Is this the end of anesthesiology?

[bronx43]

True... means that there will always be work for the doctors specializing in those areas. Pain is also different in that there aren't too many treatments that have been tried out and not enough people/physicians understand it. Also different because pain patients actually care about their pain (unlike their DM, cancer, heart disease, COPD, etc).

People don't care about their heart disease or cancer? Pretty sure popular culture and the media attention for those two significantly outweigh that for all other diseases combined. Nothing strikes more fear into the general public than getting a cancer diagnosis or a heart attack.

And if you are trying to imply that pain has more potential for innovation than these other diseases, I would again disagree wholeheartedly. For potential for innovation and funding for research, I would say oncology, neurology, and cardiology are top 3. Pain medicine isn't even close.

---

Members don't see this ad.

 

[Disciple]

Also different because pain patients actually care about their pain (unlike their DM, cancer, heart disease, COPD, etc).

People care about their oxycodone, Soma and Xanax. Try selling them on weight loss, exercise and cognitive/behavioral therapy. Ask them which option they're willing to pay out of pocket for.

Are you suggesting someone developing a magic bullet for chronic pain? Yes, whomever achieves that will probably be able to retire early.

 

[DermViser]

I'm going to bump one of the original threads because it's inspiring to see the same fears being thrown around a dozen years ago are still present today. Love it, hate it, disagree with it and say that this time it really is the end this time but really it's threads like this that give me hope. People sure seemed much more rational back then than many of the present day posters.

You apparently have not been paying attention with respect to cost containment by third party payers. The first goal is to achieve near "universal" healthcare. The second goal is to clamp down hard on reimbursement to hospitals. Dr. Ezekiel Emmanuel, one of the writers of Obamacare has explicitly said this.

 

[gasdoc77]

Today we received a royal decree from one of our surgeons that he wants spinals for everyone. I like doing spinals but time and again our practice is dictated entirely by the surgeon. Anesthesia should be a 1 year internship and a 1 year residency of learning skills. Why bother learning principles backwards and forwards when we just do as we are told in the end without consultation. Like me, you all will one day feel way overtrained for your field, or at least what we have allowed it to become. Being a mere technician makes me livid. I like the analogy of being an electrical engineer to change a light bulb.

 

[Disciple]

You apparently have not been paying attention with respect to cost containment by third party payers. The first goal is to achieve near "universal" healthcare. The second goal is to clamp down hard on reimbursement to hospitals. Dr. Ezekiel Emmanuel, one of the writers of Obamacare has explicitly said this.

Agree.

Phase I, increase reimbursement to hospitals to provide the necessary resources to round up independent physicians.

Phase II, cut hospital reimbursement.

 

[DermViser]

Agree.

Phase I, increase reimbursement to hospitals to provide the necessary resources to round up independent physicians.

Phase II, cut hospital reimbursement.

Exactly. The unintended (or may be intended) consequence of all these new regulations is that private practices are getting swallowed up by hospitals and consolidating like crazy to where private practice doctors become employees, where the hospital makes the decision to accept the plan or not, not the individual doctor.
There's a reason that Obamacare exchange plans have such narrow networks even with the Gold plans. The top hospitals who choose to not participate (even ones that Obama praised for their good, efficient care like Cleveland Clinic and Mayo) are hedging their bets that excluding themselves from these plans that reimburse much lower than what they are used to will end up being a good risk to take. What Obamacare does by increasing the number people on Medicaid and the people on Obamacare plans bought on the exchanges is essentially backing the hospitals into a corner, where the hospital will feel it will have no choice but to accept the reimbursement

 

[Ipassgas]

I think it is intended.
It's easier to manage/control 10,000 hospitals than 1,000,000 doctors. It's easier to write a million checks than a hundred million checks, so next we'll introduce medical homes and capitated ACOs, and let the facilities and doctors squabble over how to divide it. Oh, I guess that's already started? Good.
Next is mandated capitated care. Your health system took care of X (Medicare, if we don't have single payer by then) patients per year for the last three years. You get one check for Y dollars per patient times X patients. You figure out what to do with it.
It's easier to write 10,000 checks than 1,000,000.
We all have different horizons. Individual doctors look 3 to 5 years away. Heath systems look 10-20 years away. Medicare/government systems are supposed to look 20 years to two generations away. Individually, we don't look far enough down the road.

