Hiring freezes

[etomidator3]

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Are you seeing hiring freezes in Anesthesia departments. My institution, a large one, is now on a hiring freeze.

 

[deleted126335]

Money is tight. Do more with less. Work harder for less. Overtime is cheaper than hiring more bodies. Even better pay a Salary and work 'em to death. Don't like it? Don't let the door hit you in the ass on the way out. There are plenty of new CRNA grads or right out of training residency docs who have loans to pay and don't have your lofty unreasonable expectations.

Addendum:

The above is basically what we have been told during a request for increase in service from the hospital when we responded with a request for increase in stipend.

 

[Consigliere]

The job market for anesthesiologists is abyssmal. New grads will find this out soon, unfortunately.

 

[leaverus]

The job market for anesthesiologists is abyssmal. New grads will find this out soon, unfortunately.

you are too much the optimist. it's worse than that.

 

[Mman]

Are you seeing hiring freezes in Anesthesia departments. My institution, a large one, is now on a hiring freeze.

We haven't been on an official "freeze", but we haven't hired anybody in 2 years. Our surgical volume which had increased 3-5% per year for more than 10 straight years flattened out in the recession and is only just now resuming that prior growth rate. Haven't had anybody retire because the older docs are still trying to recoup their stock market losses from 2009 and are working longer than they anticipated. Also a lot of trepidation as to what Obama-care will mean to revenue in the future and many don't want to commit to paying new docs when revenue might drop significantly.

I'd imagine lots of other groups are similar. Just waiting to see how it all shakes out. I suspect in 3-4 years there will be a rather large need for hires as the pent up demand will need to be met.

 

[Consigliere]

We haven't been on an official "freeze", but we haven't hired anybody in 2 years. Our surgical volume which had increased 3-5% per year for more than 10 straight years flattened out in the recession and is only just now resuming that prior growth rate. Haven't had anybody retire because the older docs are still trying to recoup their stock market losses from 2009 and are working longer than they anticipated. Also a lot of trepidation as to what Obama-care will mean to revenue in the future and many don't want to commit to paying new docs when revenue might drop significantly.

I'd imagine lots of other groups are similar. Just waiting to see how it all shakes out. I suspect in 3-4 years there will be a rather large need for hires as the pent up demand will need to be met.

I shall save this post and bring it up in 2016 to show you just how horribly wrong you were.

 

[deleted126335]

I shall save this post and bring it up in 2016 to show you just how horribly wrong you were.

AGREE.

I will believe that there is hope for the job market if and only if there is a massive drop in the number of medical students who match into anesthesia.

 

[Mman]

I shall save this post and bring it up in 2016 to show you just how horribly wrong you were.

Please do. There are a LOT of anesthesiologists nearing age 65 and the utilization of our services both in and out of ORs continues to grow. I'd bet that it 2016, there will be something like 10% more anesthetics given in the US than there were in 2012.

Any bet against a need for future hiring can only be right if anesthesiologists aren't in the equation. And we are still working in opt out states and there are many states that aren't anywhere near opting out of anything.

 

[Mman]

AGREE.

I will believe that there is hope for the job market if and only if there is a massive drop in the number of medical students who match into anesthesia.

Why? The need for our services goes up every year as the US population expands, yet the number of residency spots has remained constant for some time.

 

[medicineman12]

Please do. There are a LOT of anesthesiologists nearing age 65 and the utilization of our services both in and out of ORs continues to grow. I'd bet that it 2016, there will be something like 10% more anesthetics given in the US than there were in 2012.

Any bet against a need for future hiring can only be right if anesthesiologists aren't in the equation. And we are still working in opt out states and there are many states that aren't anywhere near opting out of anything.

Typical SDN "the sky is falling". We've heard this before...

 

[deleted126335]

Why? The need for our services goes up every year as the US population expands, yet the number of residency spots has remained constant for some time.

http://www.grogono.com/nrmp/2001/Recruitment01.pdf

Go to page 8 figure 1.

