BLADEMDA

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"The health care law presumed that physician reimbursement could be cut by 21 percent, then frozen in real terms," said Reynolds. "The law also expands Medicaid to cover 16 million people not previously considered poor enough to qualify. From past expansions of Medicaid, economists have found that most of the new enrollees were not uninsured, but instead switched from employer-provided plans."

Reynolds said the inevitable reaction from government is the application of even-harsher price controls.

"Price controls boost demand and discourage supply, resulting in ‘shortages,'" Reynolds said. "Politicians imagine that they can somehow force medical care providers to work for peanuts, but we abolished slavery a long time ago."
 
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Every thread on this issue I've seen for the past couple years, I see Blade trying to scare everyone away. I was recently visiting a major city and saw a guy holding up "The end is near" sign and the first thing that came to mind was BLADEMDA on SDN. My guess is he has been doing bread and butter gas and tries to avoid critical cases where an MDA will ALWAYS be needed because a nurse only knows what a nurse knows. Go to a critical case where there are a dozen things going on with the patient, who is on a dozen meds and drugs and ask the CRNA how to manage this patient. Or maybe ask the orthopod repairing the hip about the anesthetic plan in this patient? Or go to a children's hospital to a congenital heart defect baby about to go through surgery and tell the parents that a CRNA will be entirely in charge.

Anesthesia is changing and the strong learn to evolve. My advice to anyone interested in anesthesia is DO IT but be ready to be a consultant in the simple cases and in the OR for only the big cases.

Anesthesiologist and CRNAs have coexisted for basically a century and chances are that they are both going to be needed for any foreseeable future. And if the apocalypse does happen and CRNAs suddenly understand everything an anesthesiologist understands and still want half the pay, then go into critical care or pain management.
 

BLADEMDA

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Every thread on this issue I've seen for the past couple years, I see Blade trying to scare everyone away. I was recently visiting a major city and saw a guy holding up "The end is near" sign and the first thing that came to mind was BLADEMDA on SDN. My guess is he has been doing bread and butter gas and tries to avoid critical cases where an MDA will ALWAYS be needed because a nurse only knows what a nurse knows. Go to a critical case where there are a dozen things going on with the patient, who is on a dozen meds and drugs and ask the CRNA how to manage this patient. Or maybe ask the orthopod repairing the hip about the anesthetic plan in this patient? Or go to a children's hospital to a congenital heart defect baby about to go through surgery and tell the parents that a CRNA will be entirely in charge.

Anesthesia is changing and the strong learn to evolve. My advice to anyone interested in anesthesia is DO IT but be ready to be a consultant in the simple cases and in the OR for only the big cases.

Anesthesiologist and CRNAs have coexisted for basically a century and chances are that they are both going to be needed for any foreseeable future. And if the apocalypse does happen and CRNAs suddenly understand everything an anesthesiologist understands and still want half the pay, then go into critical care or pain management.

There have been SDN members who have visited my practice. I've met them. They know the type of cases I do and the high acuity I see on a daily basis. My skills and knowledge have never been better in my lifetime. I routinely do the ASA4 case and rescue CRNAs regularly. I know the value of team leader on the team. That said, I do dream of the day in the future when I can routinely do my own bread and butter cases.

I fully understand the mind set of the med student and resident when it comes to my posts on this subject. I try to post the truth as I see it. I have no agenda other than to post what I see for the future of Anesthesiology. The fact that many chairmen and leaders in the ASA know my posts are true but refuse to publicly acknowledge the major issues facing this specialty in the future is very disheartening to say the least.

The specialty will exist tomorrow and in the future. But, what will it look like? What will the role of the anesthesiologist be in the operating room? Team leader or colleague? Supervisor or just another anesthetist next room over from the CRNA? Did the Announcement by the VA on independent CRNA practice not register yet?

We all pay back those who mentored us over the years in different ways. I am grateful to those who took time to educate and teach me this specialty. I value education and knowledge and the way I get to use it daily in my practice. I hope to return just a sliver of my mentors efforts with me during my younger years by posting honestly on SDN. From anesthesia to religion to politics I've always posted what I believe to be true. No hidden agenda other than my conservative views on most issues.

My goal isn't to scare you; but, rather warn you of the likely future which awaits you ahead. By all means please match into Anesthesiology and advance the field in every manner possible. I know many med students will do exactly that this year. No matter what I say the spots will get filled. But, remember you were warned before going through 4 years of Residency about the problems this specialty faces under Obamacare.

There is nothing left for me to say other than good luck with Anesthesiology. You will need it.
 

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It is unconstitutional for the government to make us do do that. If they do I'm moving to Canada or Mexico.
Unconstitutional laws get passed all the time. The courts are slow, and don't always make the right decision.

Mexico, really?!? It's warmer than Canada and the food's better, I'll say that. :)




PGG, what happened to the attempted enforcement in Mass?
As I recall the bill passed either the state senate or house but failed to get through the other one. I don't think it ever made it to the governor's desk.

Like other unconstitutional thoughts and bad idea, I'm sure its proponents are biding their time before trying again.
 
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There have been SDN members who have visited my practice. I've met them. They know the type of cases I do and the high acuity I see on a daily basis. My skills and knowledge have never been better in my lifetime. I routinely do the ASA4 case and rescue CRNAs regularly. I know the value of team leader on the team. That said, I do dream of the day in the future when I can routinely do my own bread and butter cases.

I fully understand the mind set of the med student and resident when it comes to my posts on this subject. I try to post the truth as I see it. I have no agenda other than to post what I see for the future of Anesthesiology. The fact that many chairmen and leaders in the ASA know my posts are true but refuse to publicly acknowledge the major issues facing this specialty in the future is very disheartening to say the least.

The specialty will exist tomorrow and in the future. But, what will it look like? What will the role of the anesthesiologist be in the operating room? Team leader or colleague? Supervisor or just another anesthetist next room over from the CRNA? Did the Announcement by the VA on independent CRNA practice not register yet?

We all pay back those who mentored us over the years in different ways. I am grateful to those who took time to educate and teach me this specialty. I value education and knowledge and the way I get to use it daily in my practice. I hope to return just a sliver of my mentors efforts with me during my younger years by posting honestly on SDN. From anesthesia to religion to politics I've always posted what I believe to be true. No hidden agenda other than my conservative views on most issues.

My goal isn't to scare you; but, rather warn you of the likely future which awaits you ahead. By all means please match into Anesthesiology and advance the field in every manner possible. I know many med students will do exactly that this year. No matter what I say the spots will get filled. But, remember you were warned before going through 4 years of Residency about the problems this specialty faces under Obamacare.

There is nothing left for me to say other than good luck with Anesthesiology. You will need it.
Thank you for your very sincere reply to my post. I know what you are saying is not baseless but I also know it has been said for so long and scared away so many bright minds from this field. It almost scared me away as well (I am currently applying) despite loving my experience in it. I have a few classmates that decided not to apply to anesthesia because of these CRNA issues. Note that despite state laws allowing solo CRNAs, any self-respecting hospital in every state has not fired their anesthesiologists.

The vast majority of CRNAs understand their limitations regardless of how they behave and they do not want to be in a case over their head without the life-saving skills of a physician. Why do you think so few American-trained MDs used to go into our field just a couple decades ago until it became one of the highest paid fields of medicine? Ironically, lawsuits and PR of the practice will keep MDAs in business, regardless of Obamacare or any other CommieCare.

