Future of Anesthesiologists

[dmk5n]

Dr. Commonsense,
Is the "collaborative model" different than Medical Direction (up to 4 concurrent locations) or Medical Supervision (>4, QZ modifier)?

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[deleted126335]

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

“Tom, don't let anybody kid you. It's all personal, every bit of business. Every piece of **** every man has to eat every day of his life is personal. They call it business. OK. But it's personal as hell.

― Mario Puzo, The Godfather

 

[DrCommonSense]

Dr. Commonsense,
Is the "collaborative model" different than Medical Direction (up to 4 concurrent locations) or Medical Supervision (>4, QZ modifier)?

Yes its basically anesthesiologists doing their own cases in parrallel to CRNAs who do their own cases for about the same amount of money.

Anesthesiologists basically become CRNAs with a 5% premium but have to cover the butt of CRNAs if there is a "fire" for free.

Anesthesiologists are easily replaced if they speak up and don't do a high risk case due to consolidation of AMCs plus far less need for Anesthesiologist services due to CRNAs replacing them in the vast majority of cases.

 

[criticalelement]

The problem with the collaborative model is that the anesthesiologist cannot be successfully sued when a NURSE murders a patient which will undoubtedly happen. Ugly things happen NOW, let alone when there are zero standards.. You have to establish a physician/patient relationship, for one, to establish negligence or breach of duty.

 

[criticalelement]

The care team is bloated but I think allowing ICU nurses and/or PAs to participate in the mid level arena would make it less bloated. Ive been at this for over ten years CRNAS with even more experience consistently make "killing errors" because they just dont have the educational backround to be able to critically get through it. I dont mean that as aMany times people dont die or become mamed because of simple luck.

 

[DrCommonSense]

The problem with the collaborative model is that the anesthesiologist cannot be successfully sued when a NURSE murders a patient which will undoubtedly happen. Ugly things happen NOW, let alone when there are zero standards.. You have to establish a physician/patient relationship, for one, to establish negligence or breach of duty.

I wouldn't be confident in that. What if administrators made it part of the contract that the anesthesiologist had to "help out" if his/her "colleague" has trouble as a "team player". Refusing to be a "team player" would get said anesthesiologist fired.

Do you honestly think most anesthesiologists would fight that aggressively? We'll see

 

[DrCommonSense]

The care team is bloated but I think allowing ICU nurses and/or PAs to participate in the mid level arena would make it less bloated. Ive been at this for over ten years CRNAS with even more experience consistently make "killing errors" because they just dont have the educational backround to be able to critically get through it. I dont mean that as aMany times people dont die or become mamed because of simple luck.

This is also why the VA is "testing" out the independent CRNA model. They want to determine the differences in mortality rates between CRNAs and Anesthesiologists.

If there isn't an appreciable difference in mortality, CRNAs will push hard for collaborative models throughout the country.

Im not sure there will be large differences in the VA for appendectomies, cholys, etc.

 

[GravelRider]

This is also why the VA is "testing" out the independent CRNA model. They want to determine the differences in mortality rates between CRNAs and Anesthesiologists.

If there isn't an appreciable difference in mortality, CRNAs will push hard for collaborative models throughout the country.

Im not sure there will be large differences in the VA for appendectomies, cholys, etc.

I agree. This is the purpose of the VA experiment. Once they determine that there is no appreciable difference between anesthesiologists and CRNAs, the collaborative model will spread.

 

[DrCommonSense]

I agree. This is the purpose of the VA experiment. Once they determine that there is no appreciable difference between anesthesiologists and CRNAs, the collaborative model will spread.

There's nothing to worry about right? I mean anyone who is concerned about this is a "chicken little" sky is falling type dude.

 

[pgg]

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

What does the actual data say about anesthesiologists actually getting sued, the actual damages awarded, and the actual frequency with which those damages exceed their liability coverage?

The news will headline the multimillion dollar verdicts returned by a jury ... but on the other hand, my first year malpractice premium in California cost less than what I earned on my first weekend of call. (Even at maturity it's only 3x that.)

The actual risk of anesthesiologists being successfully sued to an amount in excess of their coverage seems ... small.

 

[DrCommonSense]

What does the actual data say about anesthesiologists actually getting sued, the actual damages awarded, and the actual frequency with which those damages exceed their liability coverage?