 

[CheGuevaraMD]

I think it is intended.
It's easier to manage/control 10,000 hospitals than 1,000,000 doctors. It's easier to write a million checks than a hundred million checks, so next we'll introduce medical homes and capitated ACOs, and let the facilities and doctors squabble over how to divide it. Oh, I guess that's already started? Good.
Next is mandated capitated care. Your health system took care of X (Medicare, if we don't have single payer by then) patients per year for the last three years. You get one check for Y dollars per patient times X patients. You figure out what to do with it.
It's easier to write 10,000 checks than 1,000,000.
We all have different horizons. Individual doctors look 3 to 5 years away. Heath systems look 10-20 years away. Medicare/government systems are supposed to look 20 years to two generations away. Individually, we don't look far enough down the road.

This is correct. The long-term goal of the federal government with respect to healthcare is to clamp down on medical cost inflation before it eats the entire budget. Global budgeting/capitation is a proven way to do this, but obviously there is a lot of resistance to this by many stakeholders. However, the government can easily play a multi-decade war of attrition to win, and it will probably do so.

Medicine will no longer be a cash cow in 20 or 30 years, but so what? No bubble lasts, people will move on to the next lucrative career.

 

[BuzzPhreed]

Today we received a royal decree from one of our surgeons that he wants spinals for everyone. I like doing spinals but time and again our practice is dictated entirely by the surgeon. Anesthesia should be a 1 year internship and a 1 year residency of learning skills. Why bother learning principles backwards and forwards when we just do as we are told in the end without consultation. Like me, you all will one day feel way overtrained for your field, or at least what we have allowed it to become. Being a mere technician makes me livid. I like the analogy of being an electrical engineer to change a light bulb.

This is fine for surgeons to think they can do. Until there is a problem. Then they want no part of "your" anesthetic. Seen it before. Stand up to them and explain why you want it done your way. It's like you trying to tell them how to close the surgical site and with what kind of suture, etc.

 

[gasdoc77]

This is fine for surgeons to think they can do. Until there is a problem. Then they want no part of "your" anesthetic. Seen it before. Stand up to them and explain why you want it done your way. It's like you trying to tell them how to close the surgical site and with what kind of suture, etc.

I recognize what you say to be true and encounter such things time and again in every practice I've been to, academic and private. I merely relay the story as an illustration of what to expect for grads-to-be. You are not expected to think but to do. Your input is neither invited nor appreciated. Any semblance of resistance is considered being a "difficult type." Spend 3+1 years learning all the nuances and academic minutia then spend your entire working career catering. Yours is not to question why...yours is but to do or die. Welcome aboard.
Additionally, people talk about "explaining this and that to the surgeon." WTF??? The mere fact that I should have to explain as if asking permission shows that whether or not I win this battle, the war was lost long before I arrived. How many of these guys used to get my help so that they could even get through med school in the first place? And now I'm asking their opinion in my area of expertise? Why don't I ask the guy washing the floors while I'm at it?

 

[DermViser]

This is correct. The long-term goal of the federal government with respect to healthcare is to clamp down on medical cost inflation before it eats the entire budget. Global budgeting/capitation is a proven way to do this, but obviously there is a lot of resistance to this by many stakeholders. However, the government can easily play a multi-decade war of attrition to win, and it will probably do so.

Medicine will no longer be a cash cow in 20 or 30 years, but so what? No bubble lasts, people will move on to the next lucrative career.

Something tells me that you actually support this. No surprise that your name is CheGueveraMD. If medicine is somehow a "bubble" for you, I feel sorry for you. Medicine has only made the advancements that it has bc of how lucrative it is.

Edit: Yup, just checked the rest of your posts. You are indeed a socialist, if not communist.

 

[bronx43]

Something tells me that you actually support this. No surprise that your name is CheGueveraMD. If medicine is somehow a "bubble" for you, I feel sorry for you. Medicine has only made the advancements that it has bc of how lucrative it is.

Edit: Yup, just checked the rest of your posts. You are indeed a socialist, if not communist.

We all want the gravy train to roll on, but let's not act like we're doing public service by having a lucrative medical industry. Who really makes advancements? It's academia and pharmaceuticals. To keep from stifling healthy advancements, just make sure there are still incentives for them and everyone else can just take it up the A.

 

[DermViser]

We all want the gravy train to roll on, but let's not act like we're doing public service by having a lucrative medical industry. Who really makes advancements? It's academia and pharmaceuticals. To keep from stifling healthy advancements, just make sure there are still incentives for them and everyone else can just take it up the A.

