I hate my job as anesthesiologist

[Doctor4Life1769]

Wasn't my intention - I figured it was harmless, since I didn't post a pic or a dating profile of the OP, but I do understand and I apologize.

While doing a 3rd year rotation in Anesthesiology, I did notice some general disconnect and disrespect for the attending I had. He was the only one in a small community hospital (IM residency). He was solid, a great teacher and very bright. Probably my best rotation because of him. He knew the business side of the job, and that is why he was still around - he was making a good amount and having to put up with a tolerable amount of BS. The OR staff loved him, the nurses and CRNAs in general loved him. The surgeons respected him. He was a very bright person who commanded respect. Oddly, it was the medicine physicians and the administration who had some contempt for him (using terms like "Gas Passer" and just being difficult administratively). He told me when the next contract comes up, if he sees a reduction in salary and/or an increase in the amount of work/BS he has to deal with, he's gone and will head elsewhere. I don't know the full details that he had to go through (I didn't care to get involved in all the administrative BS a medical student), but it just seemed ridiculous.

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[lfesiam]

I'm the guy who "outed" him as a real Anesthesiologist. I offer Dr. O my sincere apologies for linking his profile which contained a photo. If I had found the other link, I would have chosen that instead, but I stopped looking.
I assure you that you can find a better job, lifestyle, etc if you commit to relocating, especially with your background. My current job ticks all 4 boxes outlined above by DreamMachine, uncommon but available. All of the residents and fellows that I know have no trouble securing jobs. Many are not partnership track, but that has benefits as well. If they can get jobs with no experience, you can easily get a great job.
Good luck, and again, my apologies. You should keep posting as your experience can definitely benefit the residents and new grads.
As for the dating joke, that's just tough love.

IlDestriero, Can I work for your group in 4 years? Will you be preferring a CT, Neuro, Regional or Peds fellow? hehehe Hard working guy here who knows when to bow his head ala JET's post.

OP, best of luck to you and I hope that you do find happiness in your job once again.

 

[IlDestriero]

IlDestriero, Can I work for your group in 4 years? Will you be preferring a CT, Neuro, Regional or Peds fellow? hehehe Hard working guy here who knows when to bow his head ala JET's post.

OP, best of luck to you and I hope that you do find happiness in your job once again.

Peds. Of course after Obama and Pelosi are done, you can come join me in Canada, Brazil or Australia. I'm working on my Portuguese.
Is there a fellowship in anesthesia for adult outpatient plastics?

 

[maceo]

What kind of online business?

porn and marital aids....

 

[maceo]

i dont think the op was looking for advice.. or sympathy.. it was just an fyi post. And any veteran anesthesiologist feels the same way at some point.

 

[lfesiam]

porn and marital aids....

 

[Consigliere]

porn and marital aids....

I'm in.

 

[IlDestriero]

I'm in.

As a partner or a client?

 

[pgg]

porn and marital aids....

Heh, you think medicine is a cutthroat business ...

 

[divinemsm]

Maybe it's just me-but one of the MAJOR reasons I chose anesthesiology was the fact that I DID NOT want my whole existence and sense of self defined by my JOB as a physician. I look at the surgery attendings with whom I am doing some god awful belly case at 2 AM-as they state, that after finishing the case, they have to head over to Hospital X for yet another case: ummmm no thanks.

I get posed with the question all the time from medical students about my feelings about "not being the boss " in the grand scheme of a particular hospital-my response to them is that I would much prefer being the boss of my life. I don't need the adulation / adoration of a hospital staff to validate myself. I'll gladly take care of the sickest patients under the knife of surgeons good, competent or incompetent-when it's all said and done they go BACK to their primary service and that's how I like it. The fact that ( for the time being at least ) it pays nicely-makes it that much more attractive.

As we all know-medical education and the process of becoming indoctrinated to its culture-is a special kind of hell that only those who have endured it can relate to. Call me a " new school " physician I want a job that lends itself to supporting other non-medicine aspects of my life. For as I see it, medicine , in the end, will leave you disappointed if you expect it to fulfill your existence.

 

[lfesiam]

I'm in.

I'll contact some pimps. we'll get this thing started in no time.

 

[aredoubleyou]

Maybe it's just me-but one of the MAJOR reasons I chose anesthesiology was the fact that I DID NOT want my whole existence and sense of self defined by my JOB as a physician. I look at the surgery attendings with whom I am doing some god awful belly case at 2 AM-as they state, that after finishing the case, they have to head over to Hospital X for yet another case: ummmm no thanks.

I get posed with the question all the time from medical students about my feelings about "not being the boss " in the grand scheme of a particular hospital-my response to them is that I would much prefer being the boss of my life. I don't need the adulation / adoration of a hospital staff to validate myself. I'll gladly take care of the sickest patients under the knife of surgeons good, competent or incompetent-when it's all said and done they go BACK to their primary service and that's how I like it. The fact that ( for the time being at least ) it pays nicely-makes it that much more attractive.