The good job market circa 1999-2009 is a direct result of the drop off in med students entering the match in the mid-late 90s.
The training programs hired like mad during this time in order to do the work of residents who just stopped showing up. This mopped up the excess anesthesiologists looking for jobs. Suddenly there were jobs, but more importantly the pipeline was empty. Hence the decade long bull market for anesthesiologists.

Now we have fewer alternatives for med students. Excess positions in the match are now much less.

Throw in a sh*tty stock market and real estate market, bounce back kids, and I believe the old guys will be hanging around longer than anyone thinks.

Add CRNAs graduating huge numbers and their legislative victories and hospitals pushing ever harder to increase supervisory ratios. Add MD only groups going the way of the dinosaur.

That is why I am pessimistic.

 

[chessknt]

http://www.grogono.com/nrmp/2001/Recruitment01.pdf

Go to page 8 figure 1.

The good job market circa 1999-2009 is a direct result of the drop off in med students entering the match in the mid-late 90s.
The training programs hired like mad during this time in order to do the work of residents who just stopped showing up. This mopped up the excess anesthesiologists looking for jobs. Suddenly there were jobs, but more importantly the pipeline was empty. Hence the decade long bull market for anesthesiologists.

Now we have fewer alternatives for med students. Excess positions in the match are now much less.

Throw in a sh*tty stock market and real estate market, bounce back kids, and I believe the old guys will be hanging around longer than anyone thinks.

Add CRNAs graduating huge numbers and their legislative victories and hospitals pushing ever harder to increase supervisory ratios. Add MD only groups going the way of the dinosaur.

That is why I am pessimistic.

I would hope somebody entering the field now understands that it is going to be evolving in the future, along with the rest of healthcare. Just because the typical gas passer position is going out of style does not mean anesthesiologists have no other role to play in the delivery of healthcare.

 

[sevoflurane]

We've hired 3 in the last couple years.
We keep growing. Record numbers in cardiac, thoracic and ortho. Atypical speaking to my other anesthesia colleagues.

 

[Mman]

http://www.grogono.com/nrmp/2001/Recruitment01.pdf

Go to page 8 figure 1.

The good job market circa 1999-2009 is a direct result of the drop off in med students entering the match in the mid-late 90s.

Yes, there was a drop off in the late 90s in terms of # of residents being trained. In the last decade, however, it's been flat. And it is almost impossible to increase it in our current system.

So while the good job market earlier was definitely related to the previous downturn in resident numbers, that does not project to a bad market in the future. As I said, the US population keeps getting bigger and we keep having more people in their 60s and 70s and 80s living here. They need surgeries. Baby boomers are getting to the age when you expect a sharp upturn in their need for CABGs and TKAs. That means the number of surgeries performed in our country should rise even faster than the overall population growth. Then add in ever increasing numbers of cases outside the OR that we get dragged in to and there is no end in sight to the demand for our services.

Physicians can hold off on retiring to some extent, but not forever.

Increasing demand and fixed supply of personnel means the job market will have to improve.

 

[DrRobert]

I disagree that surgical procedures will increase with an aging population. While nobody knows for sure what's coming, here is what some of the "higher ups" in the ASA and AMA have told me...

Rationing is coming. But unlike Europe, the US government does not want to be seen as the rationer. Instead, they will "force" surgeons to ration care. How will they do that?

They are already planting the seeds. And there are 2 ways to do it. We can use knee replacement surgery as an example.

1. Bundled payments. Medicare only pays one global fee for a knee replacement. If the patient suffers a complication and needs additional resources (wound infection, PE, MI, CVA, CHF, etc) the hospital and treating physicians will have to "eat it". Eventually the hospital and treating physicians will tell the surgeons we are not going to tolerate this unless the surgeons want to give up their portion of the global fee. So surgeons will be forced to operate only on the healthiest patients to avoid complications. Over age 70 nope. BMI > 30 nope. Smoker nope. HgbA1C > 7 nope. EF <50% nope. Uncontrolled HTN nope. Pretty soon there's not a lot of patients left to operate on.

