Future of Anesthesiologists

[bashwell]

I don't think this trend is limited to anesthesia. I'm not sure how things are in Australia where you are from, but here in the US many specialties are getting reimbursement cuts, including some surgical specialties.

Setting your expectations too high leads to dissatisfaction down the road. I believe in doing your research beforehand, but keeping expectations reasonable.

I sure hope it's not a "trend" across anesthesia and other specialties for people to expect lower salaries, etc.! That'd be sad if so. But I think you're very wise and prudent to have reasonable expectations, and completely agree with you there. I was just saying it seems some people going into anesthesia are "low-balling" themselves, but that I really hope that's NOT the case. That's all I meant to imply.

In Australia things seem good or even great to me for anesthesia. The approximately $300k (starting) salary for 40-45 hours is completely possible and in fact that's pretty standard or common. You get increases for seniority and other things, so could get up to $400k+. Plus you get paid extra for taking on call, working odd hours, holidays, etc. And this is for an anesthesiologist (aka anaesthetist) working in the public healthcare system here, not private. Private you can expect a lot more. For pay it's (very roughly) 1 day of private = 3 days of public. You always sit your own cases, unless you're in a public teaching hospital where you and a resident (aka registrar) will be present. Also no CRNAs here. There are anaesthetic nurses who help, but they're nothing like CRNAs. No mid-level encroachment. And while there are issues with the Australian healthcare system, and while the government is always trying to minimise healthcare costs, it's currently much more stable than the US healthcare system, so much less to worry about in terms of sudden reimbursement cuts, etc. It's also much less stressful or chill while you're working, or so I've been told by people who have worked in both US and Australia. All in all, I'd say things are pretty good for anaesthesia in Australia.

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[Chloroform4Life]

I sure hope it's not a "trend" across anesthesia and other specialties for people to expect lower salaries, etc.! That'd be sad if so. But I think you're very wise and prudent to have reasonable expectations, and completely agree with you there. I was just saying it seems some people going into anesthesia are "low-balling" themselves, but that I really hope that's NOT the case. That's all I meant to imply.

In Australia things seem good or even great to me for anesthesia. The approximately $300k (starting) salary for 40-45 hours is completely possible and in fact that's pretty standard or common. You get increases for seniority and other things, so could get up to $400k+. Plus you get paid extra for taking on call, working odd hours, holidays, etc. And this is for an anesthesiologist (aka anaesthetist) working in the public healthcare system here, not private. Private you can expect a lot more. For pay it's (very roughly) 1 day of private = 3 days of public. You always sit your own cases, unless you're in a public teaching hospital where you and a resident (aka registrar) will be present. Also no CRNAs here. There are anaesthetic nurses who help, but they're nothing like CRNAs. No mid-level encroachment. And while there are issues with the Australian healthcare system, and while the government is always trying to minimise healthcare costs, it's currently much more stable than the US healthcare system, so much less to worry about in terms of sudden reimbursement cuts, etc. It's also much less stressful or chill while you're working, or so I've been told by people who have worked in both US and Australia. All in all, I'd say things are pretty good for anaesthesia in Australia.

Man I want to move to Australia. How's the tort system there? Any fear of big malpractice awards?

 

[amLOLdipine]

I sure hope it's not a "trend" across anesthesia and other specialties for people to expect lower salaries, etc.! That'd be sad if so. But I think you're very wise and prudent to have reasonable expectations, and completely agree with you there. I was just saying it seems some people going into anesthesia are "low-balling" themselves, but that I really hope that's NOT the case. That's all I meant to imply.