As we all know-medical education and the process of becoming indoctrinated to its culture-is a special kind of hell that only those who have endured it can relate to. Call me a " new school " physician I want a job that lends itself to supporting other non-medicine aspects of my life. For as I see it, medicine , in the end, will leave you disappointed if you expect it to fulfill your existence.

well said

 

[Consigliere]

Male pornstars barely make any cash, although the benefits are outstanding. Not that I've looked into it or anything.

Which is why Peter North allegedly did gay porn in the first part of his career

 

[sevo85288]

If any OR nurse spoke like that to one our anesthesiologists, they would be fired that same day. FYI. There are places where anesthesiologists are respected and indeed loved by administration. I am lucky to work at one of those places.

 

[countingdays]

You guys should really use the search function.

There is no need to have yet another 'I hate my job' / 'gay porn salaries' thread.

 

[hoyden]

you seem to be in a remote area, so you probably make a ton of cash - and have been doing so for 20 years. i would definitely take time off and then go somewhere where you will be appreciated more.

Just curious - why all you, guys are thinking 20 years... I highly suspect it is less than 10 - a 2001 graduate - why should he be re-certified otherwise?!

 

[Jay K]

Is there a fellowship in anesthesia for adult outpatient plastics?

Yeah, unfortunately it's called CRNA (at least in the CRNA-friendly independent practice state that I live in).

 

[sevoflurane]

I am 52 year old board-certified and recertified anesthesiologist with no malpractice suits.

Over the past several years I have come to hate my job. Let me open and state that to a large extent this is my own fault. I have always been of the mind that if you dont like something, you complain. If your complaints are not resolved, you walk. Well at age 52 I am hesitant to walk away from a good-paying job.

The problems with my job are that I get no respect from the hospital staff or administration. I have been told by an OR nurse in the past year, "I dont need to help you, you are only an anesthesiologist." I have no call room although all other physicians who stay overnight do. My input on clinical aspects of care are ignored. They are overruled by a nurse somewhere in the system. My input on OR nurses/Pacu nurses/outpatient nurse hiring is not asked for or solicited. I have to put up with CRNAs that think that they have the same education and ability as I do (I have both a M.D. and Ph.D. in pharmacology, and both clinical and research fellowships) all from top universities; and am board-certified, and recertified 2009.

I think that the lack of respect for me comes down from the top levels of the hospital chain which really does not respect physicians; although I believe I am mistreated more than any other physician in the hospital. The fact that the hospital payor mix is so poor means that my billings do not support an anesthesiologist. Therefore, the hospital views me as a liability since they supplement my income each month. Therefore I am treated as an employee. After years of this treatment from the adminstration, the attitude is carried over to everyone else that the anesthesiologist can be treated like sh.. Thus I am to a large extent to blame for putting up with this crap. So I have finally gotten to the point where no amount of money is worth one's own self-respect.

I am hoping that my situation is specific to the hospital where I am. I will be hiring another MDA to work for me. I will only work part-time. This will give me an opportunity to work at other hospitals to see if I can find the enjoyment that I once had for this job.

PM'ed you.

 

[Hamhock]

Which is why Peter North allegedly did gay porn in the first part of his career

Can anyone verify how much male pornstars make?
(not owners/directors)!
HH

 

[invitro]

Did you consider doing a fellowship? I am doing peds next year and it seems that peds anesthesiologists are pretty satisfied and are very much in demand at the children's hospitals I rotate at. Unfortunately in academics you make much less than in a private setting (220-300k) but the hours are not terrible (40-50) and you can do as much or as little as you wish. I plan to do as many kids as possible and would like to do my own cases 50-60% of the time when Im done...it seems like that is a possibility at many of the bigger children's hospitals.

I don't know about peds cardiac, but it seems many of the anesthesiologists concentrated in that area are very satisfied with their jobs. The compensation is not quite as lopsided for them as it appears there is a stipend associated with managing these complex but quite gratifying cases. I think most of them start closer to 300k salary wise.

 

[inmyslumber]

I didn't think the original poster was a CRNA. I think the poster needs to look for a new workplace. Some hospital environments are so toxic that it is hard to change it...better to find somewhere else where you will be happy.

And I wouldn't have thought to google a username. Or expose the person's real identity on the forum. It was proper that the person who "outed" the OP apologized.

I wonder how we would all interact if we all got together face-to face with our nametags "Hello my name is...inmyslumber"

Anyway, totally off topic (and maybe inappropriate) but...handsome looking guy!

