Future of Anesthesiologists

[ORjunkie16]

Hello, im a college student currently taking pre med courses. I have always been interested in medicine and specifically anesthesiology because i like working with patients, being able to knownall kinds of diseases and diagnoses, being in the OR and the fact that Anesthesiologists get to participate in all kinds of surgeries anything from head to tow lol. Now, recently i have been searching and i found out that in some places the CRNA's are working independently, to the point that they are taking over an Anestheseiologist's job. Is this really happening? Im still in college and it will take 11 years for me to become an anesthesiologists if im successful but are they going to be replaced by CRNAs by then? I mean sure they have studied too but they have not taken the MCAT, never been to a Medical School and never had 4 years of residency. They get a 4 year degree, work for 1 year at the ICU or ER and then 2.5 years of anesthesia study so if you cross that one year of working at the ICU since its just working and not a residency, you are talking about only 6 and a half years of actually studying versus 12 to 13 years for a MD anesthesiologist. Dont get me wrong, they deserve to practice, but not to the point that they can replace a doctor and work without supervision. For example if **** hits the fan and the situation requires an actual MD level knowledge to respond to it, what are they going to do? it just annoys me so I want to know if i become an anesthesiologist after 13 years of kicking my own butt, i wont be able to get a job because an "advanced" nurse is going to take care of it for a lower cost? I would appreciate some responses. Thanks!

---

Members don't see this ad.

 

[Wiscoblue]

Question is, what kind of fellowship are you keen on?


Sent from my iPad using Tapatalk

 

[ORjunkie16]

Question is, what kind of fellowship are you keen on?


Sent from my iPad using Tapatalk

Either Pediatric or Orthopedic

 

[bashwell]

Since someone took issue with what I said, I think it'd be better if people instead read articles such as these by Dr. Richard Novak, an attending anesthesiologist at Stanford University, because what I've said is basically the same as what Novak is saying, and he's a far more superior authority than I am or ever will be:

http://theanesthesiaconsultant.com/...actor-in-anesthesia-care-in-the-21st-century/

http://theanesthesiaconsultant.com/2016/01/02/10-trends-for-the-future-of-anesthesiology/

Also see this very long SDN thread:

http://forums.studentdoctor.net/threads/future-anesthesia-job-market.1062141/

 

[deleted59964]

Bashwell - how is it that you are so well informed about CRNAs AAs and the american practice of anaesthesia ?

 

[bashwell]

Hey @JobsFan! Cheers, I'm out now but I'll pm you when I'm back.

 

[GravelRider]

Best advice I can ever give you: Do not go to medical school. The time, effort, sacrifice, and enormous expense does not pay off. My recommendation for people who want to be in healthcare nowadays is to go to nursing school. Doctors are losing autonomy and nurses are gaining autonomy. They will meet at some level where they will be considered equals.

 

[DrOwnage]

Best advice I can ever give you: Do not go to medical school. The time, effort, sacrifice, and enormous expense does not pay off. My recommendation for people who want to be in healthcare nowadays is to go to nursing school. Doctors are losing autonomy and nurses are gaining autonomy. They will meet at some level where they will be considered equals.

... Do you actually think nurses would be considered as professionally equal to doctors at some point? I'm sorry that's ridiculous. The disparity in training and individual talent between people who get accepted and graduate from medical school vs. nursing school will always be discernible to the public's eye. Now if we're talking cRNA vs. MD Anesthesiologist, we can find a lot of disagreement about that.

 

[GravelRider]

I think there will be an evening out of autonomy, respect, and compensation. I'm talking about "advanced practice" nurses. Many of these programs are already calling themselves "doctorate" programs to blur the lines even further. There is nothing in our healthcare system that cares about quality or the disparity in training between nurses and physicians. Healthcare, like any other industry in America, is structured to make the business people at the top very wealthy.