The news will headline the multimillion dollar verdicts returned by a jury ... but on the other hand, my first year malpractice premium in California cost less than what I earned on my first weekend of call. (Even at maturity it's only 3x that.)

The actual risk of anesthesiologists being successfully sued to an amount in excess of their coverage seems ... small.

Yeah the problem with this "analysis" includes:

1) Most anesthesiologists getting sued probably don't have much money to go after. Remember from Medscape studies, most anesthesiologists have between 500K-1 million and 1-2 million by their 60s or older. In their 30s and 40s, they have mostly debt. So i spoke about the caveat of physicians who have significant ASSETS while practicing. When the malpractice lawyer gets a forensic accountant and finds out there is no money to go after, they will "settle" for the limits or go after the hospital.

2) Im speaking about the future risk under the collaborative "model"

3) Even getting sued at your limits makes employment much more difficult.

 

[deleted171991]

What does the actual data say about anesthesiologists actually getting sued, the actual damages awarded, and the actual frequency with which those damages exceed their liability coverage?

The news will headline the multimillion dollar verdicts returned by a jury ... but on the other hand, my first year malpractice premium in California cost less than what I earned on my first weekend of call. (Even at maturity it's only 3x that.)

The actual risk of anesthesiologists being successfully sued to an amount in excess of their coverage seems ... small.

California has malpractice caps.

 

[DrCommonSense]

California has malpractice caps.

My argument about malpractice was for anesthesiologists that have significant assets (qualified as >2 million or so).

If a person has negative 500K net worth, I don't see this being an issue for them getting sued over their limits.

 

[pgg]

California has malpractice caps.

It's not the only state. I don't live or work there any more, but I have the same policy with the same company covering work in another state, and my annual premium only went up a few hundred dollars (but coverage went up from $1/3M to $2.25/6.75M).

Regardless ...

How many anesthesiologists get successfully sued, in any state, for an amount that exceeds their malpractice coverage?

I'm just pointing out that premiums for our specialty aren't crazy high, and they already account for 1:4 supervision of, and fireman duty for, dangerously unqualified and undertrained midlevels. That says more about our actual risk than conjecture about hypothetical assets vs specialty choice permuted with future CRNA independence vs pseudo-independence possibilities, sprinkled with some Joan Rivers news stories and jury award hysteria.

 

[pgg]

My argument about malpractice was for anesthesiologists that have significant assets (qualified as >2 million or so).

If a person has negative 500K net worth, I don't see this being an issue for them getting sued over their limits.

Yeah, so do you have any data showing that rich anesthesiologists get sued more than poor anesthesiologists, and suffer losses in excess of their insurance coverage more often?

 

[deleted171991]

It's not the only state. I don't live or work there any more, but I have the same policy with the same company covering work in another state, and my annual premium only went up a few hundred dollars (but coverage went up from $1/3M to $2.25/6.75M).

Regardless ...

How many anesthesiologists get successfully sued, in any state, for an amount that exceeds their malpractice coverage?

I'm just pointing out that premiums for our specialty aren't crazy high, and they already account for 1:4 supervision of, and fireman duty for, dangerously unqualified and undertrained midlevels. That says more about our actual risk than conjecture about hypothetical assets vs specialty choice permuted with future CRNA independence vs pseudo-independence possibilities, sprinkled with some Joan Rivers news stories and jury award hysteria.

Wrong. Those premiums only account for the risk of losing exactly the amount on the malpractice policy (e.g. $1M per patient/3M per event). They don't account for the risk of losing much more per patient, let's say $3M, which is a totally unimpressive number if the patient gets harmed, and would wipe many of us out.

It's the risk difference between shorting a stock or staying long. In the former case, the sky is the limit (for the losses). In the latter, one can never lose more than the price they bought the stock at.

Assuming 1% of the docs lose/settle one case per year for non-trivial sums (more than 2% get sued), if the premium is $10K, that suggests that the average payout per case is less than $1M.

 

[DrCommonSense]

Yeah, so do you have any data showing that rich anesthesiologists get sued more than poor anesthesiologists, and suffer losses in excess of their insurance coverage more often?

It is opaque but I sincerely have ZERO confidence that an anesthesiologist with 2 million in assets that can be targeted will not lose his/her shirt because the malpractice attorney decides that "it is an unsaid agreement to not sue over limits".