Yeah, those medical advancements both medical equipment and pharmaceuticals, just save lives, that's all, no biggie. Where do you think most clinical trials happen? Where do you think most basic science research happens? In academic medical centers.

 

[BuzzPhreed]

Additionally, people talk about "explaining this and that to the surgeon." WTF??? The mere fact that I should have to explain as if asking permission shows that whether or not I win this battle, the war was lost long before I arrived.

Explaining and asking permission are two different concepts. Communication is good. No one likes to be blindsided. And there may be valid reasons why you shouldn't do for example a regional technique.

But I've been in private practice for over 6.5 years including staying 1 year post-training in an academia job where I trained. Consistently I find if a stubborn surgeon wants something a particular way that simply explaining to him or her why you want to do it your way usually suffices. Again, communication.

What I saw in my most recent debacle of a job was a bunch of anesthesiologists who were more afraid of losing their contract than actually being doctors. The surgeons bring the business to the hospital and they catered to that. As a result they were spineless and did not necessarily do the right anesthetic. Many surgeons also seem to think that they could walk behind the curtain and give anesthesia as good as you can. Little do they know. A particular surgeon comes to mind who was notorious for writing up anesthesiologists and CRNAs who would give his patients any pressors during a case (i.e. referring it for peer review). This guy had the whole department so intimidated yet he brought so much business to the hospital that administration always backed him and the anesthesia group always backed down. So you routinely ended up with patients coming for surgery who had continued their ACE inhibitor or ARB and who had a pressure in the 70's for the whole case. We're talking sometimes for 4-5 hours. Unacceptable.

I'm working again for a group that is employed by the hospital. Some may not see this as ideal. But first off I'm making a ton more money and I never have to ask permission from the surgeon to do a particular technique. We discuss the case and I come up with a plan. What are they gonna do if we disagree and I do it my way anyway? Fire me? It's my specialty. It's my medical license. It's my plan. Bottom line is that most surgeons just don't want the patient to move or die within the next 30 days. The hospital owns the group and ironically this gives me more power. I know that's a bit counterintuitive but I deal with a lot less clinical b.s. than I did during my temporary stint in a "true" PP group.

 

[deleted126335]

I have had a surgeon or two who were used to getting their way "demand" a regional anesthetic that I thought was inappropriate. My response was very simple, "then you put it in".
Ended the conversation. Of course, I did make an enemy. It was worth it.

 

[bronx43]

Yeah, those medical advancements both medical equipment and pharmaceuticals, just save lives, that's all, no biggie. Where do you think most clinical trials happen? Where do you think most basic science research happens? In academic medical centers.

Right... and I'm saying the government can carry out their goals while maintaining research funding for advancement. The private sector is what eats up all the health care resources, and they offer little to no contribution to medical advancement.

 

[DermViser]

Right... and I'm saying the government can carry out their goals while maintaining research funding for advancement. The private sector is what eats up all the health care resources, and they offer little to no contribution to medical advancement.

The private sector is why healthcare is as lucrative as it is. See how much you will be reimbursed by private insurance vs. Medicaid.

 

[CheGuevaraMD]

Something tells me that you actually support this. No surprise that your name is CheGueveraMD. If medicine is somehow a "bubble" for you, I feel sorry for you. Medicine has only made the advancements that it has bc of how lucrative it is.

Edit: Yup, just checked the rest of your posts. You are indeed a socialist, if not communist.

My username is somewhat facetious, but you are plainly just a rentier. It's ridiculously crazy to be okay with medical inflation to increase consistently. What about spending on everything else? It's also somewhat crazy to assume that health is the ultimate goal of any society.

We are a democracy. What's the shame in voters wanting to reduce healthcare spending and increase spending on anything else? What's wrong with science, art, education, or, hell, even personal consumption?

 

[Spinach Dip]

What I saw in my most recent debacle of a job was a bunch of anesthesiologists who were more afraid of losing their contract than actually being doctors.

Job security first.
Patient care, like, fourth.

 

[DermViser]

My username is somewhat facetious, but you are plainly just a rentier. It's ridiculously crazy to be okay with medical inflation to increase consistently. What about spending on everything else? It's also somewhat crazy to assume that health is the ultimate goal of any society.

We are a democracy. What's the shame in voters wanting to reduce healthcare spending and increase spending on anything else? What's wrong with science, art, education, or, hell, even personal consumption?