Nursing school opens up more doors than medical school. You are less burdened by the time of training and debt. If you go to nursing school you can be anything from a clipboard carrier yelling at doctors for having facial hair, to providing anesthesia, to doing critical care, to opening your own independent primary care practice. Nursing school is a much more attractive option than medical school these days.

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[Mman]

Best advice I can ever give you: Do not go to medical school. The time, effort, sacrifice, and enormous expense does not pay off. My recommendation for people who want to be in healthcare nowadays is to go to nursing school. Doctors are losing autonomy and nurses are gaining autonomy. They will meet at some level where they will be considered equals.

I was given similar advice 20 years ago and I'm glad I didn't listen to it. When Clinton was rolling out the HMO models it was going to be the end of medicine as we knew it.

Nobody knows the future. I only suggest people do what they want to do, but go in with eyes open.

 

[btbam]

What academic anesthesiologist works 55 hours a week? Ours are out at noon on their precall day, come in at noon on call, and have their postcall day off.

 

[Man o War]

I was given similar advice 20 years ago and I'm glad I didn't listen to it. When Clinton was rolling out the HMO models it was going to be the end of medicine as we knew it.

Nobody knows the future. I only suggest people do what they want to do, but go in with eyes open.

Same. In fact I was told anesthesia would be run by nurses in 10 years and we would be making primary care money (that bench mark has long passed). I've done just fine financially in this specialty.

 

[Stank811]

I am not sure a lot on this board has worked with new APNP grads of any speciality. And if you have and consider them a risk I would re-evaluate your skill level and what you are bringing to the table for those who are requesting your services. Not worried about the CRNA factor or any other advance practice provider.

Does that mean a CRNA who has 20+ yrs of experience who has been doing cardiac for 15+ and has continued to learn by taking courses is uable to do hearts...absolutely not. But new crna graduates bring little to the table in regards to independence.

 

[Consigliere]

Do anything but anesthesiology, kid.

 

[GravelRider]

I'm not talking about your compensation. You will do fine in medicine and not be poor. Physicians are losing autonomy and nurses are gaining autonomy. I think nursing school is a much better option if you want to be in healthcare and take care of patients. The one caveat to that would be if you want to perform surgery.

 

[ORjunkie16]

Best advice I can ever give you: Do not go to medical school. The time, effort, sacrifice, and enormous expense does not pay off. My recommendation for people who want to be in healthcare nowadays is to go to nursing school. Doctors are losing autonomy and nurses are gaining autonomy. They will meet at some level where they will be considered equals.

It should not be like that tho. Like I said, i woud respect them for studying and becoming a nurse, but not the kind of respect that a foctor recieves. Im not a doctor yet but if you guys are and a nurse tries to talk down to you and boss you around, ask them some tough questions about some diseases and how they can be treated with what medicines and techniques. A question that you wont learn out of medical school and watch them walk away realizing whobthey are trying to talk down to lol. Like i said, i dont hate them, its about principles. A security guard is respected too, but if he tries to look down on a police officer, he will be confronted and should learn where his place and the red line is. Just logic..

 

[skypilot]

This chart is an eye opener. Don't forget all the private practice Anesthesiologists that are making Academic Anesthesiologist level salaries. There are plenty.

 

[amLOLdipine]

This chart is an eye opener. Don't forget all the private practice Anesthesiologists that are making Academic Anesthesiologist level salaries. There are plenty.

That chart would still hold true if you replaced Anesthesiology with one of many other fields, though. it's not an issue limited to anesthesiology at all.

Heck, CRNAs probably make more than a lot of family docs or general pediatricians, even without needing to factor in pay per hour.

 

[Random Anesthesiologist]

What is our quota for threads like these? I feel like I'm seeing the same ones constantly.

 

[deleted171991]

What academic anesthesiologist works 55 hours a week? Ours are out at noon on their precall day, come in at noon on call, and have their postcall day off.

You don't know what you are talking about.

Even coming in at noon on call day means 20 hours of work in my book, so it's normal to be off post-call. There are also late days that you don't see, as a resident. Time to start appreciating your attendings.

