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How does everyone think this anesthesia "boom" will last? My guess is another year or so.
That is a very optimistic view of the future.Why not forever? At some point within the next 5 years, the last of the baby boomers have to ride into the sunset. Those anesthesiologists who graduated residency in the late 80s and early 90s are still hanging around. And once they’re gone, the next cohort of attendings who graduated residency in the late 90s is very small, comparatively.
As of right now, you probably need 1.5 new graduate millennials for every 1 retiring baby boomer. Most new graduate millennials and eventually gen Zs aren’t interested in working the crazy hours of generations past.
And for those concerned about the rapid expansion of CRNA schools, I doubt those graduates will be putting in big hours considering their big leap in per hour pay over the last few years.
So it seems to me that demand will still be around for several years. Pair that with the increasing demand for anesthesia services for GI procedures, IR procedure, cath lab procedures, EP procedures which seems to increase every year.
If its 4 nights a week 6p-6a, with 15 weeks off, thats only 337 a hour. If it's not a busy system, that's not terrible, But, if you're guaranteed to work every night, then more may be required.I don’t think many anesthesiologists would work night coverage for 600k with 15wks off. I certainly wouldn’t. That sounds terrible.
How does everyone think this anesthesia "boom" will last? My guess is another year or so.
The job market was terrible 10-12 years ago.The anesthesia market goes in about 10 year cycles. We are around the mid-point of the high cycle. We have a solid 4-5 years of income increases before things even start going south... assuming the wider economy doesn't completely tank in the interim.
Why not forever?
Nothing will ever take place of a human being needing to deliver anesthesia. The credentials of that human however….Lol. I bet the ceo of blockbuster said the same thing in the 90s. Just like blockbuster some technology will make all of us obsolete. Better drugs, AI, robots or all the above.
I agree. I graduated in 2013 and market was horribleThe job market was terrible 10-12 years ago.
netflix offered to sell itself to blockbuster for $50 million, and they said no.Lol. I bet the ceo of blockbuster said the same thing in the 90s. Just like blockbuster some technology will make all of us obsolete. Better drugs, AI, robots or all the above.
That is a very optimistic view of the future.
I agree that you will need 2-3 of the new guys to replace one of the old guys since they will all want to work as little as possible. The downside to that is if they do a third of the work they will likely get paid a third of the money by pure market dynamics and they will compete with CRNAs as equals.
Also the future of health care in the U.S. will be some sort of single payer system which will likely result in across the board drop in pay.
So, the good news : You will all have jobs, the bad news you will take a big pay cut.
This logic doesn't work in medicine. Many pediatric and adult medical subspecialties are on substantial demand mostly because their pay is so poor nobody goes in to them. The entire game is dictated by CMS billing rules and they have been quite bold about making huge changes with minimal forethought over the last few years.Barring single payer. Supply demand still reign.
At least demand for procedures that require anesthesia is high.
Question is now how many new residency programs have opened and how many are planned.
5 years ago EM was having a good run. Then covid hit and now there’s a residency program in every hospital it seems!!
Just because the rest of you sold out for ACT doesn't mean he has to. You can call your own shots in this market. I refuse to work with CRNAs as well.It's funny you mention this. Juts yesterday I was chatting with the chairman of the practice that I cover for, and they hired two young anesthesiologists and they are being let go after 6 months due to work ethic issues.
The hospital I cover is by no means a busy place - in fact its a boutique hospital with 95% outpatient surgery with good payor mix and overall healthy population and well-cared for patients.
He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends.
It costs money to hire and recruit.
My experience has been similar trying to hire for my practice. One person we spoke to, wanted $650K with 12 weeks off and wanted to do his own cases all the time (meaning no pre-ops, no supervision/direction, no leadership, no management of CRNAs etc - which is the real challenging part of any anesthesia practice - not even once in a while. We all rotate as a group with this duty).
Give me 4 gall bladders to do than that and I'd gladly take it vs. doing 40 pain and GI cases with 4 CRNAs and doing all breaks, lunches, pre-ops etc etc. But we all have to work and share the laborious parts of our practice. He didn't want to.
I fully understand quality of life and its importance. But at certain point, newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.
I dont know...maybe Im old school...