Good luck with that.

 

[deleted682700]

If your record is stellar and have no suits , you end up getting 100-200 $ more per shift depending on your ability to negotiate and the need of the hospital. Even when the anesthesiologist has settled big time, he or she can easily find locums work. This only applies to first time law suit.

I can imagine what happens after a second incident? Will you be able to purchase malpractice

 

[DrCommonSense]

If your record is stellar and have no suits , you end up getting 100-200 $ more per shift depending on your ability to negotiate and the need of the hospital. Even when the anesthesiologist has settled big time, he or she can easily find locums work. This only applies to first time law suit.

I can imagine what happens after a second incident? Will you be able to purchase malpractice

Ok but I don't see how this applies to my question about assets.

Also, I doubt its "easy" to find work, even after the 1st lawsuit, if the settlement is in the millions.

 

[Noyac]

I still think these "large" settlements are rare. I'm not saying they can't happen though. But I've been at this for 15yrs. I've seen some anesthesia malpractice incidents occur which are very rare. I've seen some that resulted in death. In all this time, I've only seen one person named in a suit. It was a bad outcome but that person ended up being dropped from the suit and the hospital settled.
Granted, my practice is probably a bit skewed. We are all physicians doing all our own work, don't underestimate how much this matters in pt care. Our population is healthier than most but we do get all sorts of sickos as well, just in lower numbers which I argue is almost worse. My first job was in a high volume, high acuity, crna mil. Still I don't call any suits.
Also, our malpractice premiums are on the lower side because we just don't get sued much. They remain at the level they are because the consequences are great in our line of work.
I'm not saying this to make anyone feel like they are safe from a suit. You must remain vigilant and practice good medicine. If you do this your chances are very low. But sometimes sh.t happens. Reactive smart, carry good coverage and move on. Don't dwell on things you can't control.

 

[DrCommonSense]

I still think these "large" settlements are rare. I'm not saying they can't happen though. But I've been at this for 15yrs. I've seen some anesthesia malpractice incidents occur which are very rare. I've seen some that resulted in death. In all this time, I've only seen one person named in a suit. It was a bad outcome but that person ended up being dropped from the suit and the hospital settled.
Granted, my practice is probably a bit skewed. We are all physicians doing all our own work, don't underestimate how much this matters in pt care. Our population is healthier than most but we do get all sorts of sickos as well, just in lower numbers which I argue is almost worse. My first job was in a high volume, high acuity, crna mil. Still I don't call any suits.
Also, our malpractice premiums are on the lower side because we just don't get sued much. They remain at the level they are because the consequences are great in our line of work.
I'm not saying this to make anyone feel like they are safe from a suit. You must remain vigilant and practice good medicine. If you do this your chances are very low. But sometimes sh.t happens. Reactive smart, carry good coverage and move on. Don't dwell on things you can't control.

Wish I was that confident for the future. I am speaking about the future trends.

http://www.amednews.com/article/20120716/profession/307169940/4/

According to this article, the number of >1 million cases has been skyrocketing in the last 2010s.

In my discussion, the caveats I include for the anesthesiologist include:

1) Assets of physician at >2 million that are vulnerable (outside of 401K or homestead houses in Florida, Texas)
2) Increasing supervision of larger and larger CRNA ratios and future collaborative "model" where physicians will get all the high risk cases but also have to be "available" to bail out CRNAs doing their own cases
3) Understanding that future salaries are decreasing due to increase CRNA autonomy coupled with downward pressures on income due to increased supply of anesthesia personnel compared to demand. CRNAs are being produced far faster than increases in surgical volume.

My NPV calculation for a physician with 3 million dollars would require >300K post tax to cut even after 30 years of work considering a lawsuit that was >3-5 million that could go after his/her personal assets.

This doesn't apply to physicians who are recently out of residency with HIGH debt or physicians who have no wealth in general.

 

[doctalaughs]

Wish I was that confident for the future. I am speaking about the future trends.

http://www.amednews.com/article/20120716/profession/307169940/4/

According to this article, the number of >1 million cases has been skyrocketing in the last 2010s.