In Australia things seem good or even great to me for anesthesia. The approximately $300k (starting) salary for 40-45 hours is completely possible and in fact that's pretty standard or common. You get increases for seniority and other things, so could get up to $400k+. Plus you get paid extra for taking on call, working odd hours, holidays, etc. And this is for an anesthesiologist (aka anaesthetist) working in the public healthcare system here, not private. Private you can expect a lot more. For pay it's (very roughly) 1 day of private = 3 days of public. You always sit your own cases, unless you're in a public teaching hospital where you and a resident (aka registrar) will be present. Also no CRNAs here. There are anaesthetic nurses who help, but they're nothing like CRNAs. No mid-level encroachment. And while there are issues with the Australian healthcare system, and while the government is always trying to minimise healthcare costs, it's currently much more stable than the US healthcare system, so much less to worry about in terms of sudden reimbursement cuts, etc. It's also much less stressful or chill while you're working, or so I've been told by people who have worked in both US and Australia. All in all, I'd say things are pretty good for anaesthesia in Australia.

Was that in Australian dollars or US dollars?

Either way, I guess I better get over my fear of huge spiders and pack my bags!

 

[pre med 2014]

Right now 400k AUD is 300K US dollar. But keep in mind the obscene cost of living generally reduces quality of life.

That being said there are many other positives to living in Australia but property ownership is not one of them. Would suck paying 500K to own a 1 bedroom apartment when you could buy a mansion in the Midwest or Arizona for that price.


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[bashwell]

Man I want to move to Australia. How's the tort system there? Any fear of big malpractice awards?

Should totally come! I'm afraid I don't know the tort system, though it's not "no fault" like I've heard it is in New Zealand. But I was once told by an OB/GYN if someone sues, and loses, then the person bringing the law suit has to pay both parties' legal fees, which is an obvious disincentive, but I'm not sure if the OB/GYN meant that as a general Australia wide thing or if it's just particular to where he was from.

However I can definitely say Australian patients in general are extremely respectful and nice. Very pleasant to work with. No or very little sense of entitlement. At least in my experience (e.g., pre-opping with the attending level aka consultant anaesthetist), it's sometimes even considered a bit rude if someone doesn't say "please" or "thank you". I'd be very surprised if there's anywhere near the same level of malpractice worries as in the US.

What's more surgeons entirely respect you. There are some bad seeds of course, but that's everywhere. For the most part the consultant anaesthetist is treated as a complete equal to the surgeon by surgeons and surgical staff and others. At least from what I've seen and experienced.

I've met a few American (and Canadian) anesthesiologists who have moved here. Maybe they're biased since they did move here after all, but they all have told me how much better things are for them here in terms of lifestyle. To be fair, they do say though that the overall money is not as good as in the US though. It's probably harder to make a huge salary. And the cost of living is very high in Australia or at least the capital cities like Sydney where I am.

 

[bashwell]

Was that in Australian dollars or US dollars?

Either way, I guess I better get over my fear of huge spiders and pack my bags!

Sorry that was in AUD! I think the exchange rate is about 75 cents to a dollar now. So you're effectively losing 25% (or more with fees). But purchasing power in Australia is still good, and you get heaps of other services if you're an Aussie resident or citizen (e.g., universal healthcare, so no need to buy private health insurance unless you want to).

I'm in Sydney and there's the dreaded Sydney funnel web spider, but honestly after being here for several years, I've never seen or heard of anyone else seeing one! Sydney is basically a huge sprawling modern city with a beautiful harbour.

 

[bashwell]

Right now 400k AUD is 300K US dollar. But keep in mind the obscene cost of living generally reduces quality of life.

That being said there are many other positives to living in Australia but property ownership is not one of them. Would suck paying 500K to own a 1 bedroom apartment when you could buy a mansion in the Midwest or Arizona for that price.


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That's a good point about the obscene cost of living. Cost of living is very expensive here.

However, I don't think quality of life is reduced at all. Or not by much. I'd say my QOL is good and more or less comparable to how I lived in the US. Better in some ways, worse in other ways. Overall, I'd say it's a toss-up, depending on personal preferences.

That said, there are much cheaper places in Australia to live than Sydney! Sydney is probably the most expensive Aussie city. $500k can get you a house in other parts of Australia. There's a current real estate bubble in Sydney that people think will burst at any time now. If that happens, it might be ugly for people who have mortgages, but it'd reduce the real estate prices.