2. Quality Initiative. Medicare will start "grading" physicians on their quality outcomes. If you don't meet the benchmarks, you don't get paid. For surgeons that means your post-op complications have to be below a certain level in order to get fully reimbursed. So how do surgeons decrease their complication rate? Operate on healthier patients. Again, only "healthy" patients will get their surgery. And we all know how many "healthy" patients are out there 😉

 

[Random Anesthesiologist]

I disagree that surgical procedures will increase with an aging population. While nobody knows for sure what's coming, here is what some of the "higher ups" in the ASA and AMA have told me...

Rationing is coming. But unlike Europe, the US government does not want to be seen as the rationer. Instead, they will "force" surgeons to ration care. How will they do that?

They are already planting the seeds. And there are 2 ways to do it. We can use knee replacement surgery as an example.

1. Bundled payments. Medicare only pays one global fee for a knee replacement. If the patient suffers a complication and needs additional resources (wound infection, PE, MI, CVA, CHF, etc) the hospital and treating physicians will have to "eat it". Eventually the hospital and treating physicians will tell the surgeons we are not going to tolerate this unless the surgeons want to give up their portion of the global fee. So surgeons will be forced to operate only on the healthiest patients to avoid complications. Over age 70 nope. BMI > 30 nope. Smoker nope. HgbA1C > 7 nope. EF <50% nope. Uncontrolled HTN nope. Pretty soon there's not a lot of patients left to operate on.

2. Quality Initiative. Medicare will start "grading" physicians on their quality outcomes. If you don't meet the benchmarks, you don't get paid. For surgeons that means your post-op complications have to be below a certain level in order to get fully reimbursed. So how do surgeons decrease their complication rate? Operate on healthier patients. Again, only "healthy" patients will get their surgery. And we all know how many "healthy" patients are out there 😉

Then comes full circle true fee-for-service care for people who pay out of pocket or carry private insurance, kind of like how the Surgery Center of OK does it.

 

[DrRobert]

Then comes full circle true fee-for-service care for people who pay out of pocket or carry private insurance, kind of like how the Surgery Center of OK does it.

I only partially agree with you. Private insurance will follow Medicare's guidelines. Guaranteed. So private insurers will also use bundled payments and quality initiatives.

Self pay might be the only way to get around it and be able to operate on the sicker patients. The obvious problem with that is how many people can afford to self-pay for a surgery in this economy?

 

[Mman]

I only partially agree with you. Private insurance will follow Medicare's guidelines. Guaranteed. So private insurers will also use bundled payments and quality initiatives.

Self pay might be the only way to get around it and be able to operate on the sicker patients. The obvious problem with that is how many people can afford to self-pay for a surgery in this economy?

Private insurance only follows that until they can't attract customers. If people want the quality of health care they are used to, they will have to pay for it. Considering that insurance companies are doing just fine financially I suspect people will continue to pay for it.

 

[deleted126335]

Yes, there was a drop off in the late 90s in terms of # of residents being trained. In the last decade, however, it's been flat. And it is almost impossible to increase it in our current system.

So while the good job market earlier was definitely related to the previous downturn in resident numbers, that does not project to a bad market in the future. As I said, the US population keeps getting bigger and we keep having more people in their 60s and 70s and 80s living here. They need surgeries. Baby boomers are getting to the age when you expect a sharp upturn in their need for CABGs and TKAs. That means the number of surgeries performed in our country should rise even faster than the overall population growth. Then add in ever increasing numbers of cases outside the OR that we get dragged in to and there is no end in sight to the demand for our services.

Physicians can hold off on retiring to some extent, but not forever.

Increasing demand and fixed supply of personnel means the job market will have to improve.

Numbers have been flat the last few years, but what I believe is a high level. Certainly more than replacement of those leaving the field.

The old guys will hang around till they are shown the door.

Add in what I believe will be a ratcheting down of inefficencies- surgery centers closing, no longer maintaining excess capacity so as to accomodate surgeons, hospitals closing or downsizing, hospital mergers, ever increasing supervisory ratios, dropping amounts of MD administered anesthesia, CRNA encroachment,... etc., etc,

 

[DrRobert]

Private insurance only follows that until they can't attract customers. If people want the quality of health care they are used to, they will have to pay for it. Considering that insurance companies are doing just fine financially I suspect people will continue to pay for it.