You think there are pediatric pulm/GI midlevels? You think there are adult rheum midlevels? You think a pediatric GI is 3 years of training?I disagree. The reason their pay is depressed is because their barriers to entry are way lower than most other fields in medicine. 3 years of training for most of them vs 4+ for most others. That’s a huge difference in specialization and it shows up in the mid level replacement they’re seeing.
They’re more easily replaceable by Midlevels given the short length of training and lax regulation of their Midlevels. Crnas, in contrast to online NPs, take at least 3 years to train, and have onerous case requirements that need tertiary medical centers. Primary care isn’t that way, so it’s much easier to make an “equivalent” on paper to depress salaries.
Direct primary care is not influenced by CMS either. They have so much demand that it’s actually viable for a meaningful percentage of their workforce to go pure cash concierge service. Huge plus to that field
It's funny you mention this. Juts yesterday I was chatting with the chairman of the practice that I cover for, and they hired two young anesthesiologists and they are being let go after 6 months due to work ethic issues.
The hospital I cover is by no means a busy place - in fact its a boutique hospital with 95% outpatient surgery with good payor mix and overall healthy population and well-cared for patients.
He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends.
It costs money to hire and recruit.
My experience has been similar trying to hire for my practice. One person we spoke to, wanted $650K with 12 weeks off and wanted to do his own cases all the time (meaning no pre-ops, no supervision/direction, no leadership, no management of CRNAs etc - which is the real challenging part of any anesthesia practice - not even once in a while. We all rotate as a group with this duty).
Give me 4 gall bladders to do than that and I'd gladly take it vs. doing 40 pain and GI cases with 4 CRNAs and doing all breaks, lunches, pre-ops etc etc. But we all have to work and share the laborious parts of our practice. He didn't want to.
I fully understand quality of life and its importance. But at certain point, newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.
I dont know...maybe Im old school...
Well - it sounds like this guy joined a practice (appears to be a private group at that) that employed an ACT model, and then decided he didn't want to do that, and became a squeaky wheel for the non-ACT assignments. Not really shouldering his fair share of the ACT work. Which virtually none of us enjoy.Just because the rest of you sold out for ACT doesn't mean he has to. You can call your own shots in this market. I refuse to work with CRNAs as well.
A lot of inaccurate assumptions and information in here but I'll just pick the CMS bone with anesthesia--you think they can't kill anesthesia? They just need to adjust unit values (not the monetary value but the actual units per case and time units that dictate how all the other payors act) down to where the outpatient specialists bill so it is impossible to generate 10k+ units/yr and you're down to the 4-5k units/yr that outpatient specialists get, then maybe you'll appreciate how much scrounging the non proceduralists have had to do all these years while CMS continues to slash and burn. Thinking that private insurance will just increase payments to you to keep the status quo especially after the no surprises act is magical thinking.There are Midlevels who essentially run the inpatient services in all of those fields.
The biggest issue is that peds GI and pulm aren’t gonna be pushing the volume of procedures that the adult side of those specialties do. The demand is not nearly as high in aggregate as it is for screening colos and EGDs for adults
CMS has already murdered anesthesia billing to nearly the maximum possible. It has had no effect on us and essentially because our services are highly in demand and private insurance patients demand those services.
Pediatric specialties are not procedural enough to be viable in private practices, so they will get farmed out to academic tertiary centers which artificially depress doctor salaries.
If you could get a decent census of patients whose parents have jobs in GI, and push 10+ scopes per procedure day in pediatric GI, you’d make a huge amount of money.
Critical care is easily farmable to Midlevels. They round on all the patients, write all the notes, and template everything with minor adjustments from the doctors in every big hospital I’ve ever worked in. These Midlevels can be trained in 3 months to be supervised by a doctor with CC training
Not as bad as 2017I agree. I graduated in 2013 and market was horrible
It actually sounds more like they were just in the talking stages--and he was complaining about the new grad's expectations of salary, time off, and doing MD only cases. I see nothing wrong with making your expectations clear with the practice and saving everyone's time. What's wrong with refusing to settle for a mediocre package and demanding more? Settling for what was given to us is how this field ended up with years of stagnating salaries and supervision ratios. If we, as a collective, all demanded more in par to what we bring to the hospital and refused to settle, we would make it a better job environment for everybody.Well - it sounds like this guy joined a practice (appears to be a private group at that) that employed an ACT model, and then decided he didn't want to do that, and became a squeaky wheel for the non-ACT assignments. Not really shouldering his fair share of the ACT work. Which virtually none of us enjoy.