My plan if I stay to practice in Australia is to also purchase property someplace in the US, come back and visit family and friends, especially with all the time off and holidays available in Australia.

 

[Psai]

I don't think this trend is limited to anesthesia. I'm not sure how things are in Australia where you are from, but here in the US many specialties are getting reimbursement cuts, including surgical specialties.

Setting your expectations too high leads to dissatisfaction down the road. I believe in doing the appropriate research before deciding on any field, but keeping expectations reasonable. I don't think this necessarily means one is being "passive". By all means, job-hunt, talk with your peers, and look for the high-paying jobs with good benefits. But at the end of the day, wouldn't you be happier if you went in expecting a 250k job but ended up getting a position paying 350k?

I would be pretty unhappy when I'm worth 800 but get paid 300 while the partners take 500 off of me

On that note, please be sure to send me a resume when you graduate. I would be happy to hire you for 180 and so would you because you should expect 90. That's double and you will be doubly happy

 

[pgg]

Buy a low-mileage used one instead and save yourself $50k in depreciation

Or better yet, stick with a Honda Civic and put the rest towards student loans and savings.

This is funny.

I lost my car in a wreck a few months ago and, while looking for something else, have been driving our 2002 Honda Civic beater. It runs a little rough and has a deformed front bumper and hood dent from where my son took out a Hyundai shortly after getting his learner's permit. I bought someone's low-mileage E46 M3 garage queen a few days ago for $23K, or approximately $50K off its factory new price. It's awesome. Some great deals and great cars in the used market.

 

[amLOLdipine]

This is funny.

I lost my car in a wreck a few months ago and, while looking for something else, have been driving our 2002 Honda Civic beater. It runs a little rough and has a deformed front bumper and hood dent from where my son took out a Hyundai shortly after getting his learner's permit. I bought someone's low-mileage E46 M3 garage queen a few days ago for $23K, or approximately $50K off its factory new price. It's awesome. Some great deals and great cars in the used market.

The E46 M3 is a classic! The S54 and S65 engines embody what M-cars should be about. They took a lot of the soul out of the car with the turbo motors in the latest F8x cars.

 

[Mman]

I agree. Also add poker players to people who can make much more money than doctors. There are guys in their early 20's who comes from nothing and are millionaires.

Well sure. With medicine, the floor is very high and the ceiling is high but nearly as high as other professions. CEOs of Fortune 500 companies can make $10-$100M per year. The best poker players in the world can make $10M+ per year. But the thing with those professions is that 99% of the people that do those things aren't making 8 figures. The median salary for a person trying to be a professional poker player is probably <$20K per year. It ain't easy and most people go broke trying. In business people don't go broke, but the vast majority earn less than $100K per year.

For a physician, the 5th percentile of income is still > $100K per year.

 

[Chloroform4Life]

Well sure. With medicine, the floor is very high and the ceiling is high but nearly as high as other professions. CEOs of Fortune 500 companies can make $10-$100M per year. The best poker players in the world can make $10M+ per year. But the thing with those professions is that 99% of the people that do those things aren't making 8 figures. The median salary for a person trying to be a professional poker player is probably <$20K per year. It ain't easy and most people go broke trying. In business people don't go broke, but the vast majority earn less than $100K per year.

For a physician, the 5th percentile of income is still > $100K per year.

Exactly, thats the point pgg and I were making. People in these other profession can make more money than doctors, but most don't.

 

[pgg]

Exactly, thats the point pgg and I were making. People in these other profession can make more money than doctors, but most don't.

Moreover, you need extraordinary talent and usually some luck to succeed in those jobs, with a healthy sprinkling of charisma and other people skills. You really don't need any of that in medicine.

 

[Mad Jack]

a healthy sprinkling of charisma and other people skills. You really don't need any of that in medicine.

