor did we celebrate our resident brothers and sisters for fighting the good fight.

The training sucks, but the struggle builds tenacity. Close to 50% of hospitals are actually losing money. Few are "making tons" Either way, we live in a capitalist economy. Hospitals will continue doing what they do until they can no longer recruit medical residents. As long as someone is willing to sign up, there is no incentive for them to change.

But you've got this to look forward to: One day, someone 20 years younger will blame you for the world's problems, too. And you'll get to blame them for all the things that have changed. It's been happening for centuries.

Thank the ACGME? Lol

Hour reductions would’ve come regardless of what a bunch of political chumps were trying to change.

Residencies would’ve had insanely bad PR if they went status quo. Can you imagine if every resident had a TikTok or instagram to reveal the truth to the public about who’s taking care of them after a 100 hour work week?

The patients would riot, lawsuits from expectant mother residents would close billion dollar hospitals, and the first time a resident on the way home after a 40 hour shift has their dash cam record their face going through the windshield, even a team of hospital lawyers will open the money firehose to never have that lawsuit again.

The internet would’ve made every change that’s happened inevitable. So no, I don’t need to thank “the ACGME” for anything except their protecting our certifications for their own monetary benefit.

 

[Bertelman]

Thank the ACGME? Lol

Hour reductions would’ve come regardless of what a bunch of political chumps were trying to change.

Residencies would’ve had insanely bad PR if they went status quo. Can you imagine if every resident had a TikTok or instagram to reveal the truth to the public about who’s taking care of them after a 100 hour work week?

The patients would riot, lawsuits from expectant mother residents would close billion dollar hospitals, and the first time a resident on the way home after a 40 hour shift has their dash cam record their face going through the windshield, even a team of hospital lawyers will open the money firehose to never have that lawsuit again.

The internet would’ve made every change that’s happened inevitable. So no, I don’t need to thank “the ACGME” for anything except their protecting our certifications for their own monetary benefit.

The power of Insta/TikTok/Twitter came 20 years after work hour restrictions. It was 4 years after those changes that iPhones were released. You don't have to thank anyone, but personally, I'm happy it happened when it did.

I also think you may be overestimating society's empathy for physician training hours. We are clearly coming at this from different generations, but I'm not counting on social media to save me from abuse at any point in my lifetime. Physicians aren't generally classified as a persecuted population.

 

[UscGhost]

Thank the ACGME? Lol

Hour reductions would’ve come regardless of what a bunch of political chumps were trying to change.

Residencies would’ve had insanely bad PR if they went status quo. Can you imagine if every resident had a TikTok or instagram to reveal the truth to the public about who’s taking care of them after a 100 hour work week?

The patients would riot, lawsuits from expectant mother residents would close billion dollar hospitals, and the first time a resident on the way home after a 40 hour shift has their dash cam record their face going through the windshield, even a team of hospital lawyers will open the money firehose to never have that lawsuit again.

The internet would’ve made every change that’s happened inevitable. So no, I don’t need to thank “the ACGME” for anything except their protecting our certifications for their own monetary benefit.

Maybe. But they came 20 years as before tik tok.

And and additional changes DUE to tiktok will further any potential improvements

 

[PainInTheAnes]

Maybe. But they came 20 years as before tik tok.

And and additional changes DUE to tiktok will further any potential improvements

Lawsuits would’ve been the primary driver. That was coming with or without social media.

Why do you think all these programs
cover transportation fares for residents coming off of night shifts? The world didn’t become nice on its own, lawyers realized how vulnerable the endowments were. That stuff did not exist in 2000

 

[aneftp]

Lawsuits would’ve been the primary driver. That was coming with or without social media.

Why do you think all these programs
cover transportation fares for residents coming off of night shifts? The world didn’t become nice on its own, lawyers realized how vulnerable the endowments were. That stuff did not exist in 2000

Took a very long time from the Libby Zion death case to implement the 80 hr work rules

Libby Zion Law - Wikipedia

en.m.wikipedia.org

 

[UscGhost]

Lawsuits would’ve been the primary driver. That was coming with or without social media.

Why do you think all these programs
cover transportation fares for residents coming off of night shifts? The world didn’t become nice on its own, lawyers realized how vulnerable the endowments were. That stuff did not exist in 2000

I am not aware of any lawsuits that drove the change in hours when I was there.

It was ACGME and resident driven.

Lawsuits are less likely because Attendings take the responsibility regardless of how many hours a resident has worked.

Lawsuits would probably be inevitable....but would require a catastrophic event in order to spur change alone. Unless it's a monopoly/unionization lawsuit

 

[PainInTheAnes]

I am not aware of any lawsuits that drove the change in hours when I was there.

It was ACGME and resident driven.

Lawsuits are less likely because Attendings take the responsibility regardless of how many hours a resident has worked.

Lawsuits would probably be inevitable....but would require a catastrophic event in order to spur change alone. Unless it's a monopoly/unionization lawsuit

Lawsuits by residents against programs.

Imagine how easy a wrongful death would be without a program providing rides home to a resident working 40 hours straight. Think that persons family might find a lawyer willing to take that case?

You can’t even fire problem residents without wrongful termination or discrimination suits now.

Residents would have found their footing regardless of work hour restrictions. Same as college football players have now. Inevitable.

Would be easy to sue for ill health conditions due to excessive work hours. HR complaints, hostile work environments. All inevitable as conditions stayed bad for residents relative to the rest of society

 

[UscGhost]

Lawsuits by residents against programs.

Imagine how easy a wrongful death would be without a program providing rides home to a resident working 40 hours straight. Think that persons family might find a lawyer willing to take that case?

You can’t even fire problem residents without wrongful termination or discrimination suits now.

Residents would have found their footing regardless of work hour restrictions. Same as college football players have now. Inevitable.

Would be easy to sue for ill health conditions due to excessive work hours. HR complaints, hostile work environments. All inevitable as conditions stayed bad for residents relative to the rest of society

All things I would be a general proponent of.

Most big companies, hospitals won't change unless they are forced to (lawsuits like you said, or ACGME mandate, or unionization)

I don't like the lawsuits filed by problem residents (usually when the residency tries to get rid of them for legit reasons). But hard to avoid