In my discussion, the caveats I include for the anesthesiologist include:

1) Assets of physician at >2 million that are vulnerable (outside of 401K or homestead houses in Florida, Texas)
2) Increasing supervision of larger and larger CRNA ratios and future collaborative "model" where physicians will get all the high risk cases but also have to be "available" to bail out CRNAs doing their own cases
3) Understanding that future salaries are decreasing due to increase CRNA autonomy coupled with downward pressures on income due to increased supply of anesthesia personnel compared to demand. CRNAs are being produced far faster than increases in surgical volume.

My NPV calculation for a physician with 3 million dollars would require >300K post tax to cut even after 30 years of work considering a lawsuit that was >3-5 million that could go after his/her personal assets.

This doesn't apply to physicians who are recently out of residency with HIGH debt or physicians who have no wealth in general.

Interesting discussion. Regarding #1 in many states (ie california) your 401k has very little protection from lawsuits as well.

Aside from the few states like florida and texas you could lose your house as well.

Any doctors have more in depth experience at asset protection strategies (trusts?)

Also just because you are in a malpractice cap state doesn't protect you completely because this usually applies to non-economic damages. If you are unlucky enough to be involved in a suit with a high-earner the judgement could still be many millions.


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[kidthor]

The ASA simply needs to issue a guideline stating that the "collaborative model" is unsafe and unethical - and that anesthesiologists should not participate in it. That way anesthesiologists have an out and reason not to participate in this scam (not wanting to violate a guideline). That, and we wouldn't be expected to participate or be a liability scapegoat in an unsafe practice setup.

But of course, the ASA doesn't seem sufficiently motivated to protect us.

 

[Mman]

Any discussion of individual physician liability with a med mal lawsuit starts and ends with what state they are in. There is no comparison between states since they all have different laws. And in general the laws are becoming more and more physician friendly across states. And at the risk of making the generalization across states I'm saying we shouldn't do, it's not lawyers that don't go after assets beyond a malpractice insurance policy, it's juries that don't hand them out.

 

[GravelRider]

The ASA simply needs to issue a guideline stating that the "collaborative model" is unsafe and unethical - and that anesthesiologists should not participate in it. That way anesthesiologists have an out and reason not to participate in this scam (not wanting to violate a guideline). That, and we wouldn't be expected to participate or be a liability scapegoat in an unsafe practice setup.

But of course, the ASA doesn't seem sufficiently motivated to protect us.

Not going to happen. Who do you think funds the ASA? The AMCs, large private practices, and hospital departments can make more money off a collaborative model. It's all about the money.

 

[kidthor]

Not going to happen. Who do you think funds the ASA? The AMCs, large private practices, and hospital departments can make more money off a collaborative model. It's all about the money.

Oh I agree with you. And I don't trust them...

But if anything should motivate them, it's maintaining physician led anesthesia practice.

 

[DrCommonSense]

Any discussion of individual physician liability with a med mal lawsuit starts and ends with what state they are in. There is no comparison between states since they all have different laws. And in general the laws are becoming more and more physician friendly across states. And at the risk of making the generalization across states I'm saying we shouldn't do, it's not lawyers that don't go after assets beyond a malpractice insurance policy, it's juries that don't hand them out.

They are?

The only caps in the vast majority of states are on "noneconomic" states.

Most of the liberal states have it very bad for malpractice environments and strong lawyer lobbies.

 

[criticalelement]

I wouldn't be confident in that. What if administrators made it part of the contract that the anesthesiologist had to "help out" if his/her "colleague" has trouble as a "team player". Refusing to be a "team player" would get said anesthesiologist fired.

Do you honestly think most anesthesiologists would fight that aggressively? We'll see

Refusing to help is not the issue. The issue is can you be sued successfully for helping out. I contend that the answer is NO because one of the factors to successfully sue is establishing a physician/patient relationship. Was there a physician/patient relationship? How do you establish a physician patient relationship if you have never met the patient pre-operatively?

 

[GravelRider]

Refusing to help is not the issue. The issue is can you be sued successfully for helping out. I contend that the answer is NO because one of the factors to successfully sue is establishing a physician/patient relationship. Was there a physician/patient relationship? How do you establish a physician patient relationship if you have never met the patient pre-operatively?

If you are helping in a critical situation in a patient who you are unfamiliar with, the Good Samaritan law may apply. It's probably still a gray area, but this would be a slippery slope that even the lawyers may not be willing to go down.