I heard my Family Medicine resident complain everyday about how she wishes people didn't scare her away from anesthesia when she was applying. Again, I do respect your view but I just want you to keep in mind that your feeding the fears of people, causing them to pursue fields they hate only to later realize the mistake they made.

Lastly, I just want to say in my hospital I have attendings and residents that have switched to anesthesiology from several fields (surgery, IM, peds, obgyn) but I have NEVER heard of an anesthesiologist or anesthesia resident switching into surgery or anything else. Why is that? Ask any Ob what they think of anesthesiology and they'll say it's one of the greatest fields at least from what I have heard. I never hear anything remotely similar from anesthesiologists talking about ObGyn.
 
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imfrankie

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Anesthesiology groups are getting fired everyday by administrators to be replaced by revenue enhancing CRNA "collaborative" models. You need to understand that. It is definitely changing.
 

BLADEMDA

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Thank you for your very sincere reply to my post. I know what you are saying is not baseless but I also know it has been said for so long and scared away so many bright minds from this field. It almost scared me away as well (I am currently applying) despite loving my experience in it. I have a few classmates that decided not to apply to anesthesia because of these CRNA issues. Note that despite state laws allowing solo CRNAs, any self-respecting hospital in every state has not fired their anesthesiologists.

The vast majority of CRNAs understand their limitations regardless of how they behave and they do not want to be in a case over their head without the life-saving skills of a physician. Why do you think so few American-trained MDs used to go into our field just a couple decades ago until it became one of the highest paid fields of medicine? Ironically, lawsuits and PR of the practice will keep MDAs in business, regardless of Obamacare or any other CommieCare.

I heard my Family Medicine resident complain everyday about how she wishes people didn't scare her away from anesthesia when she was applying. Again, I do respect your view but I just want you to keep in mind that your feeding the fears of people, causing them to pursue fields they hate only to later realize the mistake they made.

Lastly, I just want to say in my hospital I have attendings and residents that have switched to anesthesiology from several fields (surgery, IM, peds, obgyn) but I have NEVER heard of an anesthesiologist or anesthesia resident switching into surgery or anything else. Why is that? Ask any Ob what they think of anesthesiology and they'll say it's one of the greatest fields at least from what I have heard. I never hear anything remotely similar from anesthesiologists talking about ObGyn.
Residents rarely understand the full private practice ramifications of their chosen specialty. It takes a few years (sometimes longer) to get a grasp on the economics and politics of a specialty.

I have never advocated going into a specialty that you despise. That would be foolish advice.
I simply try and post the issues which Anesthesiology faces in the future. Some of these issues are not present in other fields to the same extent. Med Students shoud pick a specialty with their eyes wide open.

Last year a CA-3 resident sent me a PM about his great private practice job. 80th percentile income wth good working conditions. Short partnership track. This resident decided to skip doing a fellowship and take this great job. Guess what? He is only a few months into this new job and the partners decided to sell to an AMC. He is now going to quit in a few months and get a job with an AMC in another state. A job which doesn't offer Median income or great benefits.

My posts are honest and reflect the world we live in today. They aren't based on Ivory tower fantasies or med student conceptions of what the field should be. The reality on the ground isn't pretty and is hard to see from the clouds.

Most med students (60-70 percent) are going to be disappointed with some, if not most, aspects of the economics and politics of this specialty down the road. As long as you have realistic expectations of the future then by all means go into Anesthesiology.

Anesthesiology residencies will fill every spot with a body. They always have and likely always will. The million dollar question is do you want to be that body?
 
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BLADEMDA

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Thank you for your very sincere reply to my post. I know what you are saying is not baseless but I also know it has been said for so long and scared away so many bright minds from this field. It almost scared me away as well (I am currently applying) despite loving my experience in it. I have a few classmates that decided not to apply to anesthesia because of these CRNA issues. Note that despite state laws allowing solo CRNAs, any self-respecting hospital in every state has not fired their anesthesiologists.

The vast majority of CRNAs understand their limitations regardless of how they behave and they do not want to be in a case over their head without the life-saving skills of a physician. Why do you think so few American-trained MDs used to go into our field just a couple decades ago until it became one of the highest paid fields of medicine? Ironically, lawsuits and PR of the practice will keep MDAs in business, regardless of Obamacare or any other CommieCare.

I heard my Family Medicine resident complain everyday about how she wishes people didn't scare her away from anesthesia when she was applying. Again, I do respect your view but I just want you to keep in mind that your feeding the fears of people, causing them to pursue fields they hate only to later realize the mistake they made.

Lastly, I just want to say in my hospital I have attendings and residents that have switched to anesthesiology from several fields (surgery, IM, peds, obgyn) but I have NEVER heard of an anesthesiologist or anesthesia resident switching into surgery or anything else. Why is that? Ask any Ob what they think of anesthesiology and they'll say it's one of the greatest fields at least from what I have heard. I never hear anything remotely similar from anesthesiologists talking about ObGyn.
Here are the better fields in terms of income, lifestyle and politics over Anesthesiology:

1, ENT
2. Optho
3. Ortho
4. Neurosurgery
5. ER medicine
6. Derm
7. PLastics
8. Gi
9. Pain medicine
10. Urology

Ob/Gyn isn't on the list. Which specialty on the list has LOWER Step 1 scores compared to Anesthesiology? Med students aren't stupid.
 

BLADEMDA

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To some extent, MD anesthesiologists have become a victim of their own excellence. Deaths during the administration of anesthesia occur at a paltry rate of 1/250,00 cases nowadays. This remarkable improvement can be attributed solely to technical improvements in the monitoring of patients during a procedure. Things like continuous pulse oximetry, end tidal CO2 monitoring, and fiberoptic-based intubation equipment have almost completely eliminated major morbidity from the profession. This is a good thing. But maybe not so good for anesthesiologists. They practice in a very algorithmic, checklist-based manner.

Thus, it was relatively easy to teach their methods to CRNAs during a period when the exponential rise in operative case loads made it necessary to incorporate “anesthesiology assistants” into a practice, thereby allowing one attending physician to cover multiple rooms. That recent studies have confirmed what everyone else in the OR already knew — that it didn’t really matter who was behind the drape while a cholecystectomy was ongoing — is hardly a surprise.

The less variability in clinical excellence one sees from certain specialists, there seems to be a commensurate decrease in perceived prestige. In other words, one’s individual reputation as a doctor can be paradoxically harmed when the overall complication rate of your chosen specialty is so low. You are seen as a mere “cog in the machine”, a cog that could easily be interchangeable with another doctor or, in this case, a CRNA.
Anesthesiology represents the easiest target. But don’t think that the other specialties are exempt from possible onslaught. The more specialized we become as doctors, and the less we emphasize and reward doctors who focus on a holistic approach to medicine (primary care, internists, general surgeons), the easier it becomes for the federal government to replace those pricey specialists with back door, non-MD options who happen to be much less expensive.

Imagine a “certified orthopedist” training program that one could enroll in directly out of college with a bachelors of science. You then spent the next three years doing nothing but learning musculoskeletal anatomy/pathology and practicing the basic orthopod operations in virtual reality and on actual patients. Perhaps actual orthopedic surgeons could be enticed to head up such a training program so that these ortho technician graduates learned their techniques from the best. Further imagine that research papers would be published demonstrating equivalent outcomes no matter who performed your knee replacement, MD or ortho technician.