-inmyslumber

 

[Hockeyguy]

The best way to make friends is to take someones problem away from them. This is also the best way to make money.
cf

You are wise beyond your years my friend. I grew up in a business family and that is the secret. Everyone thinks its being an innovator and that is certainly one way to do it but what you described above is the real answer.

 

[Narcotized]

.

 

[jetproppilot]

[.

 

[bbal]

I have been an anesthesiologist in private practice for 10 years at two different jobs (two different major metropolitan areas; community hospitals). My experience has been the complete opposite of yours (first job no crnas, current job has them). I would suggest you find another job.

 

[jetproppilot]

i don't know where to begin my response. I am a slow typist and lousy writer. I totally believed this man's outpooring of angst above. The fact that you youngfolks(we are on a student forum) , question his story first , instead of showing sympathy re-affirms to me the limited exposure many of you have had to the real world. I applaud dr. Destriero for her investigative reporting. I've walked in some of this guys shoes. I am his age. Worked in little places. Under lousy ceo's. Luckily i have always been shown respect by my surgical and medical colleagues. I have done 99% of my own cases and worked as a solo self employed ologist for >90% of them. I have never brought in the big numbers you ms4's/ pgy3-4's think you are entitled to the first year out. I provided 1:3 on call to a poor hospital with ob and made peanuts by your guys standards. I worked 24 hrs did epidurals for $65/2-7hrs ( medicaid) and then worked post call . What kept me coming back? We were a new generation of young (30-40's) hard working physicians bringing "modern" medicine to an old institution with some pretty aging docs. We didnt have all the specialties backing us up. We had no pulmonologist- i ran the vents , the other 2 aging md ologists didn't know how. We all had a blast working together improving outcomes and patient satisfaction. Most of us were solo with no stipends. Eventually one by one we got burnt out and wanted a bigger piece of the pie( fund our retirement). One by one we left and found practices that were less prone to burnout. It was kinda funny how the more average talented people stayed and the above average folks left. ...........but you know guys it's not always fair out there. You come out of training, start a job and anything can happen. I once went into partnership briefly and was cheated out of $ xxx,xxx by a colleague i thought was the most earnest guy around. Do not expect your first job to be your last. Sorry for the lousy penmanship, but i dont know how to cut/paste/save. I could write 30 pages of pearls here for you new folks, but it would take me a week. I'll try to contribute more. Tip #1 - work where you want to live and try to pick a tort reform state. Hang in there orangele and explore those other hospitals.

wow.

 

[jetproppilot]

Can anyone verify how much male pornstars make?
(not owners/directors)!
HH

Like any other profession, its stratified.

Franchise shooters like Ron Jeramie, Peter North, have built their monetary strength beyond their last cumshot with strategic marketing of past movies and present personal websites. Peter North is a seven figure annual dude.

Most porn stars are paid by the scene and the scene only.

Think $1500 top money for a scene by a struggling porn star.

If you're "upper tier of the working class porn star"

think about two hundred large annual.

10-99.

Not W-2.

 

[cfdavid]

I once saw a "flick" where they took dudes right off the streets and offered them the "opportunity" to have sex with some female porn "stars"........ (I believe it was the real deal too), and the vast majority of dudes simple could not get "up to the task"....... Not saying I would be any different under those circumstances, but some dudes had all this bravado only to be severely let "down"......

cf

 

[igottaquestion]

I've always assumed there's a decent chunk of male pornstars willing to work for free.

 

[iwumd07]

Bertleman has made some insightful suggestions on how we can CHANGE things in this specialty.

Let's turn this thread (or make another one) into what we CAN do in order to at least mitigate some of these ills that seem all too common in too many circumstances.

Clearly, I'm not even a PGY1 yet, so I admit that I may be naive (almost certainly am) to the day to day experiences of an attending doing this work for 20+ years.

****That being said, I agree that anesthesiologists MUST get more involved. Just the other day, I was wondering WHY THE HE.L I've NEVER heard a lecture by an anesthesiologist. I've had lectures from pretty much every other specialty, and have always appreciated (and respected) those that taught well and put on a good presentation/case study/whatever.....

SO, we can start there. If you work at a teaching hospital, volunteer to give lectures on pain management or sedation to medical or even surgical residents as well as to medical students. VOLUNTEER (even in ones spare time or post call morning) to do a presentation to IM residents during their morning report. Surely, an -ologists experience in pain management, ICU related stuff like sedation, ventilation, and even fluid management would be useful. Present a case that ties everything together.

In the private sector, WE MUST find ways to add to the value chain, even if this means doing work that may not be as highly reimbursed. ****This will take some "out of the box" thinking, because if it were that easy, it would likely already have been done.

The best way to make friends is to take someones problem away from them. This is also the best way to make money. Again, we should be exchanging ideas on this, as it's not easy.

