Future of Anesthesiologists

[deleted171991]

malpractice insurance. you aren't going bankrupt

I honestly don't know where you got his concept that juries don't award more than your malpractice insurance. They do, especially with OB. Most states don't have economic damage caps, and some don't have even those. And juries still think doctors are loaded.

Also, as critical keeps saying, getting a blot on your malpractice history can make you unemployable by many good groups. They just don't want to deal with the risks, the same way this society never truly reintegrates its felons. This is not a specialty where one can just start out on one's own, open a solo practice if nothing else works.

I have never been on the receiving end of this, but I have seen enough near misses to know that doctors can be classified into two groups: those who have been sued already, and those who don't know how lucky they are that their history is still clean.

And there is a huge difference when one is sued while being a partner, or as an employee. In the latter case, his employer dumps him like a hot potato, and good luck finding another job that doesn't exploit him. In a specialty where our employers and patients whine if the latter get even a nick in the lip, anybody less than perfect will have a hard time finding a good job.

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[criticalelement]

I feel sad for you. I know janitors that are happier at work than you.

I feel sad for me too. And I too know janitors that are happier at work than me. And I am not being facetious. And it is really not the work per se, it is the environment. I understand the dynamics of the situation of the Anesthesiologist and it is NOT favorable. People treat going under as a matter of course. Im getting a haircut ............ even surgeons and staff. Yet it is your adrenals that are catching the beating.

 

[aneftp]

I honestly don't know where you got his concept that juries don't award more than your malpractice insurance. They do, especially with OB. Most states don't have economic damage caps, and some don't have even those. And juries still think doctors are loaded.

Also, as critical keeps saying, getting a blot on your malpractice history can make you unemployable by many good groups. They just don't want to deal with the risks, the same way this society never truly reintegrates its felons. This is not a specialty where one can just start out on one's own, open a solo practice if nothing else works.

I have never been on the receiving end of this, but I have seen enough near misses to know that doctors can be classified into two groups: those who have been sued already, and those who don't know how lucky they are that their history is still clean.

And there is a huge difference when one is sued while being a partner, or as an employee. In the latter case, his employer dumps him like a hot potato, and good luck finding another job that doesn't exploit him. In a specialty where our employers and patients whine if the latter get even a nick in the lip, anybody less than perfect will have a hard time finding a good job.

Yes and no on the malpractice. As AMCs get bigger and bigger. They become self insured (see Sheridan, American anesthesiology, and I think even team health now). While smaller groups cannot absorb someone with a bad malpractice history. Many AMCs can absorb the cost of bringing on someone with a bad malpractice history. And academic medical centers and hospital employed positions can also absorb someone with a bad history as well.

 

[criticalelement]

I honestly don't know where you got his concept that juries don't award more than your malpractice insurance. They do, especially with OB. Most states don't have economic damage caps, and some don't have even those. And juries still think doctors are loaded.

Also, as critical keeps saying, getting a blot on your malpractice history can make you unemployable by many good groups. They just don't want to deal with the risks, the same way this society never truly reintegrates its felons. This is not a specialty where one can just start out on one's own, open a solo practice if nothing else works.

I have never been on the receiving end of this, but I have seen enough near misses to know that doctors can be classified into two groups: those who have been sued already, and those who don't know how lucky they are that their history is still clean.

And there is a huge difference when one is sued while being a partner, or as an employee. In the latter case, his employer dumps him like a hot potato, and good luck finding another job that doesn't exploit him. In a specialty where our employers and patients whine if the latter get even a nick in the lip, anybody less than perfect will have a hard time finding a good job.

Listen to this guy!

 

[deleted171991]

Yes and no on the malpractice. As AMCs get bigger and bigger. They become self insured (see Sheridan, American anesthesiology, and I think even team health now). While smaller groups cannot absorb someone with a bad malpractice history. Many AMCs can absorb the cost of bringing on someone with a bad malpractice history. And academic medical centers and hospital employed positions can also absorb someone with a bad history as well.

All of those probably satisfy the definition of a bad job, for many posters. And even self insurance doesn't mean that they are ready to pay out millions for your mistake. Nope, it's one on them, the rest on you (for the typical 1M/3M coverage).

Also, when given the choice between a malpractice virgin and a potential problem, most groups will still choose the former.