It isn’t difficult to see where all this is heading. The cost of healthcare must be controlled to prevent bankrupting our country. Medical school graduates overwhelmingly opt out of primary care and internal medicine. If you can’t force or entice our brightest students to stop applying for derm and ortho and radiology residency slots, then maybe you can at least give them a little competition for that business from non-MD sources.


Dr. Jeffrey Parks
Dr. Jeffrey Parks is a board certified general surgeon working in Cleveland who writes regularly at Buckeye Surgeon.

Follow Dr. Jeffrey Parks: Website |



Read more: http://medcitynews.com/author/jparks/#ixzz2***dL766
 
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Here are the better fields in terms of income, lifestyle and politics over Anesthesiology:

1, ENT
2. Optho
3. Ortho
4. Neurosurgery
5. ER medicine
6. Derm
7. PLastics
8. Gi
9. Pain medicine
10. Urology

Ob/Gyn isn't on the list. Which specialty on the list has LOWER Step 1 scores compared to Anesthesiology? Med students aren't stupid.
I have a good enough score to probably match into at least half of those (especially if I just wanted to stay in my home institution), as do many anesthesiology residents at big name anesthesia programs. In answer to your question: #5 (~equal step), 8 (IM...), 9 (ie via neuro or pmr), 7 (if you want to do GS and bust your @$$) Speaking of pain medicine... Blade, go into Pain med right now. Do a 1 year fellowship and do 100% pain cases, you'll make more $ than most of your list and with much less hours. What's stopping you?

I would not trade in what I know is inherently more awesome to be an eye dentist, a pimple popper, or a FM who can intubate but knows nothing about anything really working in the ER, and I do not want to do surgery but like procedures. But I guess the grass is always greener my friend.
 

BLADEMDA

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As long as you are willing to work as an Anesthesiologist for about 25 percent more than a CRNA would demand then you will always have a job. I posted this comment several times over the years and I stand by it today.

The problem is that CRNA salaries are falling due to the CRNA mills pumping out new graduates. In just s few years or less CRNA salaries will be in the low $110K range for a new graduate. This means the overall pressure on the market is downward in terms of income. I'm seeing this Same trend for new Anesthesiologists as well.

This trend will likely continue with Obamacare and then the public option. Ultimately, your salary will have little to do with what is fair or reasonable and more to do with politics and CRNA practice standards in your state/institution.

While I support the ASA's fight against the AANA I recognize the war will be lost. How can I good conscience recommend a specialty whose future is suspect at best? This isn't Dajavu's AANA from 30 years ago. The AANA fully embraces the liberal model of healthcare which includes Autonomy for CRNAs and full scope of practice. A concept which is part of the Obamacare model for healthcare in the USA.

Others have suggested the pendulum must swing too far for the consequences to be felt. I agree with them. But, the AANA will dismiss any negative outcomes as failures of the collaborative model implementation Rather than failure of the model itself.
 
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BLADEMDA

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I have a good enough score to probably match into at least half of those (especially if I just wanted to stay in my home institution), as do many anesthesiology residents at big name anesthesia programs. In answer to your question: #5 (~equal step), 8 (IM...), 9 (ie via neuro or pmr), 7 (if you want to do GS and bust your @$$) Speaking of pain medicine... Blade, go into Pain med right now. Do a 1 year fellowship and do 100% pain cases, you'll make more $ than most of your list and with much less hours. What's stopping you?

I would not trade in what I know is inherently more awesome to be an eye dentist, a pimple popper, or a FM who can intubate but knows nothing about anything really working in the ER, and I do not want to do surgery but like procedures. But I guess the grass is always greener my friend.
Thanks for giving me advice. I have no doubt that your career in Anesthesiology over the next 25 years will be far different than mine. However, I have over 2 decades of actual hands on Anesthesia experience vs your 2 week rotation so spare me the lecture on how to make money.

I don't care if you match into Anesthesiology or Colo Rectal surgery. You are entitled to your opinion about Anesthesiology's future as much as anyone else. But, you are not entitled to distort the facts about income, job prospects and increasing CRNA autonomy. I've presented those facts here on this thread. I propose you do the same and we will see where the facts lead.
 
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Thanks for giving me advice. I have no doubt that your career in Anesthesiology over the next 25 years will be far different than mine. However, I have over 2 decades of actual hands on Anesthesia experience vs your 2 week rotation so spare me the lecture on how to make money.

I don't care if you match into Anesthesiology or Colo Rectal surgery. You are entitled to your opinion about Anesthesiology's future as much as anyone else. But, you are not entitled to distort the facts about income, job prospects and increasing CRNA autonomy. I've presented those facts here on this thread. I propose you do the same and we will see where the facts lead.
I don't claim to know more than you. Suffice it to say that I have come across people like you in every field that constantly complain about it and claim they wish they never even went into medicine to begin with. You said it right, everyone is entitled to their opinion. After years of talking about Anesthesiology doomsday, I again ask you why you do not go into Pain Medicine or CCM? These fields are easy to get through Anesthesiology and do not require much additional training and you will never have to worry about another CRNA. Or just go get an MBA and be an administrator, since you are all about the politics.

I can guarantee that you are the personality type who would be saying exactly what you are saying regardless of not only what field of medicine you went into but regardless of what field of work you went into.
 

imfrankie

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He doesn't need to do that. He'll be retired soon enough. He's trying to give you some honest advice.
 
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He doesn't need to do that. He'll be retired soon enough. He's trying to give you some honest advice.
Thanks. Maybe I am a little cynical when strangers care so much about my well-being and career choices that I feel like there is another motive, even if that motive is to just vent their own frustrations with a real or perceived threat. What I said to begin with is that I do not think his claims are baseless but life sucks for most everyone in this economy but I am sick of hearing it. I see it in every blog/forum/thread about every single issue. I hear it in the hospital, I hear it on the news, I hear from friends and strangers alike all the time.

Fine, thank you for taking time out of your life to save stupid lowly medical students.
 

BLADEMDA

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I don't claim to know more than you. Suffice it to say that I have come across people like you in every field that constantly complain about it and claim they wish they never even went into medicine to begin with. You said it right, everyone is entitled to their opinion. After years of talking about Anesthesiology doomsday, I again ask you why you do not go into Pain Medicine or CCM? These fields are easy to get through Anesthesiology and do not require much additional training and you will never have to worry about another CRNA. Or just go get an MBA and be an administrator, since you are all about the politics.

I can guarantee that you are the personality type who would be saying exactly what you are saying regardless of not only what field of medicine you went into but regardless of what field of work you went into.
Just the facts please. Stick with the facts.


The "doomsday" you speak of is the evolution of Anesthesiology under Obamacare. It is the reasons private practices are selling out to AMCs every day across the country. This doomsday means CRNAs will gain autonomy and practice in a collaborative model. There will be a job for you and a decent salary. But, make no mistake that Obamacare hurts Anesthesiology significantly more than most other specialties.

I still recommend medicine as a career. I just don't recommend Anesthesiology as a top specialty choice to med students.