To my fellow students, and anesthesiologists to be, we should make it a point to not allow general medicine (which we ARE ALL trained in) to fade from our skill-set. We must take the physician first, anesthesiologist second approach, IMHO. This is a mentality that we can all adopt, which will be benefitial to all, including the profession.

cf

I COMPLETELY AGREE! I've always been involved with other aspects of the hospital and school, including administration and education aspects. There needs to be more ingenuity and initiative in the next generation of anesthesiologists (and the current ones too)! It's time to stop complaining of not making 350K+ and start practicing medicine for the reasons we did it in the first place....for the patients! I desire a fair compensation just as much as anyone else. CF has it right. We need to think 'out of the box', recognize a need or demand, and meet that need.

Anesthesiologists have some of the most intellectual, innovative, scientific, and practical minds that I have ever witnessed. As a soon-to-be M4, I strive to one day be included in a group of physicians who, in my opinion, can provide excellent care for ANY patient of ANY severity. But when all I hear about the profession is whining about poor compensation, competition from the AANA, and mistreatment from those in their prospective work environments, it saddens and disgusts me. I will tell you all like I tell my fellow medical students who whine and complain, "If you have the time and energy to whine/complain, then you have the time and energy to MAKE A CHANGE!" As for the ASA, I am joining as a medical student. I STRONGLY suggest that the ASA get its act together. There are too many genius minds and superb physicians sitting around muttering qualms they have about their profession. DO SOMETHING ABOUT IT! And if you don't want to do anything about it, then do something else. No one is keeping you in the anesthesia world, and I know for a fact that you can live quite comfortably with a different career that pays less than half of your current salary. It's NEVER too late to change career paths...even for a physician.

So please, stop discouraging future generations of students from becoming a physician and anesthesiologist. If you're unhappy, figure out what you're truly unhappy about and FIX IT. Worried about Obamacare? Lobby to FIX IT! Don't like all the competition for the competition? STOP TRAINING THEM! But please, please don't tell us to 'consider another passion' because you're unhappy with your life. The future NEEDS passionate and driven 'student doctors' like us to pursue medicine/anesthesiology and take care of YOU when you get sick. After all, do you really want a mid-level provider completely responsible for YOUR care in the hospital/ICU/OR?

 

[maceo]

I COMPLETELY AGREE! I've always been involved with other aspects of the hospital and school, including administration and education aspects. There needs to be more ingenuity and initiative in the next generation of anesthesiologists (and the current ones too)! It's time to stop complaining of not making 350K+ and start practicing medicine for the reasons we did it in the first place....for the patients! I desire a fair compensation just as much as anyone else. CF has it right. We need to think 'out of the box', recognize a need or demand, and meet that need.

Anesthesiologists have some of the most intellectual, innovative, scientific, and practical minds that I have ever witnessed. As a soon-to-be M4, I strive to one day be included in a group of physicians who, in my opinion, can provide excellent care for ANY patient of ANY severity. But when all I hear about the profession is whining about poor compensation, competition from the AANA, and mistreatment from those in their prospective work environments, it saddens and disgusts me. I will tell you all like I tell my fellow medical students who whine and complain, "If you have the time and energy to whine/complain, then you have the time and energy to MAKE A CHANGE!" As for the ASA, I am joining as a medical student. I STRONGLY suggest that the ASA get its act together. There are too many genius minds and superb physicians sitting around muttering qualms they have about their profession. DO SOMETHING ABOUT IT! And if you don't want to do anything about it, then do something else. No one is keeping you in the anesthesia world, and I know for a fact that you can live quite comfortably with a different career that pays less than half of your current salary. It's NEVER too late to change career paths...even for a physician.

So please, stop discouraging future generations of students from becoming a physician and anesthesiologist. If you're unhappy, figure out what you're truly unhappy about and FIX IT. Worried about Obamacare? Lobby to FIX IT! Don't like all the competition for the competition? STOP TRAINING THEM! But please, please don't tell us to 'consider another passion' because you're unhappy with your life. The future NEEDS passionate and driven 'student doctors' like us to pursue medicine/anesthesiology and take care of YOU when you get sick. After all, do you really want a mid-level provider completely responsible for YOUR care in the hospital/ICU/OR?

Ill bet the farm that you are a first or second year medical student.

Moreover, this is a board the original poster has a right to post anything he/she wants on this board as long as it is related to anesthesiology or medicine regardless of who it disgusts.. including you

 

[iwumd07]

Ill bet the farm that you are a first or second year medical student.