As SDN proves time and time again

 

[GA8314]

Moreover, you need extraordinary talent and usually some luck to succeed in those jobs, with a healthy sprinkling of charisma and other people skills. You really don't need any of that in medicine.

This is so very very true. To succeed in many areas of "big business" you need to be a stud. Simply put. Smart, hard working, and a stud. Not so much in medicine.

Are there "studs" in medicine? Absolutely. Do you need to be one? Absolutely not.

Definition of stud: Someone with excellent people and communication skills with a lot of charisma and the intelligence to back it all up, not to mention he/she carries him/herself in a manner that projects extreme confidence and authority.

 

[aimedicine]

I sure hope it's not a "trend" across anesthesia and other specialties for people to expect lower salaries, etc.! That'd be sad if so. But I think you're very wise and prudent to have reasonable expectations, and completely agree with you there. I was just saying it seems some people going into anesthesia are "low-balling" themselves, but that I really hope that's NOT the case. That's all I meant to imply.

In Australia things seem good or even great to me for anesthesia. The approximately $300k (starting) salary for 40-45 hours is completely possible and in fact that's pretty standard or common. You get increases for seniority and other things, so could get up to $400k+. Plus you get paid extra for taking on call, working odd hours, holidays, etc. And this is for an anesthesiologist (aka anaesthetist) working in the public healthcare system here, not private. Private you can expect a lot more. For pay it's (very roughly) 1 day of private = 3 days of public. You always sit your own cases, unless you're in a public teaching hospital where you and a resident (aka registrar) will be present. Also no CRNAs here. There are anaesthetic nurses who help, but they're nothing like CRNAs. No mid-level encroachment. And while there are issues with the Australian healthcare system, and while the government is always trying to minimise healthcare costs, it's currently much more stable than the US healthcare system, so much less to worry about in terms of sudden reimbursement cuts, etc. It's also much less stressful or chill while you're working, or so I've been told by people who have worked in both US and Australia. All in all, I'd say things are pretty good for anaesthesia in Australia.

Why are u here then?

 

[bashwell]

Why are u here then?

You mean on this forum? Why shouldn't I be on this forum?

You mean in the US? I'm not.

Or are you referring to somewhere or something else?

 

[Nivens]

ugh.. As a 4th year that recently matched anesthesia I don't know why I keep coming back to this forum. I think this specialty is amazing and I have been wanting to do it since pre med days but after reading some of the things on this thread I don't know anymore. I haven't even started intern year yet but do you attendings think I should just reapply to a different specialty?

PM me

 

[criticalelement]

For a physician, the 5th percentile of income is still > $100K per year.

I really dont understand your point. Would you do what you do for lets say 105K per year?

 

[criticalelement]

This is so very very true. To succeed in many areas of "big business" you need to be a stud. Simply put. Smart, hard working, and a stud. Not so much in medicine.

Are there "studs" in medicine? Absolutely. Do you need to be one? Absolutely not.

Definition of stud: Someone with excellent people and communication skills with a lot of charisma and the intelligence to back it all up, not to mention he/she carries him/herself in a manner that projects extreme confidence and authority.

Getting in medical school, staying in, jumping though the hoops, etc etc etc.. without commiting a hate crime = STUD in my book.

 

[Mman]

I really dont understand your point. Would you do what you do for lets say 105K per year?

yes

 

[Chloroform4Life]

Getting in medical school, staying in, jumping though the hoops, etc etc etc.. without commiting a hate crime = STUD in my book.

Hate crime?

Why?

 

[criticalelement]

yes

There lies the problem. And your employer knows you would do what you do for 105k so they will continue to wittle your salary down until they find a breaking point. And it seems they are not even close to that point yet.

We cant win with your way of thinking.

Personally for me until im getting paid 6-700 k per year I am grossly underpaid.

 

[GA8314]

There lies the problem. And your employer knows you would do what you do for 105k so they will continue to wittle your salary down until they find a breaking point. And it seems they are not even close to that point yet.