FYI, my career has been a long and successful one. I hope to continue to Practice anesthesia alongside my nurse anesthesia colleagues for many more years.
 

BLADEMDA

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Thanks. Maybe I am a little cynical when strangers care so much about my well-being and career choices that I feel like there is another motive, even if that motive is to just vent their own frustrations with a real or perceived threat. What I said to begin with is that I do not think his claims are baseless but life sucks for most everyone in this economy but I am sick of hearing it. I see it in every blog/forum/thread about every single issue. I hear it in the hospital, I hear it on the news, I hear from friends and strangers alike all the time.

Fine, thank you for taking time out of your life to save stupid lowly medical students.
Anesthesiology residencies will fill. They always have. Those with high step scores may have other (?better) options available to them. I simply urge you make your decision with all the facts in hand. I am sorry to burst your bubble. Things have NOT improved since I started posting on SDN. There has been a continued gradual decline (as expected) in this specialty with most of the good jobs becoming harder and harder to find.

I truly hope that I am wrong here. I hope the ASA pulverizes the AANA and the glory days return to this specialty. Unfortunately, the facts strongly suggest darker days lie ahead for all of us. Please prepare yourself accordingly and don't spend what you haven't earned.
 

BLADEMDA

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Thanks. Maybe I am a little cynical when strangers care so much about my well-being and career choices that I feel like there is another motive, even if that motive is to just vent their own frustrations with a real or perceived threat. What I said to begin with is that I do not think his claims are baseless but life sucks for most everyone in this economy but I am sick of hearing it. I see it in every blog/forum/thread about every single issue. I hear it in the hospital, I hear it on the news, I hear from friends and strangers alike all the time.

Fine, thank you for taking time out of your life to save stupid lowly medical students.
I do apologize if my posts appear overly negative. You are correct that life is harder for most Americans than it will ever be for me. But, the main issue facing Anesthesiology is the AANA and independent practice autonomy. Obamacare gives the AANA a huge boost towards achieving their goal.

I do believe patient care will suffer and those of us who worked our entire lives to become outstanding Physician Anesthesiologists will be demoted to a glorified CRNA. This isn't an endearing concept to me.
 

BLADEMDA

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You will likely always have a job. I'm hesitant to say "always" because the AANA may join the AFL CIO and thus the democrats may pass a law requiring one to be a CRNA to actually administer anesthesia. All other groups must obtain permission from the Chief CRNA at the facility.

But, as long as the AANA claims Anesthesiologists have the proper credentials and education to be equal to a CRNA then you should have a job. Perhaps, you could work under the supervision of the Chief CRNA DNAP, PhD at your facility?
So nobody thought this was funny? Is that because it can actually happen?:eek:
 

BLADEMDA

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I still recommend medicine as a career. If in the end Anesthesiology is your final decision then be prepared for the hard road ahead. Maybe, the next generation can give the ASA the spine it so desperately needs. I hope it isn't too late.
 
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I do apologize if my posts appear overly negative. You are correct that life is harder for most Americans than it will ever be for me. But, the main issue facing Anesthesiology is the AANA and independent practice autonomy. Obamacare gives the AANA a huge boost towards achieving their goal.

I do believe patient care will suffer and those of us who worked our entire lives to become outstanding Physician Anesthesiologists will be demoted to a glorified CRNA. This isn't an endearing concept to me.
My ego is such that I don't care if they call me the janitor and the CRNA can be addressed as royalty for all I care. As long as I can provide a service due to that outstanding physician training, that nobody else in the hospital that is not an MDA can provide (and therefore should be paid accordingly). I know that you are better trained than a CRNA and therefore can provide a better service or a service that a CRNA cannot do due to their limited knowledge base.

The greatest test I think was not Obamacare (in most 1st world countries with socialized healthcare, they are without nurse anesthetists) but rather the Mama Clinton act that allowed states to opt out. The result, despite the laws allowing it, are that only the most trivial of cases in the most poor, rural areas do not have any physician oversight.

Ok, I think this is my last post on the issue. Good luck to us all, no matter where in our careers we are. Thanks for a lively discussion :laugh:
 

BLADEMDA

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My ego is such that I don't care if they call me the janitor and the CRNA can be addressed as royalty for all I care. As long as I can provide a service due to that outstanding physician training, that nobody else in the hospital that is not an MDA can provide (and therefore should be paid accordingly). I know that you are better trained than a CRNA and therefore can provide a better service or a service that a CRNA cannot do due to their limited knowledge base.

The greatest test I think was not Obamacare (in most 1st world countries with socialized healthcare, they are without nurse anesthetists) but rather the Mama Clinton act that allowed states to opt out. The result, despite the laws allowing it, are that only the most trivial of cases in the most poor, rural areas do not have any physician oversight.

Ok, I think this is my last post on the issue. Good luck to us all, no matter where in our careers we are. Thanks for a lively discussion :laugh:
The AANA collaborative model allows for Anesthesiologists to exist alongside their CRNA colleagues. In this model CRNAs do their own cases as do the MD (A)s. From time to time the CRNA will consult the Anesthesiologist if he/she has any questions or concerns. This is the same model our military uses for anesthesia services.

The end result is that Anesthesiologists do the sicker patients and bigger cases while the CRNAs do the bread and butter stuff. In addition, CRNAs get to do most of the surgicenter work.

Overall, I will adapt to the collaborative model when it becomes the norm but it isn't my first or second choice for practicing anesthesia. In fact, I can honestly say I would never have chosen Anesthesiology as a career if I knew my only option was the collaborative model.
 

Silent Cool

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So nobody thought this was funny? Is that because it can actually happen?:eek:
I thought it was funny.

"My name is John/Jane Smith, MS, DNP, PhD, AACRNADAJB -- Chief Holistic Nursologist"

:laugh:

I fear for the future :(
 

aneftp

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I see the bigger and ever evolving picture of crnas.

I think from 2000-2010 AANA tried to push agenda crnas were "better" " than MDs cause they were involved in cases 100% of time.

The ASA fought back and simply referred to the level of training of Crna vs MDs. Notice AANA doesn't push that agenda much more anymore.

Beginning after the financial crash. AANA figured out the public wasnt buying into notion of having MDs replace. You see the nursing profession in general along with the rest of the liberal American public has been pushing this "equality" agenda the past couple of years. Equal work equal pay. So AANA really has been pushing for equality by trying to bring their profession up to a "doctorate" level. That's where the collaborative model is trying to come into play.

The AANA knows they don't have the public support now or in the future to replace anesthesiologists. They know they don't have the manpower either despite the huge increase in number of puppy mill srna programs the past decade. That's why the equality push and collaborative model push.

There are very few Crna only true ASC. Most "ASC" that are Crna only are really 100% GI centers. And gi docs are trying to replace crnas altogether with either RNs pushing propofol or having sedasys. And obviously Physician owned ASCs have certain motives to hire crna only.
 

BLADEMDA

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Which other non primary care specialty has this kind of poster?
 

BLADEMDA

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I think what Blade is getting at is in the future, under a "medicare for all" system that will be implemented by the next president in 2018, anesthesia will get hit far worse than other specialties. I know medicare pays on average 75% of what commercial insurance pays but for anesthesia it is closer to 35%.

I know most people see the socialized medicine issue from the perspective of physicians, but I think it is important to see how the system's current setup is not fair.