Moreover, this is a board the original poster has a right to post anything he/she wants on this board as long as it is related to anesthesiology or medicine regardless of who it disgusts.. including you

Well, I hope you weren't too partial to the farm. I'll be an M4 in 3 months. I completely agree with the rights of the OP. I was not referring to the OP's post, hence why I quoted cfdavid's previous post. I am making statements based on the negativity that is circulating across all the anesthesiology forum posts. It seems that there are quite a few unhappy anesthesiologists, especially on these forums. Mainly what I am saying is that you all have the intellect and resources to make changes for the betterment of anesthesiology.
I don't see how that is insulting in anyway, nor does it warrant assuming I am naive because I'm a medical student. I have had conversations with a multitude of anesthesiologists since undergrad, both in academic and community-based settings. Most are very happy with their career decisions. They have always told me that if any doctor, in any specialty, discourages the next generation from pursuing their dreams of becoming great physicians, to then question why that doctor is still practicing.

 

[maceo]

Well, I hope you weren't too partial to the farm. I'll be an M4 in 3 months. I completely agree with the rights of the OP. I was not referring to the OP's post, hence why I quoted cfdavid's previous post. I am making statements based on the negativity that is circulating across all the anesthesiology forum posts. It seems that there are quite a few unhappy anesthesiologists, especially on these forums. Mainly what I am saying is that you all have the intellect and resources to make changes for the betterment of anesthesiology.
I don't see how that is insulting in anyway, nor does it warrant assuming I am naive because I'm a medical student. I have had conversations with a multitude of anesthesiologists since undergrad, both in academic and community-based settings. Most are very happy with their career decisions. They have always told me that if any doctor, in any specialty, discourages the next generation from pursuing their dreams of becoming great physicians, to then question why that doctor is still practicing.

Just because you are not hearing what you want to hear does not give them any less right to say whatever they wanna say. Are your dreams falling apart at the seams? are you questioning your decisions?

Happiness is not a requirement to practice medicine. If it were, there wouldn't be many physicians practicing I can tell you that. Instead of being appreciative that people are offering other view points, you are questioning this guys fitness to practice. WTF? SHould I say everything is rosey and great and I get a 12 hour erection everytime I am in the OR next time a medical student shadows me even though thats not how i feel?

 

[iwumd07]

Just because you are not hearing what you want to hear does not give them any less right to say whatever they wanna say. Are your dreams falling apart at the seams? are you questioning your decisions?

Happiness is not a requirement to practice medicine. If it were, there wouldn't be many physicians practicing I can tell you that. Instead of being appreciative that people are offering other view points, you are questioning this guys fitness to practice. WTF? SHould I say everything is rosey and great and I get a 12 hour erection everytime I am in the OR next time a medical student shadows me even though thats not how i feel?

You've taken this elsewhere. Read my original post and the one to which I'm referring. I'm talking about being advocates for each other and reclaiming anesthesia for the anesthesiologists. So many people on the forums are (rightfully so) upset about the direction that anesthesia has gone, with respect to MD vs. CRNA vs. AA. Again, the most brilliant physicians I've met are anesthesiologists. I feel strongly that these people can and will help to improve the course and condition of healthcare in this country.

 

[Brahms2]

This is my first post. I work in a group at a community hospital which also is affiliated with an anes residency program (at which I trained). I agree with the OP and thought I'd pass along an email I recently sent to the residency chairman who is a friend of mine. So, for what its worth:

Name,
I was reading this blog and it got me thinking about the residency program. I'm going to bring up the elephant in the room. The number one issue with the program
is CRNAs - end of story. To add icing to the cake, every major training group also trains CRNAs. Surgeons here, who mainly deal with CRNAs have come to
view the field of anesthesiology as something a bit below M.D. status and treat us in kind. For instance, how many times has an attending forgone a swan
after the surgeon tells him not to place one? I've seen it more than once. What is a surgeon supposed to think when he sees CRNAs doing
complicated neuro and cardiac cases day in day out? I fully believe that the surgeon attitude I had to deal with (not just me but my attendings) was a direct result of the CRNA presence. This environment eats away at a resident's honor, motivation, and enthusiasm - you've worked a quarter of your life to become a doctor and
now find yourself in a hostile environment (nurses, scrub techs, surgeons, CRNAs) and all you can do is tell yourself that it must be better as an attending - do any other residents have to put up with that? Absolutely not. In fact, I got 10X the respect as a medicine intern as I did a CA-3.
Who's fault is it? I say its the anesthesiologists who started this trend in the first place.
Was (city) ever an all MDA place? When did it change? Does it matter now? No.
However, if we really want to get serious, we must have residency training in a CRNA free-zone and I can't beleive that this is not possible.
There are 15 or so residents at any given time which seems like plenty to cover St. hospital - assuming those guys hired some more docs (which they could easily do if they weren't paying multiple millions to their CRNAs). Maybe a doc would have to sit cases every now and then - boo hoo, sorry for asking you to do your job.
Is this idea a complete logistical impossibility? Would case numbers be an issue? What a great way to weed out those who want to teach from those who don't.



http://mkeamy.typepad.com/anesthesiacaucus/2008/02/we-have-met-the.html

 

[Brahms2]

If any OR nurse spoke like that to one our anesthesiologists, they would be fired that same day. FYI. There are places where anesthesiologists are respected and indeed loved by administration. I am lucky to work at one of those places.