I don't know enough about the post-malpractice employment part but, having read a few personal experiences about how it feels just to be sued, certain risks are not worth it to me under a certain income level.

At least, in critical care, it's much tougher to prove malpractice. Plus people are already so sick that expectations are much lower.

 

[Mman]

I honestly don't know where you got his concept that juries don't award more than your malpractice insurance. They do, especially with OB. Most states don't have economic damage caps, and some don't have even those. And juries still think doctors are loaded.

Simply incorrect. The majority of states will never (or almost never) award a judgment beyond your insurance. I don't know where you get the idea that the risk is high of it happening and I'll reiterate if your concern is going bankrupt, don't be a doctor.

 

[criticalelement]

Simply incorrect. The majority of states will never (or almost never) award a judgment beyond your insurance.

How can you possible make a statement like that? How do you know? How do you know that? THere was just a 52 million dollar jury judgement in NYS against an obstetrician. I bet you the doctor had a 2/4 million dollar policy. This is one of many that ive heard of in that state and other states as well.

 

[Mman]

How can you possible make a statement like that? How do you know? How do you know that? THere was just a 52 million dollar jury judgement in NYS against an obstetrician. I bet you the doctor had a 2/4 million dollar policy. This is one of many that ive heard of in that state and other states as well.

Because my lawyer and malpractice company showed me the data.

You heard about a $52 million jury judgement in NYS? Oh boy! How many doctors are in this country? If a plane crashes in Nairobi, do you not fly a plane ever?

I'm serious when I say if somebody is concerned about going bankrupt from a malpractice suit that they shouldn't practice medicine.

 

[deleted171991]

I was intrigued by Mman, so I did a web search.

This is what I found:
- Anesthesiologists have a 7%/year chance of getting sued which is slightly below average (7.3%) across specialties.
- Per malpractice attorney organizations, the chance of having to pay out of pocket (beyond the typical one million paid by the insurance) is less than 3%, among those sued. But they use the same data to show that malpractice contributions to healthcare costs are not high, so there is no need for malpractice reform. Suuuure!

My personal conclusions haven't changed much: getting sued, per se, is a huge slap in the face for most anesthesiologists' careers. However, I am less concerned now about the chances of out of pocket payout. I don't believe in the 3% number, but it's probably less than 10%, as long as one has a decent policy (at least $1M in my book). One should worry less about the payout, and more about not getting sued in the first place.

The discussion started from whether it's worth doing OB anesthesia. I am still of the opinion that the 18-20 years of malpractice risk are not worth it for $130/hour (or as an employee, in general). This beyond the fact that OB and peds will have the highest payouts (long term care).

 

[IlDestriero]

We've all been involved in some bad or less than ideal outcome that could have probably lead to a lawsuit of some kind. From a chipped tooth to some case the surgeon botched or nasty traumas where the patient was lucky to get out alive. I don't forget that. Maybe they are groundless, maybe not, maybe we get found 20% responsible, who knows. I don't want to be in the crosshairs. However, I can't work in fear of getting sued. Work hard, stay current, do your best, have a good attitude, and be friendly and competent sounding when you speak to the families. That's all you can do.


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Il Destriero

 

[deleted171991]

We've all been involved in some bad or less than ideal outcome that could have probably lead to a lawsuit of some kind. From a chipped tooth to some case the surgeon botched or nasty traumas where the patient was lucky to get out alive. I don't forget that. Maybe they are groundless, maybe not, maybe we get found 20% responsible, who knows. I don't want to be in the crosshairs. However, I can't work in fear of getting sued. Work hard, stay current, do your best, have a good attitude, and be friendly and competent sounding when you speak to the families. That's all you can do.


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Il Destriero

+1. Communication and affability are king, when about malpractice risk.

 

[criticalelement]

+1. Communication and affability are king, when about malpractice risk.

True, perhaps when having a long term relationship with patients, however, less true with us. IF you have a bad outcome, and it is attributable to anesthesia you WILL be named in the lawsuit. Guaranteed. Nothing personal.

 

[BLADEMDA]

The facts are the facts: 60% of Anesthesiologist will be sued during their careers. This means one lawsuit should not be the end of your career. If this happens to you try to remember good doctors do get sued even if they did nothing wrong. If the outcome wasn't as expected or there was a complication the patient and/or family may sue you and the surgeon.