Most assistant professors (who are the cogs of the academic world), work at least 50 hours/week. Just because some of them are lazy dinguses, propped up by their longtime friendship with the leaders, doesn't mean that most are.

Anyway, people should stop believing that it's "normal" to work 50+ hours weekly. It's not, as an employee, in most civilized countries. The physician workweek of 50-60 hours on average comes from an age when physicians were true professionals and business partners. Also, it used to be that employees were paid overtime above 8-9 hours/day, e.g. in the academic world; now good luck if they do it after 10-11.

The problem is that they have so many providers to hire, if needed, that they can **** with you as they wish. Sixty hours or more weekly for crna-level hourly salary? Yes, sir! One call every 4 days or more frequently? Yes, sir! Do stupid elective cases in the middle of the night, after having worked 20 hours? Yes, sir, aye-aye, sir! There is no ACGME to protect attendings, especially in bad markets.

Work hard 10-20 years, live frugally, invest wisely, and maybe you'll have enough ****-you money so you don't have to jump for every stupid greedy employer. Until then, good luck practicing anesthesia; don't forget to numb up yourself, too.

 

[urge]

I hear Mman hires the crnas for way cheaper. And they take call too.

I imagine they didn't survey those for this data.

 

[Mman]

I hear Mman hires the crnas for way cheaper. And they take call too.

I imagine they didn't survey those for this data.

1) that's average salary, not starting salary. As I've said, our average cost per CRNA is under $200K per year including benefits.
2) that's 7 year old data in an environment with increasing oversupply

 

[deleted171991]

Best advice I can ever give you: Do not go to medical school. The time, effort, sacrifice, and enormous expense does not pay off. My recommendation for people who want to be in healthcare nowadays is to go to nursing school. Doctors are losing autonomy and nurses are gaining autonomy. They will meet at some level where they will be considered equals.

The reason for this is that we let the bean counters alter our patient-doctor relationships. The more personal this relationship is, the more likely one will be respected and valued as a physician, and the more irreplaceable one will be, in the hearts and minds of the patients. That's where the battle is won or lost.

That's why nurses score so high in public perception, and that's why they can afford ****ing with doctors. If we were the ones who had 30 minutes to waste per patient, getting to know the patient and his/her family, we would be the heroes of the healthcare world that nobody could touch without drawing the patients' ire. It's still like that with certain physicians, especially those who will treat the patient and the family crib to coffin, for better or for worse, the kind that go to their patients' houses and funerals.

This is the battle that we need to win. We need to stop compressing our patient encounters, stop taking less time just because the darn bean counters want to squeeze the lemon till it bursts, stop allowing nurses or other middlemen to do parts of our jobs. We need to win the PR battle, the "I love my doctor" battle. By the way, that's associated with way fewer malpractice suits, even when the doctor is obviously at fault. We need to start expressing the love for our patients, treat them like family, not like parts on an assembly lane, just because we work now in a factory (it's just labeled "hospital").

Food for thought.

Btw, that's why I want to be my own master, work as much as I want, in my own rhythm. Repeat after me: the patient always comes first, the patient always comes first, the patient always comes first...

 

[deleted171991]

2) that's 7 year old data in an environment with increasing oversupply

Meaning that, nowadays, both the CRNAs and employed docs make less. But they still make almost the same on an hourly basis, when counting CRNA overtime.

Let's just say that it's not worth taking the risks for 3 CRNAs and 3x the patients for a 30% bump in hourly salary. At least not in my book.

 

[IlDestriero]

I wonder if this chart includes the 52k that many PP groups put into their retirement accounts or not? I also wonder how many PP groups do that, and if not why not?
Others may make more, but it's always nice to see I'm doing pretty well though.
If your job sucks, go look for another one.
Income, lifestyle, location. Pick 2.