We cant win with your way of thinking.

Personally for me until im getting paid 6-700 k per year I am grossly underpaid.

Look, I'm sure you have other specialists saying they'd "do this job for way less" etc. etc. But, it's not like he's advocating this. And, professionally, our organization(s) are continually lobbying for our interests. So, it's not like just because many of us may do this job for less it's some sort of harbinger for policy makers to make it so. That's not how it works.

 

[skypilot]

There lies the problem. And your employer knows you would do what you do for 105k so they will continue to wittle your salary down until they find a breaking point. And it seems they are not even close to that point yet.

We cant win with your way of thinking.

Personally for me until im getting paid 6-700 k per year I am grossly underpaid.

Look, I'm sure you have other specialists saying they'd "do this job for way less" etc. etc. But, it's not like he's advocating this. And, professionally, our organization(s) are continually lobbying for our interests. So, it's not like just because many of us may do this job for less it's some sort of harbinger for policy makers to make it so. That's not how it works.

Except our professional organizations are making it more difficult to remain board certified with MOCA. Armies of CRNAs are being produced every year and CMS is overloading us with PQRS and MIPS so that the system becomes so complex that only corporate medicine can bill for our services and we all become employees. Then the real squeeze begins.

 

[dannyboy1]

I really dont understand your point. Would you do what you do for lets say 105K per year?

No. I am still a physician with a medical license. Could make more than that working urgent care with no nights/weekends

 

[Random Anesthesiologist]

You are only scratching the surface here. Most employed attendings would never tell you anything negative about CRNAs, unless they want to put their jobs at risk. Same goes with the way they behave with "their CRNA colleagues". It's Omertà. You guys are not insiders. Same goes for the CRNAs or midlevels in general; many more are militant than actually show it in the daily interactions.

And some procedurally-challenged or just lazy academic attendings downright like having CRNAs.

I've seen some newer attendings try to be buddy-buddy with CRNAs at the expense of residents, going so far as to bad-mouth residents they work with or just have personality differences with, or just to be involved in gossip. It's really kind of shameful to see, but at least sets an example of the kind of attending I don't want to be. I mean, it's one thing to just be nice and go about your business, but it's another to bad mouth people you work with just to feel closer to someone. You never know who is listening.

 

[Random Anesthesiologist]

That's a good point about the obscene cost of living. Cost of living is very expensive here.

However, I don't think quality of life is reduced at all. Or not by much. I'd say my QOL is good and more or less comparable to how I lived in the US. Better in some ways, worse in other ways. Overall, I'd say it's a toss-up, depending on personal preferences.

That said, there are much cheaper places in Australia to live than Sydney! Sydney is probably the most expensive Aussie city. $500k can get you a house in other parts of Australia. There's a current real estate bubble in Sydney that people think will burst at any time now. If that happens, it might be ugly for people who have mortgages, but it'd reduce the real estate prices.

My plan if I stay to practice in Australia is to also purchase property someplace in the US, come back and visit family and friends, especially with all the time off and holidays available in Australia.

I'd go to NZ before Oz, sorry mate.

 

[IlDestriero]

Do they have hand sized potentially lethal spiders in NZ? If not, sign me up!


--
Il Destriero

 

[pre med 2014]

..

 

[pre med 2014]

This is so very very true. To succeed in many areas of "big business" you need to be a stud. Simply put. Smart, hard working, and a stud. Not so much in medicine.

Are there "studs" in medicine? Absolutely. Do you need to be one? Absolutely not.

Definition of stud: Someone with excellent people and communication skills with a lot of charisma and the intelligence to back it all up, not to mention he/she carries him/herself in a manner that projects extreme confidence and authority.

To the contrary I'd say most med students are pretty much studs, especially the students a year above me. The only reason you need charisma to excel in other professions is because your skills to some degree are non essential. Whereas people will always need to have surgeries and will always need someone to know how to put them to sleep for surgery.