The chances that the lawsuit will exceed your $1 million liability policy is remote and more likely, the lawsuit will either be dismissed or settled for a lot less than the $1 million. Sometimes it is easier and cheaper to settle the lawsuit for $100,000 rather than defend the case or go to trial.

Technically, even if you get "dismissed from the case" that lawsuit should be reported to all current and future medical boards and hospitals for the rest of your career. Or, if you win your case at trial (no malpractice) that lawsuit must be disclosed for the remainder of your career.
In both of those scenarios the lawsuit will likely not be reported to the National Data Bank.

 

[BLADEMDA]

What You Must Report to the NPDB
The NPDB collects information and maintains reports on the following:

• Medical malpractice payments
• Federal and state licensure and certification actions
• Adverse clinical privileges actions
• Adverse professional society membership actions
• Negative actions or findings by private accreditation organizations and peer review organizations
• Health care-related criminal convictions and civil judgments
• Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid exclusions)
• Other adjudicated actions or decisions

 

[dhb]

+1. Communication and affability are king, when about malpractice risk.

Or blaming the patient for your incompetence:
I've heard of a couple of surgeon who would go see the patient after an adverse event, and would curse them for their rotten anatomy and what not.
They would say to them they were lucky because if it had been any other surgeon they would have died on the table etc... and the patients would thank them profusely

 

[amLOLdipine]

People have been asking about the future of fields like anesthesia and radiology for as long as internet forums have been around.

Guess what? Anesthesiologists and radiologists still have jobs, and still make a good living.

See this thread from 15 years ago:
http://forums.studentdoctor.net/thr...-radiologists-emergency-med-spec-select.15448

 

[sethco]

We've all been involved in some bad or less than ideal outcome that could have probably lead to a lawsuit of some kind. From a chipped tooth to some case the surgeon botched or nasty traumas where the patient was lucky to get out alive. I don't forget that. Maybe they are groundless, maybe not, maybe we get found 20% responsible, who knows. I don't want to be in the crosshairs. However, I can't work in fear of getting sued. Work hard, stay current, do your best, have a good attitude, and be friendly and competent sounding when you speak to the families. That's all you can do.


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Il Destriero

I have been a party to a lawsuit where only the Anesthesia personnel (myself, my attending at the time, and the University) were named in the suit, despite it being an obvious surgical complication. This happened during residency, so it probably would not have had as much effect on me as my attending. I was later dropped from the suit as a part of a "high/low" agreement, but still had to testify. The "expert" witnesses that the plaintiff dug up were pretty appalling, being either not in the field of Anesthesiology or being out of clinical practice for 10+ years!!! I can tell my attending was really shaken up during the process, and I am sure it probably (maybe subconsciously) affected the way he practices for future patients. This is a shame because he is among the best teachers I know and really cares about resident education.

That being said, very rarely do I ever think of it and I like to think that it hasn't affected the way I practice. However, since it happened during residency, I guess I will never know

 

[Mman]

People have been asking about the future of fields like anesthesia and radiology for as long as internet forums have been around.

Guess what? Anesthesiologists and radiologists still have jobs, and still make a good living.

See this thread from 15 years ago:
http://forums.studentdoctor.net/thr...-radiologists-emergency-med-spec-select.15448

great find. I find it amazing how long the archive of threads is here and what you can dig up. Anesthesiology has been a dying specialty since the 1970s if not earlier.

 

[Carbocation1]

New Medscape salary 2016 report is out. Derm, Cards, Ortho, EM --> all increased. Gas stayed the same, therefore dropping in the rankings compared to last year.

 

[amLOLdipine]

New Medscape salary 2016 report is out. Derm, Cards, Ortho, EM --> all increased. Gas stayed the same, therefore dropping in the rankings compared to last year.

Anesthesiology grew by 1%. Not a huge increase, but certainly not a huge decrease like Allergy/Pulm. And coming in at #7 overall is not bad at all.

It's worth noting that Anesthesia showed a 7% growth in the 2015 report, so the market may be stabilizing a bit. Everything tends to happen in cycles. Radiology was on the decline for the past few years, but the job market has started to pick up again.