--
Il Destriero

 

[deleted162650]

Il D is spot the F on. That last sentence needs to be in bold at the top of this forum, and then it needs to get mailed out and hand delivered to a few of our more disgruntled members.

 

[deleted162650]

.

 

[deleted162650]

.

 

[deleted171991]

If your job sucks, go look for another one.
Income, lifestyle, location. Pick 2.

That was the old version. The new version is: Pick 1.

 

[Mman]

That was the old version. The new version is: Pick 1.

pick 3 if you are lucky
pick 2 if you are the majority of people
pick 1 if you are very picky and/or grumpy

 

[IlDestriero]

That was the old version. The new version is: Pick 1.

1 might be enough if you really want it bad enough. And if it's income, it means you get an early release from the torture. Unless of course you mismanaged and squandered your loot on super cars, hookers and blow. But you'd still have the memories, maybe, and the repair bills. There's lots of pride in a $25k valve job.


--
Il Destriero

 

[GA8314]

I'm 2 years out and even being a newbie to the attending world, I'm still glad that I chose what I did. In most ways.

I would say you "can't get wealthy" in this gig anymore. But, guess what? You actually can. Sure, it depends on what you consider wealth. But, if you do some consistent things over the years, you can acquire some wealth, even if incomes go down.

On a side note, I make just under $1500 every time I take a usually quiet overnight call in OB. I sleep in the call room and sometimes get hammered but usually not, and I make $130/hour. How many gigs can you choose to do this type of thing or take an extra call or two, AND it pays for your car and mortgage for the month??

This is not atypical to what is out there. Does that mean I must actually show the f.ck up and WORK?? Ah, yes. Yes it does. But, for most people making an extra $1500 takes a LOT more than what we have access to. I can not believe the sense of entitlement on this forum. How about being happy for what you have and stop the fu.cking bit.ching.

 

[BLADEMDA]

As long as you are well informed about the specialty, both positives and negatives, the choice to decide on Anesthesiology is a personal one. At least those who pick the specialty and read SDN can't ever say they were not told about the negatives.

 

[criticalelement]

I make $130/hour.

I can not believe the sense of entitlement on this forum. How about being happy for what you have and stop the fu.cking bit.ching.

130 bucks an hour is a crna wage....... You sound like the ceo to a management company. Thats what they would say... shut up and work!!!

 

[amLOLdipine]

On a side note, I make just under $1500 every time I take a usually quiet overnight call in OB. I sleep in the call room and sometimes get hammered but usually not, and I make $130/hour.

Is 130/hour your regular rate or only when on call? If the pay is different when you're on call, what's the regular rate?

 

[pgg]

130 bucks an hour is a crna wage....... You sound like the ceo to a management company. Thats what they would say... shut up and work!!!

$130/hr for overnight call when you usually don't do anything except sleep isn't a bad deal. The fact that it's in-house call is a drawback, but not a dealkiller. It all depends on the actual work load.

I used to take weekend call for about $70/hour. The horror! I had my phone on me and was on the hook for anything that came in Friday 4 PM to Monday 7 AM. Usually ended up working 8 or 10 hours total, typically daylight hour cases on Saturday that were Friday overflows. The surgeons had lives and didn't add on BS at 2 AM. 63 hours of carrying a pager for $4500. Tell me you wouldn't take that $70/hour job ...

 

[deleted171991]

There are people in this world for whom not almost everything is about money, or can be fixed with money.

Anyway... I should just keep my mouth shut.

 

[Carbocation1]

There are people in this world for whom not almost everything is about money, or can be fixed with money.

Anyway... I should just keep my mouth shut.

 

[waterbottle10]

I guess it depends on the academic center? All I hear from attendings is how bad calls are, you get swamped and if you can sleep 1-2 hours you are lucky. But recently we had a lecture in our department about the future, and how a high percentage of anesthesiology departments in the country are in the Red, and its only expected to get worse with Obamacare in full force. They were saying to hold off any buying anything expensive, like car, house, etc.