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[bashwell]

I'd go to NZ before Oz, sorry mate.

I might too! NZ and Australia are the same college (ANZCA) so being certified in one is good for the other.

 

[bashwell]

Do they have hand sized potentially lethal spiders in NZ? If not, sign me up!


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Il Destriero

I think the only thing that's lethal in NZ is the Maori. Otherwise it's mostly hobbits over there

 

[Mman]

There lies the problem. And your employer knows you would do what you do for 105k so they will continue to wittle your salary down until they find a breaking point. And it seems they are not even close to that point yet.

We cant win with your way of thinking.

Personally for me until im getting paid 6-700 k per year I am grossly underpaid.

I am the employer. And I'd still do it for a lot less than I make now. Nobody is whittling me down because I would do so.

 

[Random Anesthesiologist]

Do they have hand sized potentially lethal spiders in NZ? If not, sign me up!


--
Il Destriero

Nope!

 

[Random Anesthesiologist]

I might too! NZ and Australia are the same college (ANZCA) so being certified in one is good for the other.

I could see myself doing this. I was a NZ resident once upon a time, and it was fun to live there.

 

[Eagle90]

Man I want to move to Australia. How's the tort system there? Any fear of big malpractice awards?

You could just take a job in Montreal, Ottawa, Toronto, Calgary or Vancouver (or just go to a smaller town for higher pay). Canada & Australia have v similar healthcare systems (except Australia is two tier whereas Canada is one size fits all) with similar billing rates. The major difference is you might have more competition for jobs in Australia, which has 33 doctors per 10,000 whereas Canada has 20-25 per 10,000. For reference the US has ~27.

Edit: & though this is hearsay on my part, lawsuits against doctors are said to be disproportionately more common in the US.

 

[bashwell]

You could just take a job in Montreal, Ottawa, Toronto, Calgary or Vancouver (or just go to a smaller town for higher pay). Canada & Australia have v similar healthcare systems (except Australia is two tier whereas Canada is one size fits all) with similar billing rates. The major difference is you might have more competition for jobs in Australia, which has 33 doctors per 10,000 whereas Canada has 20-25 per 10,000. For reference the US has ~27.

Edit: & though this is hearsay on my part, lawsuits against doctors are said to be disproportionately more common in the US.

I too have heard Canada is a great country for anesthesiologists to practise. I guess it depends whether someone prefers hot or cold weather.

Maybe you can verify Eagle90, but I know there are lots of Canadians in Australia, and just based on hearsay from talking to Canadians I know here, it seems like completing training and exams etc in Australia qualifies one to practise in Canada as well? Or at least it seems the Canadians I know don't really worry about being able to move back and forth between both nations more easily than the US where (with a few exceptions) you have to redo residency. I guess it's the whole Commonwealth connection.

Currently the Canadian and Australian dollar seem more or less on par with one another. But my understanding is Canada has a much lower cost of living than Australia. So that's something to consider.

 

[deleted162650]

You could just take a job in Montreal, Ottawa, Toronto, Calgary or Vancouver (or just go to a smaller town for higher pay). Canada & Australia have v similar healthcare systems (except Australia is two tier whereas Canada is one size fits all) with similar billing rates. The major difference is you might have more competition for jobs in Australia, which has 33 doctors per 10,000 whereas Canada has 20-25 per 10,000. For reference the US has ~27.

Edit: & though this is hearsay on my part, lawsuits against doctors are said to be disproportionately more common in the US.

The Drs/captia may be a little misleading as >80% of docs in Oz are primary care compared to the US where is more like 80% are non-primary care specialties.

 

[timbaktoo]

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.