 

[amLOLdipine]

I find it somewhat funny that ortho and urology are near the bottom of this list:

 

[67552931811]

great find. I find it amazing how long the archive of threads is here and what you can dig up. Anesthesiology has been a dying specialty since the 1970s if not earlier.

My dad was telling me about how he was constantly told of the doom and gloom of anesthesia when he was applying for residency and to stay away: that was in the 80s.....

 

[Doctor4Life1769]

My dad was telling me about how he was constantly told of the doom and gloom of anesthesia when he was applying for residency and to stay away: that was in the 80s.....

Things got better in the 90s because the circumstances allowed for it.
It's cyclical. It's to be seen if the specialty is able to rebound in the future.

 

[67552931811]

Things got better in the 90s because the circumstances allowed for it.
It's cyclical. It's to be seen if the specialty is able to rebound in the future.

touché

 

[deleted171991]

Things got better in the 90s because the circumstances allowed for it.
It's cyclical. It's to be seen if the specialty is able to rebound in the future.

We've discussed many times why there won't be much rebound this time. The market is being flooded with providers, both anesthesiologists and CRNAs. Not only that but, for the first time, CRNAs have a high probability of getting independent practice in one of the biggest corporations: the VA. Once it happens there, the model will propagate everywhere, the same way ACT has conquered 70% of the market. And things have been really slow in the past, because of much fewer anesthesia providers, which won't be an issue in the future.

The anesthesiologists who will survive the coming slaughter will be the ones able to do cases CRNAs can't, period. That applies to many specialties and midlevels, but they are far behind anesthesia, which has been seen as a half medical half nursing specialty, even before the CRNA independence movement. So the stakeholders are already primed to replace doctors with nurses, in anesthesia; all they need are the guinea pig organizations to prove it. It's just a matter of time, before it will reach critical mass. ACT will die the same way solo anesthesia is rapidly dying wherever anesthesia falls under corporate management. Those managers just LOVE the idea of replacing docs with cheap nurses; if you don't believe me, see what happens in an academic hospital when a regular doc pisses off a CRNA. The lucky few who will still have jobs practicing anesthesia will work as firefighters, or doing sick cases and difficult procedures that suck the life out of you, all for less pay than in a surgicenter today.

It's simple market forces: in 10 years, there will be five people wanting to take your place, should you not bend knee to your corporate overlord. Remember Palm? Or Blackberry? Our children will say to their children: remember doctors? There is no cycle, no more as there was for all the industries that have been offshored in the last decades. You are dinosaurs, you just don't know it yet. Good luck waiting for the end of the coming Ice Age.

P.S. I honestly hate being the pessimist, but I've been watching this for the last 8 years, and the trend is clear. It's just the speed that I can't really guess.

 

[amLOLdipine]

We've discussed many times why there won't be much rebound this time. The market is being flooded with providers, both anesthesiologists and CRNAs. Not only that but, for the first time, CRNAs have a high probability of getting independent practice in one of the biggest corporations: the VA. Once it happens there, the model will propagate everywhere, the same way ACT has conquered 70% of the market. And things have been really slow in the past, because of much fewer anesthesia providers, which won't be an issue in the future.

The anesthesiologists who will survive the incoming slaughter will be the ones able to do cases CRNAs can't, period. That applies to many specialties and midlevels, but they are far behind anesthesia, which has been seen partly as a nursing specialty even before the CRNA independence movement. So the stakeholders are already primed to replace doctors with nurses, in anesthesia; all they need are the guinea pig organizations to prove it. It's just a matter of time, before it will reach critical mass. ACT will die the same way solo anesthesia is rapidly dying wherever anesthesia falls under corporate management. Those managers just LOVE the idea of replacing docs with cheap nurses; if you don't believe me, see what happens in an academic hospital when a regular doc pisses off a CRNA. The lucky few who will still have jobs practicing anesthesia will work as firefighters, or doing sick cases and difficult procedures that suck the life out of you, all for less pay than in a surgicenter today.

It's simple market forces: in 10 years, there will be five people wanting to take your place, should you not bend knee to your corporate overlord. Remember Palm? Or Blackberry? Our children will say to their children: remember doctors? There is no cycle, no more as there was for all the industries that have been offshored in the last decades. You are dinosaurs, you just don't know it yet. Good luck waiting for the end of the coming Ice Age.