Where is that? It is my suspicion that the environment gets better as one moves further Northwest. I think its a regional phenomenon.

 

[cfdavid]

I don't know. I think it would be imprudent and naive to label these guys as cry-babies or whiners...... (not to mention dismissive of possibly very valid and urgent concerns).

SO, we need to think hard about solutions which I've done to some extent given that I'm 100% committed to this profession. And, it's clearly NOT going to be any one overall sweeping solution. But, rather many smaller changes.

First, it seems unlikely to just wish away (or work towards that end) CRNAs.....
So, I don't think the focus should be on THEM to some extent (other than to battle them in court and keeping PACs healthy).

We need to reflect on our strengths as physicians. ***I've often considered one possible area of focus. This is within the context of surgeons having an ever increasing motivation to operate from an economic perspective. For them to stay relevant, they need to hone their TECHNICAL skills as new technologies/devices/procedures come out.

Several of the anesthesiologist I know have stated that "the anesthesiologist is the internist of the OR", and while it may not be that way now, I think it COULD and that trends (such as the above paragraph) can make it that way. This is an opportunity for us.

Many have, in the past, reflected negatively on the concept of "perioperative medicine", but personally I think we might benefit from embracing this approach to the field.

Again, CRNAs are very specialized advanced practice nurses (whether they go on to pursue a Dr. in nursing or not.). Surgeons are highly skilled individuals to be sure. And we are all familiar with surgical residents/attendings frowning on the caution (of say, giving fluids to ICU pts) of medicine residents/attendings whom play certain things more carefully (i.e. more concerned with volume overload even though the pt is still 3rd spacing etc.).

On the flip side, medical residents often balk at the medicine knowledge of their surgical colleauges. Granted said knowledge among the surgical community has hsitorically been strong (because they've mandated it be to some extent (I'm thinking more gen surg than perhaps some of the uber-specialties). But, as financial stains that WE'RE all going to be dealing with, you'll see more surgeons focusing their time in the OR, with more mid-levels helping on the floors and in clinic (JUST as I'm seeing in cardiology right now). But, this is a huge opportunity for anesthesiologists to redefine ourselves as truly "internists of the OR". Not internists, but just as I said, internists of the OR.

****So, the point is that we MUST stay relevant. Perhaps greater interest in Critical Care is also in order. The historical debate has been that 1) per MMD, he rarely uses it in his practice structure and 2) it just doesn't pay what the OR does currently.

****Now, WTF kind of attitude is that?? I know surgical colleagues doing CC fellowships and surely they make more doing work in the OR. But, they do it to gain knowledge and skills, and perhaps out of a love for critical care.

I've said it before, and I'll say it again. When was the last time a med student listened to an anesthesiology attending giving a lecture on pharmacology or preoperative checklists/clearance?? How about fluid rescucitation or management pre-peri-post operatively?? Pain control and PCA management??
These guys are faculty, and aside from resident didactics and teaching, their prescense outside of the OR is minimal.

Now, I'm not advocating continuing to "train the competition", but that's not at all the point of doing some teaching/increasing exposure. It's because anesthesiologists are the experts in such things. We need to make that very clear, but also accept that responsibility.

An example; Just Friday, I was chatting with my own PD (I'm PGY1), and he says, so CF "why do we apply cricoid pressure". I replied.

He states, well actually, new data............. and cites several studies suggesting cricoid pressure is ineffective in compressing the esophagus as well as potentially causing passive opening of the LES, thereby it may actually increase the risk of aspiration.....

Now, isn't this something that could be discussed during a lecture on advanced airway management to a group of medicine/pulm fellow dudes? How about during ACLS training for incoming residents???

The point is that there is a myriad of opportunities for anesthesiology to separate ourselves from mid-levels as well as staying relevant. Respect will follow.

Thoughts??

cf

 

[cfdavid]

Another reflection which can be applied to where we decide to go as a prefession is in considering the field cardiovascular medicine over the last 40 years.

Cardiologists got aggressive. They innovated. They TOOK over procedures which had not previously been their domain, nor original innovations. They published.

Sure, "they own the patient" and this clearly makes it easier for what Cards has become, but they also took ownership (in many institutions) for reading/interpreting their own studies. While there may not be as many parallels to anesthesiology in this regard, this can serve as a source of inspiration and a reminder that medicine is a field in constant flux, and as such, opportunities ("challenges") open up all the time. So, it's up to us. Cards could just have easily, as a profession, said, "well, we're just medicine guys". "we have no business doing all of these procedures." "Besides, that's IR or Vascular" "We don't want to step on anyone's toes". But, that's not at all the direction that cards leadership decided to take their profession.