 

[pgg]

All this worry seems a little excessive in the face of the simple fact that it's extremely uncommon for anesthesiologists to actually lose personal assets to a malpractice judgment ... or even suffer a judgment for a significant portion of their liability limit.

From Medscape:
About 2/3 of anesthesiologists will get sued during their careers.
About 1/3 of cases will settle (obviously for less than their liability limit).
About 1/2 of cases will be dismissed, or the anesthesiologist will be dropped from the suit, or there will be no monetary award.
About 1/10 will go to trial and a verdict will be returned.
About 2% of suits will result in a trial, and a verdict in favor of the plaintiff.
More than 90% of all monetary awards are less than $2 million.

More data:
Annual risk of an anesthesiologist getting sued AND paying an award: about 2-3%
Median amount of payment: about $100K
Mean amount of payment: about $300K

Sure, you might be the next CNN headline of a $70 million verdict for a chipped tooth, but you might get shot next time you walk into a Chick-Fil-A too.

Do the math. Keep wringing your hands if you like. Or ... maybe be rational about it, practice defensively, and pay your premiums (and tail!) ...

After all, anesthesia is so safe that nurses can do it, right?

 

[criticalelement]

All this worry seems a little excessive in the face of the simple fact that it's extremely uncommon for anesthesiologists to actually lose personal assets to a malpractice judgment ... or even suffer a judgment for a significant portion of their liability limit.

Consider this before you consider worrying and tell me whether or not it is excessive.

When sued, you will wish you werent born each time you deal with something to do with the suit..

Now tell me is it worth the worry?

 

[deleted171991]

More than 90% of all monetary awards are less than $2 million.

In my state, most PP groups have $1M/$3M limits. And our awards are much higher than the national average.

 

[DrCommonSense]

All this worry seems a little excessive in the face of the simple fact that it's extremely uncommon for anesthesiologists to actually lose personal assets to a malpractice judgment ... or even suffer a judgment for a significant portion of their liability limit.

From Medscape:
About 2/3 of anesthesiologists will get sued during their careers.
About 1/3 of cases will settle (obviously for less than their liability limit).
About 1/2 of cases will be dismissed, or the anesthesiologist will be dropped from the suit, or there will be no monetary award.
About 1/10 will go to trial and a verdict will be returned.
About 2% of suits will result in a trial, and a verdict in favor of the plaintiff.
More than 90% of all monetary awards are less than $2 million.

More data:
Annual risk of an anesthesiologist getting sued AND paying an award: about 2-3%
Median amount of payment: about $100K
Mean amount of payment: about $300K

Sure, you might be the next CNN headline of a $70 million verdict for a chipped tooth, but you might get shot next time you walk into a Chick-Fil-A too.

Do the math. Keep wringing your hands if you like. Or ... maybe be rational about it, practice defensively, and pay your premiums (and tail!) ...

After all, anesthesia is so safe that nurses can do it, right?

You're using old stats. As I have pointed out, the number of huge lawsuits have been increasing dramatically.

With the huge plethora of unemployed lawyers and Medicaid morbidly obese patients, Russian roulette will get worse and worse.

 

[pgg]

Consider this before you consider worrying and tell me whether or not it is excessive.

When sued, you will wish you werent born each time you deal with something to do with the suit..

Now tell me is it worth the worry?

Most doctors get sued, and yet somehow most doctors carry on living.

Control the things you can control. Live your life. Quit being miserable and fearful. Or don't.

 

[deleted171991]

Most doctors get sued, and yet somehow most doctors carry on living.

Control the things you can control. Live your life. Quit being miserable and fearful. Or don't.

He may have gotten burnt the way we haven't. We should consider ourselves lucky.

 

[Mman]

They are?

The only caps in the vast majority of states are on "noneconomic" states.

Most of the liberal states have it very bad for malpractice environments and strong lawyer lobbies.

Pain and suffering aka "noneconomic" damages are the ones that create the large settlements. When you cap those, you instantly cut down on the size of lawsuits. Simple medical damages is orders of magnitude less than what juries give out for pain and suffering in some cases.

 

[criticalelement]

Most doctors get sued, and yet somehow most doctors carry on living.

Control the things you can control. Live your life. Quit being miserable and fearful. Or don't.

I am miserable but not fearful.

I just would rather not get sued and will try any tactic necessary to avoid that.. Thanks for the life advice, brah.