It's kind of hard to believe the same doom & gloom when the exact same sentiment has been repeated for the last 30 years...

And with talk like "coming of the Ice Age", you make it sound like there is no backup plan. Even if the sky falls for anesthesiology, a CC fellowship is only 1 year. Problem solved.

 

[Doctor4Life1769]

We've discussed many times why there won't be much rebound this time. The market is being flooded with providers, both anesthesiologists and CRNAs. Not only that but, for the first time, CRNAs have a high probability of getting independent practice in one of the biggest corporations: the VA. Once it happens there, the model will propagate everywhere, the same way ACT has conquered 70% of the market. And things have been really slow in the past, because of much fewer anesthesia providers, which won't be an issue in the future.

The anesthesiologists who will survive the incoming slaughter will be the ones able to do cases CRNAs can't, period. That applies to many specialties and midlevels, but they are far behind anesthesia, which has been seen partly as a half medical half nursing specialty, even before the CRNA independence movement. So the stakeholders are already primed to replace doctors with nurses, in anesthesia; all they need are the guinea pig organizations to prove it. It's just a matter of time, before it will reach critical mass. ACT will die the same way solo anesthesia is rapidly dying wherever anesthesia falls under corporate management. Those managers just LOVE the idea of replacing docs with cheap nurses; if you don't believe me, see what happens in an academic hospital when a regular doc pisses off a CRNA. The lucky few who will still have jobs practicing anesthesia will work as firefighters, or doing sick cases and difficult procedures that suck the life out of you, all for less pay than in a surgicenter today.

It's simple market forces: in 10 years, there will be five people wanting to take your place, should you not bend knee to your corporate overlord. Remember Palm? Or Blackberry? Our children will say to their children: remember doctors? There is no cycle, no more as there was for all the industries that have been offshored in the last decades. You are dinosaurs, you just don't know it yet. Good luck waiting for the end of the coming Ice Age.

Yes, I'm fully aware. The cycle probably will plateau out with the rewards not being nearly as great as the downslopes.
These med students just don't get it though. It's almost like they've felt the Bern.

 

[Doctor4Life1769]

It's kind of hard to believe the same doom & gloom when the exact same sentiment has been repeated for the last 30 years...

And with talk like "coming of the Ice Age", you make it sound like there is no backup plan. Even if the sky falls for anesthesiology, a CC fellowship is only 1 year. Problem solved.

The circumstances are changing, not for the better. I'm sure you'll be happy working for EMCare or Sheridan for 250k.

 

[amLOLdipine]

Yes, I'm fully aware. The cycle probably will plateau out with the rewards not being nearly as great as the downslopes.
These med students just don't get it though. It's almost like they've felt the Bern.

The more med students buy into the doom and gloom, the better it will be for those of us who do go into the field.

 

[Doctor4Life1769]

The more med students buy into the doom and gloom, the better it will be for those of us who do go into the field.

That's how the pyramid scheme was born. The whales pump, you buy in, then they dump and you're left holding nothing. In these instances, sometimes you're better off cutting your losses and dumping at a loss. Some stocks that sink don't ever really recover.

 

[amLOLdipine]

That's how the pyramid scheme was born. The whales pump, you buy in, then they dump and you're left holding nothing. In these instances, sometimes you're better off cutting your losses and dumping at a loss. Some stocks that sink don't ever really recover.

The same thing has been said so many times about anesthesia and radiology in the past. It's all a cycle.

Take radiology, for example. Med students were abandoning radiology in droves several years ago. The match was filled with more FMGs than IMGs just a few years back. Doom & gloom warnings were being posted on SDN every day telling med students to avoid radiology like the plague.

Well, look what happened. The job market has picked up and the # of positions being posted on ACR has almost tripled in the last 4 years.

The circumstances are changing, not for the better. I'm sure you'll be happy working for EMCare or Sheridan for 250k.

For the right job setting, I'd be happy with less than that. SO is also in medicine will make a healthy income, so $$$ isn't really the #1 priority on my list.

 

[Doctor4Life1769]

The same thing has been said so many times about anesthesia and radiology in the past. It's all a cycle.

Take radiology, for example. Med students were abandoning radiology in droves several years ago. The match was filled with more FMGs than IMGs just a few years back. Doom & gloom warnings were being posted on SDN every day telling med students to avoid radiology like the plague.