I assume an educated person like yourself has been reading the news lately. Major health insurance companies have been enacting double digit rate hikes despite the overall costs of healthcare leveling out. And the states have no power to stop it. There is no reason this won't continue.

The result? Individuals cannot afford to buy private health insurance so they are going on Medicaid or going without any coverage. Companies are no longer offering health insurance to their employees. The ones that still offer coverage are increasing employee premiums to reflect the increases in premiums leveed by the insurance companies.

At some point, virtually no one will have private health insurance. This will cause quite a stir from the American public. What will be the result? Universal Healthcare i.e. Medicare for all! Again, the US government gets what it wants (universal healthcare) without looking like the bad guy. They blame the insurance companies and look like heroes for saving everyone with a national health system.

The government isn't as stupid as they appear folks.

 

[Mman]

Numbers have been flat the last few years, but what I believe is a high level. Certainly more than replacement of those leaving the field.

I believe what, something like 1100-1200 people graduate an anesthesia residency every year in this country? Assume an overly generous average of a 30 year full time career per graduate and you are holding flat at 33000-36000 anesthesiologists in the country at any time, excluding foreign trained docs working here. But a 30 year full time career is way overgenerous as a median. Plenty of docs end up working part time or even leaving fulltime medicine for family responsibilities.

I don't think that's enough to meet the long term need.

 

[Mman]

I assume an educated person like yourself has been reading the news lately. Major health insurance companies have been enacting double digit rate hikes despite the overall costs of healthcare leveling out. And the states have no power to stop it. There is no reason this won't continue.

The result? Individuals cannot afford to buy private health insurance so they are going on Medicaid or going without any coverage. Companies are no longer offering health insurance to their employees. The ones that still offer coverage are increasing employee premiums to reflect the increases in premiums leveed by the insurance companies.

At some point, virtually no one will have private health insurance. This will cause quite a stir from the American public. What will be the result? Universal Healthcare i.e. Medicare for all! Again, the US government gets what it wants (universal healthcare) without looking like the bad guy. They blame the insurance companies and look like heroes for saving everyone with a national health system.

The government isn't as stupid as they appear folks.

I am aware of all of that. I am also aware that in places like the UK with nationalized health care that private hospitals still exist. That overwhelming majority of voters have no desire for national healthcare. People with insurance like their insurance and plan to keep it.

The government is more stupid than it appears, particularly when the politicians only job is to get re-elected, not to enact any meaningful change for the country.

 

[chessknt]

I assume an educated person like yourself has been reading the news lately. Major health insurance companies have been enacting double digit rate hikes despite the overall costs of healthcare leveling out. And the states have no power to stop it. There is no reason this won't continue.

The result? Individuals cannot afford to buy private health insurance so they are going on Medicaid or going without any coverage. Companies are no longer offering health insurance to their employees. The ones that still offer coverage are increasing employee premiums to reflect the increases in premiums leveed by the insurance companies.

At some point, virtually no one will have private health insurance. This will cause quite a stir from the American public. What will be the result? Universal Healthcare i.e. Medicare for all! Again, the US government gets what it wants (universal healthcare) without looking like the bad guy. They blame the insurance companies and look like heroes for saving everyone with a national health system.

The government isn't as stupid as they appear folks.

Indeed, I was hoping the supreme court would stop this backdoor to single payer but the US is on a crash course of fail.

 

[DrRobert]

I am aware of all of that. I am also aware that in places like the UK with nationalized health care that private hospitals still exist. That overwhelming majority of voters have no desire for national healthcare. People with insurance like their insurance and plan to keep it.

Hmm. My medicaid patients seem happier than pigs in shyt. They don't take care of themselves, are able to afford iPhones, use their food stamps to eat McDonalds 5 times a day, and can visit the ER as much as their little hearts desire. If they need pain meds they get it, if they need a hot meal they get it, if they need a TV and more blankets they get it, and if they need surgery they get it.