This brings up a separate issue that was just recently discussed. That of the interventional pain guys doing some heavy duty procedures. Managing post-procedural complications became an issue which was discussed. But, don't cardiologist need to be bailed out now and again by CT surgeons and Vascular surgeons when they perforate an aorta or ventricle? This hasn't stopped them from dominating interventions, where one could just as easily suggest that these "should" be CT/Vascular/IR patients to begin with. How about when the Vascular guy needs to intervene on a pseudoaneurysm post PTCA/PCI as I saw the other day???? Does that mean that the interventional cards folks have "no business" doing procedures which can involve complications needing the attention of other specialties??

Again, just some things to kick around.

 

[cfdavid]

Seiously, let's start being productive. If we need to take this discussion to the private forum, then so be it. If so, just give a heads up so people can glance up there...

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[sebsvenmdc]

Yeah, I just don't get this CRNA stuff. They claim to be able to do what anesthesiologists do for a given surgery. This means that either:
1) they are more intelligent than anesthesiologists as a whole because with less education they are equally competent
OR
2) anesthesiologists are vastly overqualified to do the necessary job
OR
3) both of the above

Obviously, 1) (and thus 3)) cannot be true. Which leaves us to 2). Are anesthesiologists grossly overqualified? Perhaps for some easy procedures like conscious sedation for endoscopies in patients without comorbidities. The implementation of various safety interventions like pulse ox (routine nowadays, but unheard of a few decades back) has seen the mortality rate from anesthesia plummet from 1:5,000 to on the order of 1:200,000.

What if scrub techs studied anatomy and had the equivalent training of CRNAs...would they be competing with surgeons once surgeons showed them the ropes? Why is this an absurd comparison?

Just a few thoughts for more dialogue. I want to embrace this profession, but it's discouraging to read a lot of the negative aspects of the field...aspects that seem to be unique to this field. In what other fields, is an M.D. thought of as less than a M.D.?

 

[maceo]

the answer is train Physician assistants to do what crnas do. they are more educated understand medicine better. there wo uld be friggin lines out the door with PAs wishing to retrain in anesthesia

 

[Jay K]

What if scrub techs studied anatomy and had the equivalent training of CRNAs...would they be competing with surgeons once surgeons showed them the ropes? Why is this an absurd comparison?

Actually, you'd be surprised at the skillset of surg techs in private practice. In the card cath rooms, they do all the cut downs and insert the intravascular catheters prior to the cardiologist coming in and they close. The surg techs often assist and/or close.

That's the funny thing about surgical closures: In academia, you'll hardly ever have an attending close your incision (it'll be a resident and with most attendings, who haven't closed in years, you wouldn't want them to). In private practice depending on the specialty, many times it's the PA who opens/closes. So everybody's wound closure and/or scar is oftentimes delegated to the surg tech and PA; I wonder how many patients realize that.

the answer is train Physician assistants to do what crnas do. they are more educated understand medicine better. there wo uld be friggin lines out the door with PAs wishing to retrain in anesthesia

They're called AA's (anesthesia assistants) - surely you're familiar with that term/profession? Although I confess I didn't know about them until I came onto this site - I'd never actually encountered them myself.

 

[NaughtyGirl]

Can we make the same argument that all physicians have no respect?

Which physicians have respect in the hospital?

Anyone?

I am 52 year old board-certified and recertified anesthesiologist with no malpractice suits.

Over the past several years I have come to hate my job. Let me open and state that to a large extent this is my own fault. I have always been of the mind that if you dont like something, you complain. If your complaints are not resolved, you walk. Well at age 52 I am hesitant to walk away from a good-paying job.

The problems with my job are that I get no respect from the hospital staff or administration. I have been told by an OR nurse in the past year, "I dont need to help you, you are only an anesthesiologist." I have no call room although all other physicians who stay overnight do. My input on clinical aspects of care are ignored. They are overruled by a nurse somewhere in the system. My input on OR nurses/Pacu nurses/outpatient nurse hiring is not asked for or solicited. I have to put up with CRNAs that think that they have the same education and ability as I do (I have both a M.D. and Ph.D. in pharmacology, and both clinical and research fellowships) all from top universities; and am board-certified, and recertified 2009.

I think that the lack of respect for me comes down from the top levels of the hospital chain which really does not respect physicians; although I believe I am mistreated more than any other physician in the hospital. The fact that the hospital payor mix is so poor means that my billings do not support an anesthesiologist. Therefore, the hospital views me as a liability since they supplement my income each month. Therefore I am treated as an employee. After years of this treatment from the adminstration, the attitude is carried over to everyone else that the anesthesiologist can be treated like sh.. Thus I am to a large extent to blame for putting up with this crap. So I have finally gotten to the point where no amount of money is worth one's own self-respect.