Well, look what happened. The job market has picked up and the # of positions being posted on ACR has almost tripled in the last 4 years.



For the right job setting, I'd be happy with less than that. SO is also in medicine will make a healthy income, so $$$ isn't really the #1 priority on my list.

What job market in rads? You have to do a fellowship after 5 years of training.
The healthcare and political climate is different than it was on the last downslope.
Be careful what you wish for

 

[amLOLdipine]

What job market in rads? You have to do a fellowship after 5 years of training.
The healthcare and political climate is different than it was on the last downslope.

What's your point? Most specialties that are well-compensated require a significant dedication to training. Most gen surg programs are 5 + 2 before fellowship. On average, radiology is still one of the highest-compensated fields in medicine, and so the length of training makes sense. Plenty of IM subspecialties are compensated much less than radiology and still require 6 years of postgraduate training (7 with a chief year).

If you wanted to take the short path, there's always family med or general IM. Not saying those are bad fields, but FM is not right for everyone.

 

[Doctor4Life1769]

What's your point? Any specialty that is well-compensated requires a significant dedication to training. Most gen surg programs are 5 + 2 before fellowship.

If you wanted to take the short path, there's always family med or general IM. Not saying those are bad fields, but FM is not right for everyone.

Way to be lazy.
That's just looking at total number of jobs. It says nothing about type of jobs, what one would be doing, pay, location, etc.

http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=111731
http://www.radiologybusiness.com/to...gist-workforce-decline-projected-through-2016

No **** a well-compensated specialty requires "dedication to training." However, with radiology there is very little if any market for the general radiologist. One goes into that specialty KNOWING that they have to specialize. IR is different and one should do a fellowship, but for MSK, body, etc? You should get that in your general residency. Pathology residents know they have to do TWO fellowships to get a job.

The link I posted even reports that while there has been a slight bump in total jobs, you're not even guaranteed to USE what you learned in your fellowship year (likely exception, IR).

Overall, the job market is pretty flat. There could be a slight spike with folks retiring, but they have their issues with Night hawk. The one thing in their favor is there is no midlevel encroachment and there aren't really corporations looking to get into the rads market like they invaded the EM, anesthesia, and hospitalist markets.

Surgery is a completely different beast and you and I know this. Well, maybe you don't from your previous ramblings. You can't learn everything you need to learn from a general surgery residency if you want to be an expert in a certain sub-specialty. However, one can still go out into the community after a general surgery residency and find a PP, academic, or hospital employed position without issues. If you do a fellowship, you are guaranteed to be doing what you sub-specialized in. Sure, while on call you may have some general cases but that's not the majority of what you'd be doing.

It's not about getting through the least number of years in training. It's about being able to utilize your training and being adequately compensated for it, and still having reasonable autonomy and not worry about midlevel encroachment to the point where these folks are able to practice independently without you (in what you worked hard to train in) such that you have to go back and do more just to get a decent job.

 

[bronx43]

The more med students buy into the doom and gloom, the better it will be for those of us who do go into the field.

Actually the fact that the number of med students is going up rapidly in this country, this sentiment is no longer true. Back in the day, when med students were driven away from a field, TONS of residency spots went unfilled, which provided for a huge drop off in the supply of providers coming into the market. Now, when a field becomes "uncompetitive," it simply means that the spots will get filled with worse applicants. The supply and demand effect simply isn't there anymore.

This idea that the physician job market and overall income potential is always cyclic is unfounded. This isn't the business cycle. This isn't the inevitable boom and bust that inherently follows periods of credit expansion and eventual deleveraging. The only reason why the market for physicians appeared cyclic in the past is due to what I already mentioned - that med students leaving or entering a field created a supply vacuum that translated into more jobs and higher pay as employer demand for those providers increased.

 

[deleted171991]

Actually the fact that the number of med students is going up rapidly in this country, this sentiment is no longer true. Back in the day, when med students were driven away from a field, TONS of residency spots went unfilled, which provided for a huge drop off in the supply of providers coming into the market. Now, when a field becomes "uncompetitive," it simply means that the spots will get filled with worse applicants. The supply and demand effect simply isn't there anymore.