 

[callsux]

Hmm. My medicaid patients seem happier than pigs in shyt. They don't take care of themselves, are able to afford iPhones, use their food stamps to eat McDonalds 5 times a day, and can visit the ER as much as their little hearts desire. If they need pain meds they get it, if they need a hot meal they get it, if they need a TV and more blankets they get it, and if they need surgery they get it.

Do you work where I do? This perfectly describes my patient population.

 

[ProwlerturnGas]

The job market for anesthesiologists is abyssmal. New grads will find this out soon, unfortunately.

Man, this is the truth. Looking to change my employment. Seeing only Locums. WOW!

 

[BLADEMDA]

AGREE.

I will believe that there is hope for the job market if and only if there is a massive drop in the number of medical students who match into anesthesia.

This doesn't make any sense. The number of Medical Students keeps increasing each year while the Residency spots stay relatively fixed. This means every Anesthesiology slot is more competitive with each graduating class.

Supply vs Demand applies more than ever and the demand for a Residency position (any position) has never been greater in my lifetime.

 

[BLADEMDA]

I assume an educated person like yourself has been reading the news lately. Major health insurance companies have been enacting double digit rate hikes despite the overall costs of healthcare leveling out. And the states have no power to stop it. There is no reason this won't continue.

The result? Individuals cannot afford to buy private health insurance so they are going on Medicaid or going without any coverage. Companies are no longer offering health insurance to their employees. The ones that still offer coverage are increasing employee premiums to reflect the increases in premiums leveed by the insurance companies.

At some point, virtually no one will have private health insurance. This will cause quite a stir from the American public. What will be the result? Universal Healthcare i.e. Medicare for all! Again, the US government gets what it wants (universal healthcare) without looking like the bad guy. They blame the insurance companies and look like heroes for saving everyone with a national health system.

The government isn't as stupid as they appear folks.

That's the true ObamaCare plan. How many years until the vast majority of Americans can no longer afford their health care plan? 3? 5? 7? At some point the 25K per year basic health cae plan becomes a non option for the vast majority of our Citizens. The alternative is "Medicare for all" option. Obama knows it will take 5-10 years to convert from a private payers to a government run health system. ObamaCare was and is a Trojan Horse for a National Health Care service.

 

[deleted126335]

This doesn't make any sense. The number of Medical Students keeps increasing each year while the Residency spots stay relatively fixed. This means every Anesthesiology slot is more competitive with each graduating class.

Supply vs Demand applies more than ever and the demand for a Residency position (any position) has never been greater in my lifetime.

I know. I believe that we are training more anesthesiologists than are leaving the field, and demand is dropping for the other reasons, e.g. expanded use of CRNAs.

I predict that this years match will be substantially the same as last years as med students have fewer options in all specialties.

IMO there is no hope for the job market changing direction until the number of residents being pumped out drops substantially.

As you point out, there is no sign of this.

 

[BLADEMDA]

I believe what, something like 1100-1200 people graduate an anesthesia residency every year in this country? Assume an overly generous average of a 30 year full time career per graduate and you are holding flat at 33000-36000 anesthesiologists in the country at any time, excluding foreign trained docs working here. But a 30 year full time career is way overgenerous as a median. Plenty of docs end up working part time or even leaving fulltime medicine for family responsibilities.

I don't think that's enough to meet the long term need.

Wrong. Dead Wrong. The Hospitals want efficient care. This means cheaper, easier to replace midlevels doing the stool sitting with less supervisers. Your method of ASA Medical Direction won't last much longer as ObamaCare doesn't reimburse enough to pay the bills.

I hope the AAs can get the same supervision rules as the CRNAs in a few years or I fear many will lose their jobs. Great markets like Atlanta will be the last to fall under ObamaCare but they will fall nonetheless.

Right now there are hundreds of new CRNA graduates looking for work in my state. Next year hundreds more will graduate again without any hope for a $120K job (which used to pay over $130K) in my State. The CRNA mills are pumping out new graduates at record levels saturating the market with cheap labor. I hear stories of $110K (W-2) jobs being posted then immediately filled by a new CRNA graduate. If things continue CRNA pay will fall back at least 1 or 2 decades in terms of pay scale. If flooding the market is part of some long term political action plan by the AANA they better hope their membership can survive it.