Hypothetically, 3 people come in to the OR at my hospital after sustaining a MVA and need urgent surgery. They all get operated on and are saved:

- 1 person has private insurance and pays for the care he received ($5000)
- 1 person is on medicare, which let's say pays 35 percent ($1750) of what the first person paid
- 1 person has no insurance, is poor, and will not pay aka "charity care" ($0)

This system in itself is not fair. If 3 people receive the EXACT same services, why is that patient #1 must pay 300% more than patient #2? If I go to the local Costco to buy milk, everyone (middle aged folks, senior citizens, poor people) pays the exact same $3.50.

Hence, when private insurance payers have seen rate hikes year after year after year and are told the reason for those hikes is "the hospitals are giving more free, uncompensated care" and "medicare doesn't pay enough", it in effect becomes a scenario where people with private insurance in the country are FORCED to subsidize the care for everyone else. Eventually, even they will get disgusted by the constant insurance hikes and will say "enough is enough; bring on price controls."

My question is this: Is this current system by which private insurance payers are forced to subsidize the care for underpayers (medicare, medicaid, and uncompensated care) fair, and if not, how would you change it?
Senator Cruz and you must get over the debate. We lost and the Liberals won. This means Obamacare is the law of the land. The patient with the money must now pay even MORE under Obamacare in terms of premiums to support the deadbeats. Costs haven't gone down one dime. However, once the system gets fully implemented CMS will dictate practice management to the hospital and physicians.

Obamacare creates winners and losers. Every Fortune 500 company knows that these trillion dollar laws can make or break a company.

The AANA fully supported the ObamaCare law and will reap the benefits from an even more cash starved medical system.
 

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BLADEMDA

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Dr. Schramm presented last, sharing his experiences with the anesthesia care team model at PRMC. PRMC implemented the model after contracting with Somnia Anesthesia, and he believes the new model has maintained the hospital's quality of care while significantly reducing anesthesia staffing costs. In fact, PRMC was able to reduce its anesthesia subsidy because of the new model in place, he said.

Today, the hospital employs what he called a "sliding scale supervision model," where patients are assigned to either an anesthesiologist, a CRNA or an anesthesiologist-CRNA team depending on their acuity and the procedure scheduled. "CRNAs typically provide care to patients in the OB ward and at the ASC; when they work at the main campus [with higher acuity patients], they work with an anesthesiologist," he said. "We view anesthesia as a 'team sport,'" he added.

Under the model, an anesthesiologist not assigned to the OR serves as a coordinator/facilitator who reviews case information and looks for any indication the case may be difficult. The chief of anesthesia then uses that information to assign the cases to each CRNA or anesthesiologist based on his or her unique strengths the day before the case is scheduled. During the cases, the coordinating physician is available for any questions. Following, 100 percent of cases are collaboratively reviewed to identify any areas that could have been improved. This model has developed "a culture of collaborative care with recognizes the individual providers' ability as well as the individual needs of the patient," said Dr. Schramm.

The model has proven successful at PRMC by expanding coverage, eliminating the anesthesia subsidy and decrease wait time for OB epidural requests. Additionally, the hospital's anesthesiologists now actively take part in quality improvement committees and participate in efforts to improve value-based purchasing and HCAHPS measures.

"I personally embrace and champion the anesthesiologist as the perioperative MD. This model allows us to use our medical training to facilitate the care of the most number of patients at the same time…and serve as ready resource for CRNA and other MDs," explained Dr. Schramm.

http://www.beckershospitalreview.com/anesthesia/webinar-shares-how-the-anesthesia-care-team-model-can-contribute-to-clinical-quality-excellence-in-your-or.html
 

aneftp

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Senator Cruz and you must get over the debate. We lost and the Liberals won. This means Obamacare is the law of the land. The patient with the money must now pay even MORE under Obamacare in terms of premiums to support the deadbeats. Costs haven't gone down one dime. However, once the system gets fully implemented CMS will dictate practice management to the hospital and physicians.

Obamacare creates winners and losers. Every Fortune 500 company knows that these trillion dollar laws can make or break a company.

The AANA fully supported the ObamaCare law and will reap the benefits from an even more cash starved medical system.
I don't think so blade. Crna salaries have gone down as well in many saturated cities. Starting pay for crnas is in the low 100s these days. Even experienced feel "offended" at offers 180k 40 hours a week.

Many MD only groups pay their mommy track MDs who work 7-3 or 7-5 (4 days a week) around $200-220k. Not much more than Crna.

AANA isn't reaping big rewards of Obamacare. Everyone is losing. I don't see salaries increasing for crnas either.

It feels like 1996 again when my brother a cardiac anesthesia guy got out and offered 110k a major top 5 population big city.

Anesthesia has had a good run for the past 13-14 years. Salaries are going down and have been the past 2 years at most marjor urban saturated areas.
 

dr doze

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I don't think so blade. Crna salaries have gone down as well in many saturated cities. Starting pay for crnas is in the low 100s these days. Even experienced feel "offended" at offers 180k 40 hours a week.

Many MD only groups pay their mommy track MDs who work 7-3 or 7-5 (4 days a week) around $200-220k. Not much more than Crna.

AANA isn't reaping big rewards of Obamacare. Everyone is losing. I don't see salaries increasing for crnas either.

It feels like 1996 again when my brother a cardiac anesthesia guy got out and offered 110k a major top 5 population big city.

Anesthesia has had a good run for the past 13-14 years. Salaries are going down and have been the past 2 years at most marjor urban saturated areas.
Agree. AANA may be winning the war by pumping out new CRNAs like sausages and ultimately advancing the "profession of nurse anesthesia" but they are doing it at the cost of major salary hits and job security for their existing members.

Ultimately they will get a bigger piece of a much smaller pie. Right now they have a smaller piece of a bigger pie. AANA prefers option 1 even if option 2 gets you more pie. I suspect many CRNAs would prefer option 2.
 
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Blade is just giving facts and a few predictions.

I trust those over med students and residents, Who I've found to be the most clueless about business, politics and finance.

People who have never paid taxes, never lost a lot of money because of government rulings, etc. Don't tend to understand or learn about these things yet.

This threat seems real and he's mentioned how to weather it with fellowships and possible lower pay.
 

BLADEMDA

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You are missing the point here. The world is changing and anesthesia is viewed as a commodity service. Older "Legacy" Groups are being told by CEOs to use the collaborative model or get replaced by an AMC that will do so.

Please take a look at this:

http://www.healthleadersmedia.com/page-1/MAG-290063/Battleground-Anesthesia


The group got "axed" because it refused to lower its subsidy and provide more services. Salaries are coming down but so is the concept of the ACT. Most of us will continue to work in the AANA model of anesthesia delivery regardless of whether we agree with it.
 
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BLADEMDA

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Yet the conversion to CRNAs can, and in many cases, must be done, says Preston Simmons, chief operating officer and interim CEO with Providence Regional Medical Center in Everett, Wash. Providence Regional, a 491-bed, acute-care hospital that is part of the Providence Health & Services' 37 acute care ministries in West Coast states, changed to a "care team" approach in 2011.

They don't use a "team approach" but rather the independent, Collaborative AANA model of CRNA directed anesthesia for a significant portion of their cases.