This idea that the physician job market and overall income potential is always cyclic is unfounded. This isn't the business cycle. This isn't the inevitable boom and bust that inherently follows periods of credit expansion and eventual deleveraging. The only reason why the market for physicians appeared cyclic in the past is due to what I already mentioned - that med students leaving or entering a field created a supply vacuum that translated into more jobs and higher pay as employer demand for those providers increased.

It doesn't matter whether the number of USMGs is going up or down. It's the number of residency spots that matters, and that has been going up. Worst case scenario, they will find FMGs to fill the spots. It's not like 20-30 years ago. Now they have a solid pipeline of foreign docs if needed. As long as there is still a huge income difference between the US and developing countries, there will always be a flood of people coming here for a better life. Those people will keep coming even for being paid the average American household income, please realize that. So there will be no "cycle" this time. We/you have been already "offshored" to nurses and more foreigners like myself, some of us just don't know it yet.

 

[Mman]

We've discussed many times why there won't be much rebound this time. The market is being flooded with providers, both anesthesiologists and CRNAs. Not only that but, for the first time, CRNAs have a high probability of getting independent practice in one of the biggest corporations: the VA. Once it happens there, the model will propagate everywhere, the same way ACT has conquered 70% of the market. And things have been really slow in the past, because of much fewer anesthesia providers, which won't be an issue in the future.

Yes, we discussed many times. And the same discussions have been had about anesthesiology longer than anybody here has been in medicine. It's always different this time. It was different 15 years ago. It was different 30 years ago. It was different 40 years ago.

It's like economic forecasting. The most popular forecasters are the nebulous bears that foresee doom, they just can't pin down the details and they never get called out for their incorrect predictions because they just say things like it should've already happened and it's still coming. The end is always near.

 

[deleted171991]

I am not talking about "the end", just about market forces that did not exist during the last cycle. In a country where the average Joe has no idea that an anesthesiologist is a physician, don't expect anybody to protest when we'll be replaced with nurses. Unless we have a Libby Zion case with an independent nurse at some point, I expect the march toward independence to continue.

Last time doctors were under fire, there was way more respect for them than nowadays. Not only from the bean counters, but from the general public. To be precise, last time the bean counters were still doctors.

 

[NOsaintsfan]

How does the aging baby boomer population and the expected increase in surgeries factor into this? As you all know surgical volume will go up over the next 20-30 years.

 

[deleted171991]

How does the aging baby boomer population and the expected increase in surgeries factor into this? As you all know surgical volume will go up over the next 20-30 years.

There is a CRNA school at every corner. There is an APRN school at every corner. And look at the body language of their students: they behave like people who are continuously told that they are equal to us. The average medical student is much more timid than the average midlevel student. These people will have no qualms while coming for your job. Fake it till you make it.

 

[deleted171991]

How does the aging baby boomer population and the expected increase in surgeries factor into this? As you all know surgical volume will go up over the next 20-30 years.

While Medicare expenses will stay the same or lower. How do you think that will happen?

 

[NOsaintsfan]

There is a CRNA school at every corner. There is an APRN school at every corner. And look at the body language of their students: they behave like people who are continuously told that they are equal to us. The average medical student is much more timid than the average midlevel student. These people will have no qualms coming for your job.

This makes sense and don't doubt it.

I can see a situation where independent practice is actually good for MD/DO's. I've seen enough near miss situations to think that if CRNA's in mass were practicing independently the bad outcomes would add up pretty quick.

It would be horrible for patients of course but sometines you have to give people enough rope to hang themselves so to speak.

 

[kidthor]

There is a CRNA school at every corner. There is an APRN school at every corner. And look at the body language of their students: they behave like people who are continuously told that they are equal to us. The average medical student is much more timid than the average midlevel student. These people will have no qualms while coming for your job. Fake it till you make it.

Their body language is absolutely telling. I watched in terror the other day as an SRNA did a rough job on a routine intubation (teeth scraping, lip pinching, tube ramming, etc.). She thought nothing of it. I'm sure she'd think any visible trauma was total random chance not at all attributable to her. Of course the attending anesthesiologist would be the one blamed for it ultimately.

Speaking of which, why should Anesthesiologists have anything to do with the teaching of SRNAs!? Yeah, I know it's a money grab for departments who want to make their balance sheets look better... but the teaching of our arrogant under-skilled replacements is an absurd forced act of self loathing.