 

[BLADEMDA]

Obama knows the real intent behind his "Obamacare" health care plan. Unfortunately, many of you fail to recognize the long term implications of this law.

 

[BLADEMDA]

The cost of health insurance in 2014: Get ready for sticker shock


expect a 30% to 40% increase in the baseline cost of individual health insurance to account for the new premium taxes, reinsurance costs, benefit mandate increases, and underwriting reforms. Those increases can come in the form of outright price increases or bigger deductibles and co-pays.

In states with the least mandates or for health insurance companies with the tightest underwriting now, the increase could be a lot more.

But when you add the impact of the requirement that older consumers can be charged no more than three times as much as the youngest consumers (the usual standard is now a five times difference), premiums increase dramatically for the youngest.

For example, expect individual health insurance rates for people in their 20s and early 30s to about double.


http://www.kevinmd.com/blog/2012/12/cost-health-insurance-2014-ready-sticker-shock.html

 

[TheKidCanRun]

Hi all. Long time lurker on this site, always love to read the lively discussions. As a CA-1, this issue is causing me significant stress already.

So where does this leave us residents? Are the majority of 1,300 new grads every year going to have a very difficult time finding employment of any kind? Does Obamacare spell the end for the anesthesiologist as we know it? This is really freaking scary, and it makes it hard to get through the grind of a 70 hour work week knowing that there may not be a ligth at the end of the tunnel after all.

CA-3's graduating from my program still seem to be finding jobs (for now), but it seems like it's been somewhat tough.

 

[ProwlerturnGas]

Back are the days of multiple fellowships to wait out the market? Already thinking about it. Amongst other things....

 

[BLADEMDA]

Hi all. Long time lurker on this site, always love to read the lively discussions. As a CA-1, this issue is causing me significant stress already.

So where does this leave us residents? Are the majority of 1,300 new grads every year going to have a very difficult time finding employment of any kind? Does Obamacare spell the end for the anesthesiologist as we know it? This is really freaking scary, and it makes it hard to get through the grind of a 70 hour work week knowing that there may not be a ligth at the end of the tunnel after all.

CA-3's graduating from my program still seem to be finding jobs (for now), but it seems like it's been somewhat tough.

Work Hard. Excel at what you do. Network for a job. Consider a Fellowship to improve your odds of finding a good job.

Things are tough out there but a quality, Fellowship trained Anesthesiologist can still find a good job.

 

[deleted126335]

Work Hard. Excel at what you do. Network for a job. Consider a Fellowship to improve your odds of finding a good job.

Things are tough out there but a quality, Fellowship trained Anesthesiologist can still find a good job.

Agree with above. Also be flexible geographically. If you want to live in urban pardise or resort area you will pay up for it big time in your compensation.

 

[gasattack3]

Agree with above. Also be flexible geographically. If you want to live in urban pardise or resort area you will pay up for it big time in your compensation.

This is part of the issue. Everyone wants to live in Chicago, NY or California. I still see plenty of ADVERTISED jobs in other places considered less desirable by most. Good paying jobs.

 

[Mman]

Wrong. Dead Wrong. The Hospitals want efficient care. This means cheaper, easier to replace midlevels doing the stool sitting with less supervisers. Your method of ASA Medical Direction won't last much longer as ObamaCare doesn't reimburse enough to pay the bills.

I hope the AAs can get the same supervision rules as the CRNAs in a few years or I fear many will lose their jobs. Great markets like Atlanta will be the last to fall under ObamaCare but they will fall nonetheless.

Right now there are hundreds of new CRNA graduates looking for work in my state. Next year hundreds more will graduate again without any hope for a $120K job (which used to pay over $130K) in my State. The CRNA mills are pumping out new graduates at record levels saturating the market with cheap labor. I hear stories of $110K (W-2) jobs being posted then immediately filled by a new CRNA graduate. If things continue CRNA pay will fall back at least 1 or 2 decades in terms of pay scale. If flooding the market is part of some long term political action plan by the AANA they better hope their membership can survive it.