 

[Noyac]

There is a lot of BS being spread on this thread. If it's not BS, then it is an extremely rare event to lose your home. If the physician is married and the home is jointly owned it is even more difficult.
This article: http://www.medscape.com/viewarticle/869203

 

[deleted682700]

Wish I was that confident for the future. I am speaking about the future trends.

http://www.amednews.com/article/20120716/profession/307169940/4/

According to this article, the number of >1 million cases has been skyrocketing in the last 2010s.

In my discussion, the caveats I include for the anesthesiologist include:

1) Assets of physician at >2 million that are vulnerable (outside of 401K or homestead houses in Florida, Texas)
2) Increasing supervision of larger and larger CRNA ratios and future collaborative "model" where physicians will get all the high risk cases but also have to be "available" to bail out CRNAs doing their own cases
3) Understanding that future salaries are decreasing due to increase CRNA autonomy coupled with downward pressures on income due to increased supply of anesthesia personnel compared to demand. CRNAs are being produced far faster than increases in surgical volume.

My NPV calculation for a physician with 3 million dollars would require >300K post tax to cut even after 30 years of work considering a lawsuit that was >3-5 million that could go after his/her personal assets.

This doesn't apply to physicians who are recently out of residency with HIGH debt or physicians who have no wealth in general.

Yes good question. What is a trust and can you get your money out if you need it? The only absolute way is to stop being an anesthesiologist. But that may not be possible. The next step is cut way down on the work. Dont work with surgeons that have problems. No emergency if u can avoid that. Work only when other seasoned anesthesiologists are around. All the above may or may not work.

Diversify your savings, throw some into ? Gold? May be palladium? Put some paper money away in Canada ? Or may be buy some agricultural property in Brazil? Just thinking aloud. Do you like a boat ? May be a nice RV.

Spend your money on nice vacations. Dont know what else to do other than take good care if your health

 

[Man o War]

Yes good question. What is a trust and can you get your money out if you need it? The only absolute way is to stop being an anesthesiologist. But that may not be possible. The next step is cut way down on the work. Dont work with surgeons that have problems. No emergency if u can avoid that. Work only when other seasoned anesthesiologists are around. All the above may or may not work.

Diversify your savings, throw some into ? Gold? May be palladium? Put some paper money away in Canada ? Or may be buy some agricultural property in Brazil? Just thinking aloud. Do you like a boat ? May be a nice RV.

Spend your money on nice vacations. Dont know what else to do other than take good care if your health

All my stuff is in an AB trust. I paid an attorney a good sum to set it up, but it would be extraordinarily difficult for someone to take my assets. A trust is simply an asset protection tool, and just one tool my attorney used. I highly recommend any doctor spend the money to get a complete, customized asset protection plan done with an experienced attorney.
On that note, I've only known one guy to get a judgment against him that exceeded his limits in all the years I've been doing this. He had a bulletproof asset protection plan in place and quit his job. They tried, but took nothing additional from him. After the case settled (with the hospital) and was over, he went back to work and is doing just fine today.

 

[BLADEMDA]

Here is the future of Anesthesiology for those "Generalists" without Fellowship training:

Southwestern Group, highest earning group in the State, large practice


There are two types of salaried positions available to choose from with competitive compensation for each. The positions allow 6 weeks of vacation and include a generous and comprehensive set of benefits that enhance the value of the total packages. There are numerous opportunities to make extra compensation.

Option 1- 4-10 hour shifts/week pays $225,000/yr

Option 2 - 5-10 hour shifts/week pays $281,250/yr

 

[Consigliere]

Here is the future of Anesthesiology for those "Generalists" without Fellowship training:

Southwestern Group, highest earning group in the State, large practice


There are two types of salaried positions available to choose from with competitive compensation for each. The positions allow 6 weeks of vacation and include a generous and comprehensive set of benefits that enhance the value of the total packages. There are numerous opportunities to make extra compensation.

Option 1- 4-10 hour shifts/week pays $225,000/yr

Option 2 - 5-10 hour shifts/week pays $281,250/yr

Looks good to me! As I get older, time and not money, is the currency I'd like to deal in.