Next time god forbid, when you or your loved one get sick, let me know who you'd like to go and see first. A boards certified Physician who has spent 7 yrs in training or an 'Advanced Practice' Nurse. Spending more time in Training is not a 'burden' my friend. It's empowering yourself with those skills that become second nature to you to a point where you can make a diagnosis in limited time with maximum efficiency

 

[GravelRider]

Next time god forbid, when you or your loved one get sick, let me know who you'd like to go and see first. A boards certified Physician who has spent 7 yrs in training or an 'Advanced Practice' Nurse. Spending more time in Training is not a 'burden' my friend. It's empowering yourself with those skills that become second nature to you to a point where you can make a diagnosis in limited time with maximum efficiency

I'm board-certified in two specialties, my friend. I'm well aware of the difference in training. I'm giving a recommendation on the better career choice based on the direction medicine is headed in. If you don't like the reality then schedule a chat with your local politician. Healthcare has nothing to do with skills and knowledge anymore. It's about metrics, protocols, and making money for a bunch of businessmen. If my child told me they wanted to work in healthcare, I would recommend nursing as a better choice. It's just my opinion.

 

[timbaktoo]

I'm board-certified in two specialties, my friend. I'm well aware of the difference in training. I'm giving a recommendation on the better career choice based on the direction medicine is headed in. If you don't like the reality then schedule a chat with your local politician. Healthcare has nothing to do with skills and knowledge anymore. It's about metrics, protocols, and making money for a bunch of businessmen. If my child told me they wanted to work in healthcare, I would recommend nursing as a better choice. It's just my opinion.

You're a board certified physician and I thought you guys should show us the silver lining . I feel so jaded right now. Allow me to understand where you're coming from. Why do you think physicians and their practices do not appeal to the eye of a businessman ? May be there is a lot to learn about the bureaucracies of medicine which we do not as a medical student/resident

 

[bashwell]

You're a board certified physician and I thought you guys should show us the silver lining . I feel so jaded right now. Allow me to understand where you're coming from. Why do you think physicians and their practices do not appeal to the eye of a businessman ? May be there is a lot to learn about the bureaucracies of medicine which we do not as a medical student/resident

Actually, physicians and their practices do appeal to the eyes of business-minded -- they want to use us to make money for them! It's all about who is in control of the mighty dollar. The revenue streams.

On top of this, government, hospital, and other bureaucrats want to regulate physicians. To make us do what they want us to do, often in the name of "patient safety".

That's why some attendings on SDN recommend choosing specialties where we are more in control over our lives, how we practice, whether we have a choice or not in accepting this or that insurance (e.g., Medicare), etc. This is usually (though not necessarily always) going to be found in patient-facing specialties and non-hospital-based specialties.

However, all this has to be weighed in light of your personal likes and dislikes about a specialty, things about a specialty like whether you can accept rounding and clinics (which some people just hate), whether you can accept years of sleepless nights and standing on your feet in one place operating, personal "fit" in a specialty, whether you can accept the culture and personalities in a specialty, whether you can accept the patient population, whether you can accept the bread and butter cases in a specialty, and so on.

 

[GravelRider]

You're a board certified physician and I thought you guys should show us the silver lining . I feel so jaded right now. Allow me to understand where you're coming from. Why do you think physicians and their practices do not appeal to the eye of a businessman ? May be there is a lot to learn about the bureaucracies of medicine which we do not as a medical student/resident

Exhibit A:
https://www.washingtonpost.com/news...es-and-doctors-the-nurses-are-slowly-winning/

 

[bpm1]

Exhibit A:
https://www.washingtonpost.com/news...es-and-doctors-the-nurses-are-slowly-winning/

Nurses are not winning. They are losing, even if they think they are winning. Everyone loses by having people do things they are not qualified/prepared to do. This is NOT a winning strategy.

 

[Consigliere]

Nurses are not winning. They are losing, even if they think they are winning. Everyone loses by having people do things they are not qualified/prepared to do. This is NOT a winning strategy.

 

[GA8314]

Nurses are making in roads into many areas traditionally occupied by physicians. This will be a constant, career long legislative and lobbying effort.