 

[Ezekiel2517]

Income, lifestyle, location. Pick 2.

All 3 of those are subjective and defined by the individual, so plenty of people can have them all, and plenty do

 

[Wiscoblue]

That's great that you get paid $130 an hour. But what would you say if I told you that you probably brought in 300 an hour for your bosses who skimmed $170 of that?


Sent from my iPad using Tapatalk

 

[Notorious T.E.E.]

They were saying to hold off any buying anything expensive, like car, house, etc.

That's really good advice. Don't sink $700k into a house until you are sure you are in a stable place you want to stay. Or, don't spend that kind of money on a house ever. It's bad to have to be a slave to your school debt, but worse to be a slave to your lifestyle.

 

[pgg]

That's great that you get paid $130 an hour. But what would you say if I told you that you probably brought in 300 an hour for your bosses who skimmed $170 of that?

I would say you're probably wrong, because this was likely $130/hour for about 12 hours of overnight call.

They didn't collect $5000 and pay him $1560 because he knocked out a bunch of ENT cases in patients with Blue Cross between 7 PM and 7 AM.

They paid him $1560 to sit there. Maybe he does a couple of emergent or urgent cases overnight ... an appy, some butt pus, whatever. The high profit cases in well-insured patients don't often come in at 2 AM (OB may be the exception to that rule). Call coverage is an expense, a loss leader, for many places.

 

[GA8314]

130 bucks an hour is a crna wage....... You sound like the ceo to a management company. Thats what they would say... shut up and work!!!

It's what the PP group pays anyone (partners included) to basically sleep all night. It's a lower volume OB service. About 1000 deliveries/yr.

 

[GA8314]

Anesthesia still pays well enough that that CAN be less true than it is for most of the population. Live like a mid-level engineer who goes on some really nice vacations, drives a nice care, and have a very high savings rate. Tackle student loans with VIGOR. And start early. Don't allow for lifestyle creep until that stuff is squared away. Then, use your earnings to accumulate wealth which you can do in this gig. For sure.

Now, what you can't do is go out and buy a $60k Mercedes, a Mcmansion, a Country Club membership. Live a NICE, comfortable life, and do some simple things and this is a great gig.

 

[GA8314]

I would say you're probably wrong, because this was likely $130/hour for about 12 hours of overnight call.

They didn't collect $5000 and pay him $1560 because he knocked out a bunch of ENT cases in patients with Blue Cross between 7 PM and 7 AM.

They paid him $1560 to sit there. Maybe he does a couple of emergent or urgent cases overnight ... an appy, some butt pus, whatever. The high profit cases in well-insured patients don't often come in at 2 AM (OB may be the exception to that rule). Call coverage is an expense, a loss leader, for many places.

What PGG said.

In fact, we don't even DO regular OR cases. It's strictly OB. That's it. Anything else goes to the regular call guy who is on home pager call.

And PGG is correct, the service doesn't pay for itself. We lose money on these shifts. Another reason we pay a reasonable wage of $130/hr. But, the rest of our business subsidizes it and we agreed to 24/7 OB call.

The point is that you can make $1500 with just a little willingness to sleep in a sh.tty call room, risk the random C-section, or a couple epidurals. Even those can make for a rougher day the next day since we consider these shifts "extras" and don't get the next day off. But, if you are recently out of residency, these are the voluntary shifts I would highly recommend to substantially augment your income.

The other point is that most jobs simply do not offer that level of augmented income, for simply doing what I've described. Do 4 of those shifts and that's an extra $6k/month. For the work, it's great pay actually. This is what many of us have the chance to do. We should feel lucky. Yes, I've said it. Lucky.

 

[Consigliere]

That's really good advice. Don't sink $700k into a house until you are sure you are in a stable place you want to stay. Or, don't spend that kind of money on a house ever. It's bad to have to be a slave to your school debt, but worse to be a slave to your lifestyle.

Word, Bigs.......word!