None of that disagrees with the post you replied to. CRNAs have definitely flooded the market and there are too many to fill too few jobs. Anesthesiologists are in the opposite boat. Our supply is completely fixed and unable to expand.

 

[kgpremed11]

The job market for anesthesiologists is abyssmal. New grads will find this out soon, unfortunately.

Thank your generation for completly selling out to CRNA's.

 

[deleted126335]

Thank your generation for completly selling out to CRNA's.

Your generation would have done the same.

 

[gasattack3]

The problem with CRNA's is not that our field utilizes mid-level providers. The biggest problem is that our field got LAZY and empowered the CRNA's to even begin thinking they can fill the role of an anesthesiologist. Sure, this is the minority, but that's the essential stance of the AANA as we all know.

Physicians need to get back into the rooms and show a MUCH more visible presence, especially during more high risk patients and procedures/surgeries. This is essential to the perception of the surgeons, and it's essential to RE-earning the respect of CRNA's who, then, won't likely be as ready to lobby to take your job.

We all understand multiple start rooms and pressures during certain times during the day. I'm not sure what the solution to this is, and MAYBE it's reigning back in the ASA 3/4's and high risk operations, even going solo on those even if it means no BS pre-ops in endo?? I'm not sure.

Perception is reality. Today, the reality is that CRNA's are functioning more or less doing sick patients and high risk procedures with MD supervision.

Why is it not the perception that the PA or NP can do the lap chole or appy?? Because the surgeons never gave them the chance. Could they do it? I'm sure they could and maybe some of them even better than the MD. But, it'll never happen, and THUS the perception that that's anything but a surgeons domain has not even crossed most people's mind.

We need to reestablish, somehow, and fight harder for scope of practice limitations. No anesthesiologist, no regional. No anesthesiologist, no advanced hemodynamic monitoring (maybe only A-lines). No anesthesiologist, no interventional pain procedure.

Or, we can just reassume, solo, the most difficult cases.

For example, while Dr.'s X, Y, and Z are doing the thoracoscopy/otomy's, open vascular cases, complex neuro and ENT cases, hearts, the sickest ortho trauma cases (you name it), THEN perhaps partner's Dr A, B, and C are supervising an increased ratio of CRNA's in endo, the ambulatory centers, etc. The following week, Dr's A, B, and C are doing those cases etc. They rotate in and out.

This model does many things positive towards our field. First, it says, "there are just some things that require an anesthesiologist". Plain and simple. It also reestablishes our role in the OR and rapport with the surgeons (and respect follows). It sends a clear message to all that certain things require the direct participation of an MD/DO. Even if you think that's BS and that your resources are better spent in another way, perception is reality. Does the OR circulator even fathom that anyone BUT a General Surgeon is qualfied to do a lap appy? Likely not. Thus, that becomes the reality, and nobody has to dick around with fighting that turf war.

It also takes away certain skills from them. Once they stop using them, they'll lose them. It maximizes your value added skill set. We need to reestablish the boundaries. This will not be easy. Greed is too often in the way. But, greed is often shortsighted. We'll need to make some sacrifices in order to turn this around and it will pay off, even financially, in the future.

We can still utilize CRNA's but we've quite obviously OVER utilized them in certain circumstances. I'm not sure how to fix the "no MD will come out to these here parts" conundrum. One step at a time though.

 

[sevoflurane]

Agree with above. Also be flexible geographically. If you want to live in urban pardise or resort area you will pay up for it big time in your compensation.

Best REAL advice I've heard in a while.

Be flexible in location. Once you get out of the hole and build up some reserves, go to where you want to play and have fun... or stay and retire earlier than the guy in LA, Boston, Chicago, etc...
While you are paying down debt and getting that reserve, time will be on your side and you can calculate your next move under no pressure with as much time as you want- if that is indeed what you want to do. Some places that are a little off the grid offer a lot more than people may think, and often times, people don't move for a variety of reasons.

 

[jwk]

The job market for anesthesiologists is abyssmal. New grads will find this out soon, unfortunately.

you are too much the optimist. it's worse than that.

Hmmmm, we hired ten last year and will be hiring more this year.