Here's a newsflash to you. Without health, you can't have those other things. Healthcare spending has gone up due to demographics changes and an overall lack of personal responsibility for one's own health (i.e. obesity esp. in children).

 

[CheGuevaraMD]

Here's a newsflash to you. Without health, you can't have those other things. Healthcare spending has gone up due to demographics changes and an overall lack of personal responsibility for one's own health (i.e. obesity esp. in children).

You seem to be the like bullies in the military-industrial complex who wail that a drop in defense spending will mean certain doom for America. Yeah, right.

Same with healthcare spending. A significant reduction in spending over 20-30 years will NOT lead to certain doom, only less money in your pocket. Boo hoo.
A culture that is more obsessed with spending money on self-inflicted illnesses and the very old rather than enriching the human spirit (via science, art, community, etc.) is certainly a doomed one.

 

[Psai]

You might say you want to spend less on healthcare but then gramps has another heart attack and presents with a PMH of MI s/p CABG and aortic valve replacement while suffering from poorly controlled DM2, hyperlipidemia, obesity, etc. Then when the doctors are unable to save him, you sue them for all they're worth.

 

[DermViser]

You seem to be the like bullies in the military-industrial complex who wail that a drop in defense spending will mean certain doom for America. Yeah, right.

Same with healthcare spending. A significant reduction in spending over 20-30 years will NOT lead to certain doom, only less money in your pocket. Boo hoo.
A culture that is more obsessed with spending money on self-inflicted illnesses and the very old rather than enriching the human spirit (via science, art, community, etc.) is certainly a doomed one.

Yeah, you definitely sound like a communist. And apparently, you and Dr. Emanuel are very much in favor of withholding care from the elderly. Bravo.

 

[DermViser]

You might say you want to spend less on healthcare but then gramps has another heart attack and presents with a PMH of MI s/p CABG and aortic valve replacement while suffering from poorly controlled DM2, hyperlipidemia, obesity, etc. Then when the doctors are unable to save him, you sue them for all they're worth.

But in Che Guevara's world, withholding care from the elderly is perfectly ok. It's for the good of the collective, after all.

 

[CheGuevaraMD]

The elderly can still receive additional care if they have the private means to procure it. We're talking about public money here. ANY nation is foolish to investment more in the elderly than in the young.

 

[CheGuevaraMD]

You might say you want to spend less on healthcare but then gramps has another heart attack and presents with a PMH of MI s/p CABG and aortic valve replacement while suffering from poorly controlled DM2, hyperlipidemia, obesity, etc. Then when the doctors are unable to save him, you sue them for all they're worth.

My grandpa is not a self-entitled American, and would die honorably. Also, my family is not petty enough to sue physicians for the normal process of life.

 

[DermViser]

The elderly can still receive additional care if they have the private means to procure it. We're talking about public money here. ANY nation is foolish to investment more in the elderly than in the young.

I would say what I really feel but you're not worth a TOS violation.

 

[CheGuevaraMD]

I would say what I really feel but you're not worth a TOS violation.

So you're just going to shout at the wind and grumble? What is the end-game here? What is your solution?

 

[Spinach Dip]

The elderly can still receive additional care if they have the private means to procure it.

Trolling: A+
Subtlety: B-

 

[DermViser]

So you're just going to shout at the wind and grumble? What is the end-game here? What is your solution?

Your solution is to withhold treatment for the elderly for a supposed benefit to the collective: that makes you very callous (and I am being very mild in my words here, trust me, so as to not get a TOS violation).

 

[CheGuevaraMD]

Your solution is to withhold treatment for the elderly to benefit the collective: that makes you very callous (and I am being very mild in my words here, trust me, so as to not get a TOS violation).

Okay, I think it's very callous to poorly fund science and deprive future generations of a better quality of life. This goes both ways. Every working American pays payroll taxes that fund Medicare. Only a select few old, sick people eat up most of the funds. You profit from this setup. Who's callous now?

Anyway, the Medicare cost growth has to come down. Everyone on both sides of the aisle agrees on that. It doesn't really matter what you think.

 

[DermViser]

Okay, I think it's very callous to poorly fund science and deprive future generations of a better quality of life. This goes both ways. Every working American pays payroll taxes that fund Medicare. Only a select few old, sick people eat up most of the funds. You profit from this setup. Who's callous now?

Anyway, the Medicare cost growth has to come down. Everyone on both sides of the aisle agrees on that. It doesn't really matter what you think.