Today, the hospital employs what he called a "sliding scale supervision model,"
 

BLADEMDA

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I like to call it the "Slippery Slope Supervision Model" as it leads to a lot of Anesthesiologists working as CRNAs down the road.


 

aneftp

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You are missing the point here. The world is changing and anesthesia is viewed as a commodity service. Older "Legacy" Groups are being told by CEOs to use the collaborative model or get replaced by an AMC that will do so.

Please take a look at this:

http://www.healthleadersmedia.com/page-1/MAG-290063/Battleground-Anesthesia


The group got "axed" because it refused to lower its subsidy and provide more services. Salaries are coming down but so is the concept of the ACT. Most of us will continue to work in the AANA model of anesthesia delivery regardless of whether we agree with it.
Blade we all understand this (admin view anesthesia as a commodity). And admin view us as "providers". Like we are fast food workers.

I actually see AMCs having a big boost with the ACA cause hospitals are pushing for more uniform billing practices. But ultimately the AMCs will go away as we head towards single payer.

It's always a game of chicken with hospital admin. They get fired if they lose the bet by replacing current anesthesia groups with AMCs. It happened to quite a few administrators out in California.

The key is for anesthesia peeps to maintain solidarity. AMCs are counting on 80% of current staff to stay. But if you have greater than 30% turnover hospital is dead in water with not enough surgical coverage. Less surgery means less revenue for hospital. Hospital CEO usually pays for it with his or her job.
 
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Blade we all understand this (admin view anesthesia as a commodity). And admin view us as "providers". Like we are fast food workers.

I actually see AMCs having a big boost with the ACA cause hospitals are pushing for more uniform billing practices. But ultimately the AMCs will go away as we head towards single payer.

It's always a game of chicken with hospital admin. They get fired if they lose the bet by replacing current anesthesia groups with AMCs. It happened to quite a few administrators out in California.

The key is for anesthesia peeps to maintain solidarity. AMCs are counting on 80% of current staff to stay. But if you have greater than 30% turnover hospital is dead in water with not enough surgical coverage. Less surgery means less revenue for hospital. Hospital CEO usually pays for it with his or her job.
The reason why docs need unions but the govt prevents it.
 

IlDestriero

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Everyone will sell out one way or another eventually. Even the ones screaming that CRNAs are dirt and I'd rather be unemployed! Those jobs will not be sustainable. Huge subsidies make you a takeover target. Bills have to be paid, your kids have to go to college, you can only move so many times.
I think about this every time I consider selling out for the lure of PP. I'm pretty safe where I am.
 

aneftp

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Either way.

I am going to count on "generation me" to bail the profession of Anesthesiology!

I am not kidding. These new generation of working professionals don't give a crap. They don't want to work but maximize their income.

How does this relate to anesthesia?

We've all seen it. Those born between 1982-current. These are your new generation anesthesia professionals. And when we include next generation crnas along with anesthesiologists. Many will be unwilling to work 60 hours a week.

The next generation will cause havoc on the system. Who is going to work late? Who is willing to take weekend calls??

Trust me. I moved back to academic medicine and I see it first hand day in and day out. No one wants to work these days.

There are plenty of crnas who opposed the AANA as there are MDs who opposed the ASA.

The profession of anesthesia whether its MDs or crnas. It's moving towards working as little as possible these days. And the new generation will only magnify this problem further.

How will administrators deal with this? Than it becomes their problem not having enough staff coverage. There are only so many ASCs around for the no call no weekends. Hospitals need 24/7 coverage. Who's going to want to do that with salaries going down? I don't see crnas jumping in to provide this even for equal money as their MD counterparts.

The generation "me" will provide administrators a hard lesson how not to treat working professionals.
 

NOsaintsfan

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The way I see it all the worry about CRNA's is only one step in a huge change that is coming.

I don't see how we will not have a single payer system in 10-15yrs. Let me explain why.

The ACA as we currently sit will bankrupt the private insurance industry (in my opinion). Private insurance has no control over costs and the American public cannot pay higher insurance premiums every year forever. Eventually the market will "max out" and many people will be forced onto Medicaid or whatever public option is available. Private insurance will simply get to expensive for most to afford it. Medicare will collapse under its own weight. It was never set up or structured to provide coverage for a large percentage of the population (25,35,50%+). When this happens it's going to be a "crisis" that only the government can fix.

I think it will happen fairly quickly. Sure the writing will be on the wall, and a few insurance companies will go under but it will come a moment where we reach critical mass and the public and MEDIA will be raising cane because of all the grandmothers/grandpaws that cannot get care are dying because they have no coverage. This will create a situation where something must be done, the private insurance market is no longer viable and the American public NEEDS healthcare. Step in uncle Sam with a solution.

I think congress set it up this way intentionally. We all know (or should know) that the democratic leadership has wanted a single payer system for a long time. The president and others have said this plenty in the past. So why didn't they just pass a single payer system in 2009 instead of the ACA? They had majorities in both houses and the presidency. The ACA passed with 0 republican votes. They didn't need bipartisan support.

I think it's because they knew the American public wouldn't support a single payer and that there would be consequences for passing the ACA (2010 midterms). So they did the next best thing. They created a system where the public will "demand" a single payer. The will make the public believe it was "our" idea. This is the way I see it anyway.

I'm not a single payer system proponent however I see it as inevitable. On principle a single payer doesn't scare me. What DOES scare me is how we are going about it and what it may look like here.

In other places with single payer systems the public generally knew it was coming and expected it. Meaning Canada, England, Europe, ect. knew what was happening with the healthcare system, it was an OVERT process.

What I fear is here in the US a single payer system will be very quickly thrown upon us out of "necessity" as a fix for an "unforeseen" disaster that "no one" saw coming.

If this comes to pass and single payer is thrust upon us in haste as a result of a "crisis" who knows what it will look like and what type of oversight and thought will be put into it. I'm scared to think what OUR system may look like.

In 15+ years many current docs will be retired or very close to retirement so they won't be affected as much at least not in terms of employment.

My question is am I way off base with my prediction?

If so where am I going wrong/what am I not taking into account?

Has anyone thought of what things may look like if a scenario like I have laid out comes to pass?

If this does happen there will be a lot more changes beside CRNA independence. That will just be one of many things that will change in healthcare.

I'm not trying to convince anyone that I'm right about this, I just want to get an idea of where the healthcare industry is going as we CURRENTLY stand. If I'm wrong I want to know why. I want to go into medicine with my eyes wide open and in tune to where the ship is heading so to speak.
 
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dr doze

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Either way.

I am going to count on "generation me" to bail the profession of Anesthesiology!

I am not kidding. These new generation of working professionals don't give a crap. They don't want to work but maximize their income.

How does this relate to anesthesia?

We've all seen it. Those born between 1982-current. These are your new generation anesthesia professionals. And when we include next generation crnas along with anesthesiologists. Many will be unwilling to work 60 hours a week.

The next generation will cause havoc on the system. Who is going to work late? Who is willing to take weekend calls??

Trust me. I moved back to academic medicine and I see it first hand day in and day out. No one wants to work these days.

There are plenty of crnas who opposed the AANA as there are MDs who opposed the ASA.

The profession of anesthesia whether its MDs or crnas. It's moving towards working as little as possible these days. And the new generation will only magnify this problem further.