Meantime, enjoy what you do, keep a good attitude, and work hard. Stay relevant and live well within your means. Live a nice life and don't be a martyr on this issue, while staying active with the knowledge that this is the cost of doing business. It's really not personal.

 

[deleted171991]

I love when people tell me it's not personal just business, right before they stab me in the back.

 

[nimbus]

I agree. Also add poker players to people who can make much more money than doctors. There are guys in their early 20's who comes from nothing and are millionaires.

One of my former partners. Last I heard he's back in medicine.

https://en.m.wikipedia.org/wiki/Roy_Winston_(poker_player)

 

[DrCommonSense]

Exhibit A:
https://www.washingtonpost.com/news...es-and-doctors-the-nurses-are-slowly-winning/

Unfortunately, the model for anesthesiologists in the future very may well be "collaborative" compared to "supervising" CRNAs. If that occurs, expect anesthesiologists to be paid marginally more than CRNAs per hour (5% premium).

The VA independence in the first step towards the decline. Once the VA can "prove" independent CRNAS are equal to "MDAs" in the vast majority of cases (will only take a few years), it will be game over. They will clamor for "collaborative" models in the future hardcore after a few years of VA independence.

Future changes will likely include:

1) Collaboration model with a slight premium for Anesthesiologist who will have to take "liability" for a CRNA that gets into a difficult situation. Salaries will decline for almost all specialists to above 30-50% over PCP but particularly for Anesthesiologists this is an acute issue with VA independence.
2) Decreased reimbursement towards the Medicare payment model (33% of private insurance) as Obamacare premiums skyrocket. This will be made possible with no stipend offered for anesthesiologist practices and increased utilization of CRNAS as more "cost effective" in the future
3) AMC take over of the vast majority of practices (NAPA is the biggest example) due to PE money and Mckinsey consultants
4) Continued pushing for "independence" by healthcare "consultants" while the profits go to PE/Consultants with MBAs taking the profit margins that are left over.
5) Increased liability due to lack of tort reform in the future coupled with increased risk with coverage of "collaborative" CRNAs while not getting paid for it.

This is the opinion of big business/Hillary/militant CRNA PACs for the future who are all collaborating together to make this come to fruition after they can use the VA as "proof":

http://www.beckershospitalreview.co...-quality-anesthesia-care-at-a-lower-cost.html

Notice the article from Becker Spine is supporting strongly by the "Lewin" group that says anesthesiologists are NOT cost effect at all basically in ANY model.


The question occurs for physicians with good net worths (>3-5 million), is it worth it to continue to practice with largely decreasing reimbursement, increased liability, etc?

Would it be better to be a PCP under these systems with a slight decrease in salary but largely less liability? Remember Anesthesiology has HUGE liability risk that is largely uncontrollable in the future due to surgeons/administrators DICTATING providers to do cases or be fired when consolidation occurs, especially with an overabundance of CRNAs.

Any good MBA could tell you about NPV valuations and DCF in the future. According to an NPV analysis, even after tax income of 300K for 30 years is only equivalent to about 3 million in the bank now at a discount rate of a conservative 6%.

That is why Anesthesiologist have net worth's on average of "2.68" on the medscape survey that is equivalent to between 500-1million and 1-2 million, most in their 60s and 70s. The future will be worse.

Therefore, it might be better to get into the "lower risk" specialities in the future, even if anesthesiologist only makes a slight premium, particularly if you have ASSETS.

Also, don't trust the crap that they won't sue you over "your limits". They will get a forensic account to determine your net worth. If you have millions exposed in stocks, cash, etc, they WILL go after that if they get a big judgement (not that difficult anymore with the huge increases in lawsuits recently).

One of many my friend: http://www.chicagotribune.com/business/ct-u-of-c-malpractice-verdict-0701-biz-20160630-story.html

http://www.chicagotribune.com/busin...ctice-settlement-0223-biz-20160222-story.html

Damn that MBA or even lower risk "lower paid" specialties are looking more and more attractive these days for physicians with any money.