 

[criticalelement]

This makes sense and don't doubt it.

I can see a situation where independent practice is actually good for MD/DO's. I've seen enough near miss situations to think that if CRNA's in mass were practicing independently the bad outcomes would add up pretty quick.

It would be horrible for patients of course but sometines you have to give people enough rope to hang themselves so to speak.

That is true but once the law is the law it is hard to go back. That is why all of us are fighting tooth and nail to prevent mid levels from making in roads towards independent practice because we believe education and length of training matters. Bad judgement decisions because of lack of understanding can lead to disastrous complications.. The leadership of the ASA is horrendous.

 

[Psai]

Their body language is absolutely telling. I watched in terror the other day as an SRNA did a rough job on a routine intubation (teeth scraping, lip pinching, tube ramming, etc.). She thought nothing of it. I'm sure she'd think any visible trauma was total random chance not at all attributable to her. Of course the attending anesthesiologist would be the one blamed for it ultimately.

Speaking of which, why should Anesthesiologists have anything to do with the teaching of SRNAs!? Yeah, I know it's a money grab for departments who want to make their balance sheets look better... but the teaching of our arrogant under-skilled replacements is an absurd forced act of self loathing.

I totally agree. I don't understand how it can be so hard to solve this problem. Stop training them, don't hire them and keep our place in the OR. We have all the education and the experience so why is the asa acting so impotent? Hey let's try to be a surgical np and do all the surgeon's work outside of the OR for free while giving up what people go into the field to do in the OR. I went into anesthesiology to be the surgeon's handmaiden in the or, not on the floors or in clinic

 

[criticalelement]

I totally agree. I don't understand how it can be so hard to solve this problem.

I have come to the conclusion that it is not a problem that wants to be solved. Many folks WANT more midlevels and less physicians. The anti physician sentiment is palpable everywhere . They think we are too entitled, we make too much money our suggestions are un reasonable, and our presence is grotesque to the national interest of this country. And the nursing and all the ancillary staff schools are taught how WE are the problem. How would you like to come to work daily and deal with that after working so hard in medical scool and residency? How would you like the govt switching things up on you after you acccrued all these loans. No wonder the default rate on student loans is going up.

 

[Mman]

I totally agree. I don't understand how it can be so hard to solve this problem. Stop training them, don't hire them and keep our place in the OR.

There are not enough anesthesiologists in the United States to staff every anesthetic 1:1, not even close, and there will never be enough. There are roughly 35,000 anesthesiologists in the country and over 100,000,000 surgeries per year. That's approximately 3,000 surgeries per anesthesiologist per year. And that ignores a lot of other procedures we get involved in such as radiology and endoscopy. And the number of surgeries and procedures requiring anesthesia each year will continue to grow as our population ages.

 

[criticalelement]

There are not enough anesthesiologists in the United States to staff every anesthetic 1:1, not even close, and there will never be enough. T.

Yes but the answer is NOT eliminate physician involvement and grant full autonomy to nurses everywhere. That is just down crazy and dangerous. It undermines medical education everywhere. Write letters to your congressman, senators and the president. Unfortunately, to raise awareness to the the problem there needs to be more high profile deaths and major organizations need to be held accountable in the form of billion dollar payments.

 

[criticalelement]

Yes but the answer is NOT eliminate physician involvement and grant full autonomy to nurses everywhere. That is just down crazy and dangerous. It undermines medical education everywhere. Write letters to your congressman, senators and the president. I would much rather open up Physician assistant schools and train a **** load of PA/AA than advance nursing.

Unfortunately, to raise awareness to the the problem there needs to be more high profile deaths and major organizations need to be held accountable in the form of billion dollar paymen

 

[Mman]

Yes but the answer is NOT eliminate physician involvement and grant full autonomy to nurses everywhere. That is just down crazy and dangerous. It undermines medical education everywhere. Write letters to your congressman, senators and the president. Unfortunately, to raise awareness to the the problem there needs to be more high profile deaths and major organizations need to be held accountable in the form of billion dollar payments.

Perhaps you could point to the place where I argued for that. I believe 100% of anesthetics in this country should be directed by an anesthesiologist.

I'm saying you can't get rid of CRNAs. You can't stop hiring them, stop training them, etc. as the post I replied to stated.