How will administrators deal with this? Than it becomes their problem not having enough staff coverage. There are only so many ASCs around for the no call no weekends. Hospitals need 24/7 coverage. Who's going to want to do that with salaries going down? I don't see crnas jumping in to provide this even for equal money as their MD counterparts.

The generation "me" will provide administrators a hard lesson how not to treat working professionals.
generation me will be told "work more or we will get someone who will". Options give you the power to say "No". Lack of options forces you to say "yes sir, thank you sir, may I have another"
Just a few posts ago you talked about new CRNA grads and new Docs working for much less than a few years ago. They will also say "YES" to staying well past 3:00 if they perceive that somebody else will say "Yes" if they say "No"
 
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IlDestriero

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generation me will be told "work more or we will get someone who will". Options give you the power to say "No". Lack of options forces you to say "yes sir, thank you sir, may I have another"
Just a few posts ago you talked about new CRNA grads and new Docs working for much less than a few years ago. They will also say "YES" to staying well past 3:00 if they perceive that somebody else will say "Yes" if they say "No"
Yeah.
Generation me can't get a job at my shop with that attitude. We have plenty to choose from, and special little snowflakes that don't want to work can work somewhere else.
 

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So, as a CA3, currently looking for jobs, it seems that the market (at least in my area) is GOOD but not great.

The super lucrative partnership track positions are seemingly being distributed very very cautiously by those lucrative groups/partners. Fellowships in such groups are probably going to be required.

That being said, I'm finding opportunities for new grads. I think the "norm" is going to be much different as many on this forum have echoed many times. Mid-range salaries (300-400) as partners are probably going to be much more common than ever before.

Some groups are offering employee positions in larger (more desirable?) cities which are actually pretty nice to start (300-350) etc.

Mediocre paying partnerships seem to be offering "typical" partnership buy ins of 250k or so with a 2 year track.

Given the uncertainty of our future earnings, it seems that being a partner is important. Sure, there are uncertainties and nobody has a crystal ball but my instinct is to take a 250k offer for future partnership earnings in the 300-400 range (with growth potential if you can grow the business) versus an employee job making perhaps more even.

I feel that a non-fellowship trained employee is much more vulnerable to whims of the "market" than a partner. Arguably, a non-fellowship trained partner is more secure than a fellowship employee. Many of the fellowship "requirements" are not legitimate in my opinion, but are being used as marketing tools or simple barriers to entry for most groups. You don't really need a peds fellowship to do general peds ENT stuff. B&B hearts at a small cardiac program? Not so much. Yet, it's true that some groups are using this as a barrier to partnership.

It seems that partners/owners control things. How many PP jobs are requiring fellowships when the senior partners don't have fellowships? Lots. A double standard? Yep, but if you're a partner it doesn't matter really does it? How many partnerships are offering "salary only" positions with virtual moratoriums on offering partnership tracks? Many, it seems.

What do you guys think? Is securing a partnership every more urgent/crucial than ever before? Securing them while they still exist, that is? (or being offered I should say).

I'm not seeing an end to partnership structures. But, it seems they are changing. Hiring CRNA's is becoming more common as are partnerships only offering employee positions, for example.
 
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A lot of you sound like you are for the free market and for less government. So then why do you also sound so protectionist and unionized? IF you are providing only a service that only you can provide then your services will always be needed. Rather than act like Detroit of the early 80s fighting Asian cars going on the market by saying things like "well it's made in the USA and USA is better than Japan and therefore American cars should always be viewed as better" regardless of the facts, we should want to use our training to actually stand out. We should want only the highest acuity, highest risk cases, we should emphasize perioperative management, we should reclaim the ICUs and pain, and then some. Then come back and say "look, we can do all these things that the other guys can't" (instead of just saying medical school and residency is harder).

I fully intend to do a fellowship as do most residents that I worked with. As far as being viewed equal to a nurse... well if I am doing exactly what a nurse is doing than what good is all that training? The only arguments I ever hear are ASA talking about how much harder it is to become an anesthesiologist and AANA talking about how equal the outcomes are. So then why not take over more roles in the hospital and do the jobs others don't want to, instead of just being overqualified providers.
 
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A lot of you sound like you are for the free market and for less government. So then why do you also sound so protectionist and unionized? IF you are providing only a service that only you can provide then your services will always be needed. Rather than act like Detroit of the early 80s fighting Asian cars going on the market by saying things like "well it's made in the USA and USA is better than Japan and therefore American cars should always be viewed as better" regardless of the facts, we should want to use our training to actually stand out. We should want only the highest acuity, highest risk cases, we should emphasize perioperative management, we should reclaim the ICUs and pain, and then some. Then come back and say "look, we can do all these things that the other guys can't" (instead of just saying medical school and residency is harder).

I fully intend to do a fellowship as do most residents that I worked with. As far as being viewed equal to a nurse... well if I am doing exactly what a nurse is doing than what good is all that training? The only arguments I ever hear are ASA talking about how much harder it is to become an anesthesiologist and AANA talking about how equal the outcomes are. So then why not take over more roles in the hospital and do the jobs others don't want to, instead of just being overqualified providers.
Detroit didn't build the best products at competitive prices. Unions are crap when you don't put out quality. They are fine when you are fighting a huge entity that is wasteful, incompetent and has completely different interests than you.

I keep hearing the argument on midlevel encroachment, "Oh, let them take all the easy cases." Someone said this in GI, "Who cares if they teach technicians how to do scopes?" Who cares!? A lot of people. Bread and butter is called bread and butter because it pays the bills. Once you take that away, there's reason for concern. What if derm lost acne and botox? What if Apple lost their iPhone/iPad? Losing half of your business isn't a good plan.

There's no crystal ball - but the one thing that is clear is that the government can ruin everything. The poster above who mentioned PP offers - yeah, PP will always be good. I think the people who are concerned are thinking about less and less PP and more and more gov't takeover. I don't think the, "it will never happen" argument counts anymore. Obamacare was supposed to never happen. People being forced to buy insurance or pay a tax was supposed to never happen.

I don't pretend to know anything about anesthesia - and I'm sure fellowship trained docs dealing with high acuity will never be without work, but like I said above - you don't really want to lose 100% of your bread and butter cases. They are worth fighting for.

Edit: the buckeye surgeon post above also speaks to why doctors unionizing would be helpful. The reality is that physicians put together all the science, good outcomes, expertise, knowledge base, etc to where doing basic cases are easy - now you can train someone to follow the algorithm. Not really fair. It would be like Apple taking decades to make a perfect new electronic device then having some company steal their blueprint and sell the same thing.

To some extent, MD anesthesiologists have become a victim of their own excellence. Deaths during the administration of anesthesia occur at a paltry rate of 1/250,00 cases nowadays. This remarkable improvement can be attributed solely to technical improvements in the monitoring of patients during a procedure. Things like continuous pulse oximetry, end tidal CO2 monitoring, and fiberoptic-based intubation equipment have almost completely eliminated major morbidity from the profession. This is a good thing. But maybe not so good for anesthesiologists. They practice in a very algorithmic, checklist-based manner.

Thus, it was relatively easy to teach their methods to CRNAs during a period when the exponential rise in operative case loads made it necessary to incorporate "anesthesiology assistants" into a practice, thereby allowing one attending physician to cover multiple rooms. That recent studies have confirmed what everyone else in the OR already knew — that it didn't really matter who was behind the drape while a cholecystectomy was ongoing — is hardly a surprise.