It's a rare person who genuinely prefers ACT work over solo work, and I daresay a large percentage of the ones who do, have been to some degree institutionalized by a lifetime of ACT work to the point that they'd struggle to function independently. You know the kind of people I'm talking about.
So I get what you're saying. One can minimize or altogether refuse ACT work, and that's pretty appealing to almost all of us, but the time to make that stand is before you accept a job.
Hard disagree. Newly minted anesthesiologists are already highly desired and valuable to a practice. Gone are the days that they smile and say "thank you sir" for giving them a below market wage to supervise 4:1 for 3 years just for the chance at becoming a partner. At a practice that may not even exist 3 years from now.newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.
I dont know...maybe Im old school...
Neutro described 2 scenarios. The first was the 2 new guys getting let go from his friend's group for wanting pay equality and to have a good schedule (early out, no weekends, whatever). As it's described they're obviously presented as lazy and greedy or whatever. I imagine the scenario could just as well be that the new guys want to be paid the same as the old guys for the same work, and they want to leave early some days like the old guys... But who knows.Well - it sounds like this guy joined a practice (appears to be a private group at that) that employed an ACT model, and then decided he didn't want to do that, and became a squeaky wheel for the non-ACT assignments. Not really shouldering his fair share of the ACT work. Which virtually none of us enjoy.
It's a rare person who genuinely prefers ACT work over solo work, and I daresay a large percentage of the ones who do, have been to some degree institutionalized by a lifetime of ACT work to the point that they'd struggle to function independently. You know the kind of people I'm talking about.
So I get what you're saying. One can minimize or altogether refuse ACT work, and that's pretty appealing to almost all of us, but the time to make that stand is before you accept a job.
2015-17 was probably the worst time to finish since 2000. A lot of the top practices were either evaluating selling to AMCs, and therefore not taking new partners, had recently sold out, or were going to sell out and offering the same partnership package without the partnership/buyout money. A lot of the people I knew who finished in 2013 at least ended up getting a lump sum with the buyout, although they probably had just as hard a time finding a job as those in the next few years.Not as bad as 2017
Horrific time to graduate. 90% of the jobs out there in my region were AMC trash or low paying academic gigs2015-17 was probably the worst time to finish since 2000. A lot of the top practices were either evaluating selling to AMCs, and therefore not taking new partners, had recently sold out, or were going to sell out and offering the same partnership package without the partnership/buyout money. A lot of the people I knew who finished in 2013 at least ended up getting a lump sum with the buyout, although they probably had just as hard a time finding a job as those in the next few years.
He said that the millennials he hired are wanting "pay of 25 year legacy partner"
Financial buy in for a partnership is a scamIf he thinks that unreasonable, it seems like he is out of touch with the current market. Most groups/hospitals nowadays will gladly pay new grads their market value and immediate financial equity right off the bat (or after 1 yr max), why the hell would anyone bend over backward for some "25 year legacy partner" to skim 30% off the top of your billable earnings for years and pad their own pockets on the back of your labor, then decide "you aren't quite a good fit" and move on to the next chump or they sell out before you make partner? In the current job market new grads have zero reason to waste their time playing these stupid games.
He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends
Literally all the PP groups in my area have upped their partner track pay from 70-80% of partners to 90-100% starting day 1 with 100% equitable distribution of cases, call, and vacation, regardless of experience. This is the market right now. Good luck hiring if you aren’t offering this as a PP group, at least in my neck of the woods. It’s that or pay 1.5-2x for locums.
Wonder why 🤔Another group had a 4 year partnership track. Partners making 650, track making 400. Can you imagine losing out on a million dollars and your “coworkers” pocketing it. They just decreased it to 3 years but they still have a ton of posts looking for people.
That’s good to know. I am starting cardiac fellowship in July. Gonna start looking more intently around August. I have had initial convos with private practices. No specifics, just friendly hellos. There was one small group, 10 anesthesiologists. I asked how long of a partnership track. He scoffed at the question and said he couldn’t imagine being a partner right out of training and would need at least 2 years. Honestly was a little off putting.
Another group had a 4 year partnership track. Partners making 650, track making 400. Can you imagine losing out on a million dollars and your “coworkers” pocketing it. They just decreased it to 3 years but they still have a ton of posts looking for people.
when will this future single payor system occur? seems to me that's been the promise for at least the past 20 years.That is a very optimistic view of the future.