 

[jwk]

Wrong. Dead Wrong. The Hospitals want efficient care. This means cheaper, easier to replace midlevels doing the stool sitting with less supervisers. Your method of ASA Medical Direction won't last much longer as ObamaCare doesn't reimburse enough to pay the bills.

I hope the AAs can get the same supervision rules as the CRNAs in a few years or I fear many will lose their jobs. Great markets like Atlanta will be the last to fall under ObamaCare but they will fall nonetheless.

Right now there are hundreds of new CRNA graduates looking for work in my state. Next year hundreds more will graduate again without any hope for a $120K job (which used to pay over $130K) in my State. The CRNA mills are pumping out new graduates at record levels saturating the market with cheap labor. I hear stories of $110K (W-2) jobs being posted then immediately filled by a new CRNA graduate. If things continue CRNA pay will fall back at least 1 or 2 decades in terms of pay scale. If flooding the market is part of some long term political action plan by the AANA they better hope their membership can survive it.

Geography is a huge consideration. Florida is overrun by CRNA schools, yet other states still go wanting for anesthetists of either type as well as anesthesiologists. Those who are bound and determined they MUST work in the big cities are likely to be mighty disappointed in many cases. Those willing to be flexible will find reward. And - those who are willing to actually get out and REALLY look for a job will find them, unlike the spouse who posted here recently, whose resident spouse was wanting her husband to do the job hunting because she was too busy.

 

[Noegrus]

Geography is a huge consideration. Florida is overrun by CRNA schools, yet other states still go wanting for anesthetists of either type as well as anesthesiologists. Those who are bound and determined they MUST work in the big cities are likely to be mighty disappointed in many cases. Those willing to be flexible will find reward. And - those who are willing to actually get out and REALLY look for a job will find them, unlike the spouse who posted here recently, whose resident spouse was wanting her husband to do the job hunting because she was too busy.

Yes. Excellent observations. But that is haaaaaaaaard work. Sitting here and rambling about how bad it is going to be, how all anesthesiologists will lose their jobs, and how CRNAs will be the overlords make for such wonderful conversation. I have never, ever heard such despair from any practicing anesthesiologist in real life.
Please don't stop them from their Doom's day prophecies. We are all gonna dieeeeeeeeee of hungerrrrrrr.....mid levels are commiessssssss.... Obamacare is commmmmminnnnggggg...... Our country will be like..... Swedennnnnnn....oh wait, no. Sweden is great. OK no, our country will be like Canadaaaaaaaaa. Wait, that's is pretty nice too. Well, our country will be baddddddd..somehowwwww....eff evidence to the contrary!

 

[Random Anesthesiologist]

Best REAL advice I've heard in a while.

Be flexible in location. Once you get out of the hole and build up some reserves, go to where you want to play and have fun... or stay and retire earlier than the guy in LA, Boston, Chicago, etc...
While you are paying down debt and getting that reserve, time will be on your side and you can calculate your next move under no pressure with as much time as you want- if that is indeed what you want to do. Some places that are a little off the grid offer a lot more than people may think, and often times, people don’t move for a variety of reasons.

Thanks for this.

My spouse and I are prepared for this aspect of job-seeking. And it's fine. If the alternative is unemployment or unsatisfied employment, I would work almost anywhere if it meant having a job and being happy. ALMOST anywhere lol.

 

[Consigliere]

Please do. There are a LOT of anesthesiologists nearing age 65 and the utilization of our services both in and out of ORs continues to grow. I'd bet that it 2016, there will be something like 10% more anesthetics given in the US than there were in 2012.

Any bet against a need for future hiring can only be right if anesthesiologists aren't in the equation. And we are still working in opt out states and there are many states that aren't anywhere near opting out of anything.

Large numbers of anesthesiologists are being displaced by large numbers of CRNAs. For instance, a group of 30 anesthesiologists who has worked at Great Hospital USA for 25 years has EmCare slide in and steal the contract. They change to an ACT model and now have 25 CRNAs and 5 anesthesiologists. 25 heads are now unemployed and looking for jobs. This is happenening all across America. If you can't see this, you are either purposefully ignoring it or ignorant.

 

[BLADEMDA]