The less variability in clinical excellence one sees from certain specialists, there seems to be a commensurate decrease in perceived prestige. In other words, one's individual reputation as a doctor can be paradoxically harmed when the overall complication rate of your chosen specialty is so low. You are seen as a mere "cog in the machine", a cog that could easily be interchangeable with another doctor or, in this case, a CRNA.
Anesthesiology represents the easiest target. But don't think that the other specialties are exempt from possible onslaught. The more specialized we become as doctors, and the less we emphasize and reward doctors who focus on a holistic approach to medicine (primary care, internists, general surgeons), the easier it becomes for the federal government to replace those pricey specialists with back door, non-MD options who happen to be much less expensive.

Imagine a "certified orthopedist" training program that one could enroll in directly out of college with a bachelors of science. You then spent the next three years doing nothing but learning musculoskeletal anatomy/pathology and practicing the basic orthopod operations in virtual reality and on actual patients. Perhaps actual orthopedic surgeons could be enticed to head up such a training program so that these ortho technician graduates learned their techniques from the best. Further imagine that research papers would be published demonstrating equivalent outcomes no matter who performed your knee replacement, MD or ortho technician.

It isn't difficult to see where all this is heading. The cost of healthcare must be controlled to prevent bankrupting our country. Medical school graduates overwhelmingly opt out of primary care and internal medicine. If you can't force or entice our brightest students to stop applying for derm and ortho and radiology residency slots, then maybe you can at least give them a little competition for that business from non-MD sources.


Dr. Jeffrey Parks
Dr. Jeffrey Parks is a board certified general surgeon working in Cleveland who writes regularly at Buckeye Surgeon.

Follow Dr. Jeffrey Parks: Website |



Read more: http://medcitynews.com/author/jparks/#ixzz2***dL766
 
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NOsaintsfan

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A lot of you sound like you are for the free market and for less government. So then why do you also sound so protectionist and unionized? IF you are providing only a service that only you can provide then your services will always be needed. Rather than act like Detroit of the early 80s fighting Asian cars going on the market by saying things like "well it's made in the USA and USA is better than Japan and therefore American cars should always be viewed as better" regardless of the facts, we should want to use our training to actually stand out. We should want only the highest acuity, highest risk cases, we should emphasize perioperative management, we should reclaim the ICUs and pain, and then some. Then come back and say "look, we can do all these things that the other guys can't" (instead of just saying medical school and residency is harder).

I fully intend to do a fellowship as do most residents that I worked with. As far as being viewed equal to a nurse... well if I am doing exactly what a nurse is doing than what good is all that training? The only arguments I ever hear are ASA talking about how much harder it is to become an anesthesiologist and AANA talking about how equal the outcomes are. So then why not take over more roles in the hospital and do the jobs others don't want to, instead of just being overqualified providers.
The answer to your question is pretty straightforward. Many on here do embrace free market principles however healthcare is far from a free market. It is heavily regulated by the government currently and in Jan. 2014 that regulation will increase exponentially. This translates to --> the government has skewed the market dramatically such as basic free market principles don't apply.

In a free market the things you spoke to would apply (ie. better services, better skill/training at higher acuity cases, perioperative treatment, ect.) and act to always give MDA's a "leg up" on CRNA competition.

In the current climate what is valued or important is NOT maximum ability and skill per se, rather a MINIMUM level of competency.

AANA seems to have largely persuaded the "market" (government) that CRNA's posses this minimum level of competency and therefor are adequate (equal) for the job.

It's really that simple.
 
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dr doze

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A lot of you sound like you are for the free market and for less government. So then why do you also sound so protectionist and unionized? IF you are providing only a service that only you can provide then your services will always be needed. Rather than act like Detroit of the early 80s fighting Asian cars going on the market by saying things like "well it's made in the USA and USA is better than Japan and therefore American cars should always be viewed as better" regardless of the facts, we should want to use our training to actually stand out. We should want only the highest acuity, highest risk cases, we should emphasize perioperative management, we should reclaim the ICUs and pain, and then some. Then come back and say "look, we can do all these things that the other guys can't" (instead of just saying medical school and residency is harder).

I fully intend to do a fellowship as do most residents that I worked with. As far as being viewed equal to a nurse... well if I am doing exactly what a nurse is doing than what good is all that training? The only arguments I ever hear are ASA talking about how much harder it is to become an anesthesiologist and AANA talking about how equal the outcomes are. So then why not take over more roles in the hospital and do the jobs others don't want to, instead of just being overqualified providers.
I have been both an employee with no hope of ownership and a partner/owner. As an employee, I hated capitalism and what I viewed as my exploitation and a rigged legal system that prevented me from fairly competing against my employers (older anesthesiologists). As an owner I love capitalism and the rule of law.

There is a reason that nobody wants to do those roles. There is plenty of demand for our services. Not all of those services come with rewards. Every reward will have to be justified and fought for.
 
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It's also hard to make financial sense out of

4 years undergrad
4 years medical school
4 years anesthesia
1 year fellowship

compared to CRNA training. Many of the years training to be a doc are MUCH more difficult.

I liked the "generation me" post above. I think it's true that today's docs don't want to work 80 hrs a week and specialties that ask for terrible lifestyle are going away.

Read this on an internet forum, advice from people around 60 to those half their age:

"I'm not quite 60 but am closer to 60 than 50 so I'm gonna take a shot anyway.
-The most important person in your life is the person who agreed to share their life with you. Treat them as such.
-Children grow up way too fast. Make the most of the time you have with them.
-A friend will come running if you call them at 2am; everyone else is an acquiaintance.
-Your job provides the means to do what's really important in life, nothing more. Do the job but live for your family."

Which is why I don't want to live @ hospital.
 

dr doze

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It's also hard to make financial sense out of

4 years undergrad
4 years medical school
4 years anesthesia
1 year fellowship

compared to CRNA training. Many of the years training to be a doc are MUCH more difficult.

I liked the "generation me" post above. I think it's true that today's docs don't want to work 80 hrs a week and specialties that ask for terrible lifestyle are going away.

Read this on an internet forum, advice from people around 60 to those half their age:

"I'm not quite 60 but am closer to 60 than 50 so I'm gonna take a shot anyway.
-The most important person in your life is the person who agreed to share their life with you. Treat them as such.
-Children grow up way too fast. Make the most of the time you have with them.
-A friend will come running if you call them at 2am; everyone else is an acquiaintance.
-Your job provides the means to do what's really important in life, nothing more. Do the job but live for your family."

Which is why I don't want to live @ hospital.
Today's generation is no different. If the rewards for the sacrifices of years in training and 80 hr work weeks were there, today's generation would make the same sacrifices. Very simply the return on investment is just not there.

I agree completely with the words of advice.
 

aneftp

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generation me will be told "work more or we will get someone who will". Options give you the power to say "No". Lack of options forces you to say "yes sir, thank you sir, may I have another"
Just a few posts ago you talked about new CRNA grads and new Docs working for much less than a few years ago. They will also say "YES" to staying well past 3:00 if they perceive that somebody else will say "Yes" if they say "No"
Generation me may settle working for less. But they won't work slave hours and they certainly will not take the majority of weekend calls.