I agree that you will need 2-3 of the new guys to replace one of the old guys since they will all want to work as little as possible. The downside to that is if they do a third of the work they will likely get paid a third of the money by pure market dynamics and they will compete with CRNAs as equals.
Also the future of health care in the U.S. will be some sort of single payer system which will likely result in across the board drop in pay.
So, the good news : You will all have jobs, the bad news you will take a big pay cut.
when will this future single payor system occur? seems to me that's been the promise for at least the past 20 years.
yes, that's what i was implying. the illumanti control all.Big pharma and private insurance have too much to lose thus will control lobbyists and keep the votes to not allow this. My guess is at least 10 years minimum likely longer.
They are coming for you for outing them.yes, that's what i was implying. the illumanti control all.
The point is that (professional fee) revenue is becoming less relevant than labor supply/demand.14 months (ie two more graduating classes) and the tide will turn. Will NEVER be as short as 2022. The issue like I said before is that salaries (compensation) are high due to the manpower shortage -but in real terms revenue (the money being brought in from collections) keeps falling. So when the tide turns lots of folks gonna be caught with their pants down wondering what the hell happened.
Before or after fusion is a commercially viable energy source? 🙂Big pharma and private insurance have too much to lose thus will control lobbyists and keep the votes to not allow this. My guess is at least 10 years minimum likely longer.
Cardiac locums are making more than the partners at that group currently. Population is aging and americas diet has not improved so I think the supply-demand side of cardiac anesthesia market won’t get better for the group unless you get replaced by either a robot, a CRNA or a robot CRNA.And then someone here will post something dumb like “all these greedy locums people are killing private practices.”
And then someone here will post something dumb like “all these greedy locums people are killing private practices.”
At least locally, we’re expecting a big shortage of fellowship trained anesthesiologists for at least 2-3 extra years since seemingly none of our residents want to do cardiac or peds (pain people seem to still want to do pain) and would rather get out and get paid now. Who knows if they’ll go back to fellowship when the boom is over.Cardiac locums are making more than the partners at that group currently. Population is aging and americas diet has not improved so I think the supply-demand side of cardiac anesthesia market won’t get better for the group unless you get replaced by either a robot, a CRNA or a robot CRNA.
But who knows. Everyone thought that cardiac surgery was a doomed specialty due to stents and TAVRs and yet people continue to need surgery.
Just focus on learning the trade for the sake of your patients. As a new grad you don't have the knowledge, speed or skill to demand the same pay as a 20 year vet. The last few new grads we hired were the perfect combination of lazy, incompetent and entitled. Almost makes you want to burn down the whole thing down rather than hand them the keys.If he thinks that unreasonable, it seems like he is out of touch with the current market. Most groups/hospitals nowadays will gladly pay new grads their market value and immediate financial equity right off the bat (or after 1 yr max), why the hell would anyone bend over backward for some "25 year legacy partner" to skim 30% off the top of your billable earnings for years and pad their own pockets on the back of your labor, then decide "you aren't quite a good fit" and move on to the next chump or they sell out before you make partner? In the current job market new grads have zero reason to waste their time playing these stupid games.
The point is that (professional fee) revenue is becoming less relevant than labor supply/demand.
Surgery isn't going to stop. It isn't going to slow. The trend is in the other direction.
There aren't enough of us. This trend isn't improving.
Hospitals will subsidize groups, or subsidize AMCs, or subsidize directly by employing anesthesia services themselves, or their ORs will close. We know the ORs won't close.
Salaries are driven by supply and demand. Do CRNAs deserve the salaries they earn? Do traveling circ RNs? Do we? It's an irrelevant question. As the man said, deserve ain't got nothing to do with it.
Often the new grads are faster, more personable and better at regional than the 20 year vets. You just have to hire the right ones.Just focus on learning the trade for the sake of your patients. As a new grad you don't have the knowledge, speed or skill to demand the same pay as a 20 year vet. The last few new grads we hired were the perfect combination of lazy, incompetent and entitled. Almost makes you want to burn down the whole thing down rather than hand them the keys.
Anyway, with rising Medicare, the No Surprises Act and astronomical labor costs it's almost better to be employed or do locums now. Perfect timing for me to slow down. Probably will be closing shop sooner than later.