 

[deleted126335]

Here is the future of Anesthesiology for those "Generalists" without Fellowship training:

Southwestern Group, highest earning group in the State, large practice


There are two types of salaried positions available to choose from with competitive compensation for each. The positions allow 6 weeks of vacation and include a generous and comprehensive set of benefits that enhance the value of the total packages. There are numerous opportunities to make extra compensation.

Option 1- 4-10 hour shifts/week pays $225,000/yr

Option 2 - 5-10 hour shifts/week pays $281,250/yr

Agree. The current (November) ASA Monitor has a dramatic graph on page 13 that shows what happened to anesthesia graduates during the 90s. This drop off was responsible for the excellent market for docs from about 2000-2012 or so. Unfortunately another drop off like that is unlikely given the relative ratios of applicants to GME slots. I suppose that a large number of anesthesiologists might retire or drastically cut back, but I don't expect it. The graph on the next page is also disturbing. 13% of anesthesia practices account for 75% of anesthesia professionals.

 

[deleted126335]

Looks good to me! As I get older, time and not money, is the currency I'd like to deal in.

Agree. But the 30 somethings don't feel the same way. I used to pick up extra call and work vacation. Now I give away call and buy extra vacation.

 

[BLADEMDA]

Here is the future of Anesthesiology for those "Generalists" without Fellowship training:

Southwestern Group, highest earning group in the State, large practice


There are two types of salaried positions available to choose from with competitive compensation for each. The positions allow 6 weeks of vacation and include a generous and comprehensive set of benefits that enhance the value of the total packages. There are numerous opportunities to make extra compensation.

Option 1- 4-10 hour shifts/week pays $225,000/yr

Option 2 - 5-10 hour shifts/week pays $281,250/yr

No partnership offered here. Instead, a new grad is being offered less than AMC wages for 50 hours per week. Many AMC jobs are only 50 hours or so and pay $50K more than these guys are posting.

The next time you say "predatory AMC" remember a few of the biggest groups seem to be just as bad if not worse.

 

[pjl]

No partnership offered here. Instead, a new grad is being offered less than AMC wages for 50 hours per week. Many AMC jobs are only 50 hours or so and pay $50K more than these guys are posting.

The next time you say "predatory AMC" remember a few of the biggest groups seem to be just as bad if not worse.

Funny.
My wife was offered a job as a PA in that town making 300. Of course I'm a good husband so called the area group and checked into it.
They (a contact working there) were not sure why I laughed and then was silent after hearing that offer.
Corresponds to the other thread asking about if it is appropriate to find out compensation before flying somewhere.


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[GravelRider]

Here is the future of Anesthesiology for those "Generalists" without Fellowship training:

Southwestern Group, highest earning group in the State, large practice


There are two types of salaried positions available to choose from with competitive compensation for each. The positions allow 6 weeks of vacation and include a generous and comprehensive set of benefits that enhance the value of the total packages. There are numerous opportunities to make extra compensation.

Option 1- 4-10 hour shifts/week pays $225,000/yr

Option 2 - 5-10 hour shifts/week pays $281,250/yr

I think we will see an averaging out of all physicians who are non-specialists settle in the $250k range for full time employment. These salaries are not much different than starting salaries for employed hospitalists and primary care physicians. True specialists who attract patients to an institution, such as surgeons, cardiologists, and oncologists will command more money even as they drift toward employed models as well.

I am not convinced that the anesthesia fellowships will bring you more money in the future. Maybe in the short term a cardiac anesthesiologist might command a higher salary, but I don't think that will last. The better reason to do a fellowship is you like it and it gives you more options.

 

[deleted162650]

A PA making 300 ?!

 

[pjl]

A PA making 300 ?!

It was a pretty good offer, which is why I looked into it. She has 20 or so friends in that range or higher. Not a lot of PAs up there, but there are some. Most start ~100, with experienced positions of 120-150 being more standard. Kind of like all the guys on here making 7 figures I guess.


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[nimbus]

Pain and suffering aka "noneconomic" damages are the ones that create the large settlements. When you cap those, you instantly cut down on the size of lawsuits. Simple medical damages is orders of magnitude less than what juries give out for pain and suffering in some cases.

I'm in a micra state where pain and suffering is capped at $250000. Still we have had some awards >$10mil. Usually involves a child or young adult who requires a lifetime of care because of a medical mishap or a permanently disabling injury to a healthy working adult who can demonstrate sizeable economic damages.