I am hoping that my situation is specific to the hospital where I am. I will be hiring another MDA to work for me. I will only work part-time. This will give me an opportunity to work at other hospitals to see if I can find the enjoyment that I once had for this job.

 

[PL32]

To throw in my two cents:

People have suggested various ways to deal with the issue of CRNAs:

1) Train a ton of them in order to drive supply way over demand, thereby dropping their payment rates. This would not affect anesthesiologist payment as we are supervisors, but it would certainly decrease their pay for OR services. The extra cash would go to the hospital or whoever is employing the CRNAs (the anesthesia group partners). The problem here is perpetuating the social problems associated with CRNAs--namely how it makes anesthesiology as a profession appear.

2) Not train any of them. This is not going to work guys. The epidemic has "tipped." The plane has crashed into the mountain as the Big Lebowski would say. With their propaganda machine running on all cylinders there is no way to go back now.

3) Train fewer anesthesiologists. This is related to point one as this would end up leading to the 1:6 supervisory ACT model. The anesthesiologists graduating under this scenario would also need "extra" training or skill sets. We would need to drop our supply to increase demand but also combine that with more specialized critical care/regional anesthesia/chronic pain skills. We would also need to take control of preoperative medicine as a field (yes i know this makes most of us snore), and do publish more studies to cement our place here, as opposed to medicine people doing this (or nobody doing it).

What other ideas are out there? I don't have a solution either obviously, just reiterating old ideas.

 

[cfdavid]

To throw in my two cents:

People have suggested various ways to deal with the issue of CRNAs:

1) Train a ton of them in order to drive supply way over demand, thereby dropping their payment rates. This would not affect anesthesiologist payment as we are supervisors, but it would certainly decrease their pay for OR services. The extra cash would go to the hospital or whoever is employing the CRNAs (the anesthesia group partners). The problem here is perpetuating the social problems associated with CRNAs--namely how it makes anesthesiology as a profession appear.

2) Not train any of them. This is not going to work guys. The epidemic has "tipped." The plane has crashed into the mountain as the Big Lebowski would say. With their propaganda machine running on all cylinders there is no way to go back now.

3) Train fewer anesthesiologists. This is related to point one as this would end up leading to the 1:6 supervisory ACT model. The anesthesiologists graduating under this scenario would also need "extra" training or skill sets. We would need to drop our supply to increase demand but also combine that with more specialized critical care/regional anesthesia/chronic pain skills. We would also need to take control of preoperative medicine as a field (yes i know this makes most of us snore), and do publish more studies to cement our place here, as opposed to medicine people doing this (or nobody doing it).

What other ideas are out there? I don't have a solution either obviously, just reiterating old ideas.

I agree on all points. #1 is already happening from what I see and hear, though don't have data on, really.

On call last night in the SICU a nurse said he was on his way to CRNA school and commented on how "it's one of the few fields where you can triple your salary with 2 1/2 years of additional training". This is likely not going to be sustainable.

#3, while cutting MD/DO supply would bolster demand, I'm not sure about a 1:6 ratio.... But, regarding perioperative medicine we MUST embrace it.

****Regarding perioperative medicine, I was "embraced" by at CT surgeon since the rooms I'm covering is a Gen Surg/Vasc/CT surgical mix (but mostly CT)....... The dude even pulled me over to check out a CXR on a pt not even mine (maybe he didn't know that...lol).....

The guy's like, "CRNA's don't know sh.t" (seriously). Then goes on to speak of the "need" for anesthesiology in the ICU. Apparently, he trained at an institution where anesthesiology and perioperative medicine ran the SICU (as is the case in many academic institutions) which resulted (in his opinion) in great coordination of care.

My white coat says anesthesiology under my name. I can tell you that, in a very short period of time, myself (and my colleagues) have been very well received by the surgeons in the hospital.

Again, change is the only constant, but there are "needs" that can be met by our profession. It is NOT all doom and gloom. These represent interesting opportunities for us going forward.

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[scudrunner]

the answer is train Physician assistants to do what crnas do. they are more educated understand medicine better. there wo uld be friggin lines out the door with PAs wishing to retrain in anesthesia

Does such training exist? I've never heard of a PA in anesthesiology, though I like the idea.

 

[cfdavid]

Does such training exist? I've never heard of a PA in anesthesiology, though I like the idea.

AA's. I think maceo is a proponent of PA's--->AA's. Most existing PA's should meet most of the requirements of AA programs, with perhaps a few exceptions. The MCAT would be one of the bigger obstacles as senior PA's would be pretty far removed from basic physics and general chemistry.

So, changes would need to be made. I think this is a great idea. It would give CRNA's some healthy competition from a less hostile source.

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