A society that treats the elderly and disabled as those to be disposed of with no regards to their health as if their life is somehow less important, is deeply depraved.

 

[CheGuevaraMD]

A society that treats the elderly and disabled as those to be disposed of with no regards to their health as if their life is somehow less important, is deeply depraved.

Everything is about balance. Spending 20% of GDP, more than twice the average for industrialized countries, is out-of-balance. Full stop.

 

[CheGuevaraMD]

Also anyone contends that we should spend unlimited resources on extending life for a limited number of individuals is crazy, in my opinion.

 

[bronx43]

LOL at this argument and at Dermviser calling CheGuevaraMD a communist. Bro, do you even know what socialism is and what socialized medicine is? He's arguing that the elderly should only receive care if they have the means to pay for it directly. In what world is that socialism? You are the one claiming that the elderly and poor should receive care no matter what, which means it is paid for by others. If anything, YOU are the socialist and he's a Libertarian who calls for free market health care.

From reading Che's arguments in this thread, I think that his position is cost containment as first priority...whether you do it through central planning via consolidation of hospitals and eventual single payer OR through free market health care which leads to self-containment of cost. I honestly agree with this position, and add that I prefer the former over the latter so that there is universal access. Whichever you pick, our current system is not sustainable by any means.

 

[Spinach Dip]

 

[BLADEMDA]

I'm all for a voucher program like Paul Ryan has proposed in the past or the elderly can stay in the current program which will restrict access to care in order to hold down costs.

Either way the socialists want to claim they are for the elderly and the poor while screwing them out of the expensive quality of life procedures. I've nerve seen such hypocrisy but the general population is too ignorant to see it.

 

[CheGuevaraMD]

LOL at this argument and at Dermviser calling CheGuevaraMD a communist. Bro, do you even know what socialism is and what socialized medicine is? He's arguing that the elderly should only receive care if they have the means to pay for it directly. In what world is that socialism? You are the one claiming that the elderly and poor should receive care no matter what, which means it is paid for by others. If anything, YOU are the socialist and he's a Libertarian who calls for free market health care.

From reading Che's arguments in this thread, I think that his position is cost containment as first priority...whether you do it through central planning via consolidation of hospitals and eventual single payer OR through free market health care which leads to self-containment of cost. I honestly agree with this position, and add that I prefer the former over the latter so that there is universal access. Whichever you pick, our current system is not sustainable by any means.

Yeah, I'm basically for cost containment. I think single-payer capitation may happen in the far future, but now Medicare seems to only be inching towards this with mandatory quality incentive programs like ACOs, bundled payments, etc. The honest truth here is the global budgeting/capitation WORKS. This is what the NHS does in the UK does and their healthcare system works fine. People hate HMOs, but they work.

Everyone in this thread demanding that unlimited amounts of money be spent on healthcare for the very sickest is basically a crazy Calvinist who is so afraid of death/potential lack of salvation that they want to hold on to life at any cost. Life ends, nature is unfair sometimes, get over it. Also lol at the guy who compared cost containment to Action T4. Grow up.

 

[DermViser]

LOL at this argument and at Dermviser calling CheGuevaraMD a communist. Bro, do you even know what socialism is and what socialized medicine is? He's arguing that the elderly should only receive care if they have the means to pay for it directly. In what world is that socialism? You are the one claiming that the elderly and poor should receive care no matter what, which means it is paid for by others. If anything, YOU are the socialist and he's a Libertarian who calls for free market health care.

From reading Che's arguments in this thread, I think that his position is cost containment as first priority...whether you do it through central planning via consolidation of hospitals and eventual single payer OR through free market health care which leads to self-containment of cost. I honestly agree with this position, and add that I prefer the former over the latter so that there is universal access. Whichever you pick, our current system is not sustainable by any means.

You obviously don't know why Medicare came to pass. An entire segment of our population was given a promise that Medicare would be for them, which they PAY INTO THEIR ENTIRE LIVES. The promise was made that Medicare would be there for them, at the time they are MOST VULNERABLE.
There are certain segments of the population who are vulnerable and shouldn't have their care cut, just bc you believe their lives are not "worth" it, i.e. the elderly, the disabled - both young and old, and children.

 

[DermViser]

Yeah, I'm basically for cost containment. I think single-payer capitation may happen in the far future, but now Medicare seems to only be inching towards this with mandatory quality incentive programs like ACOs, bundled payments, etc. The honest truth here is the global budgeting/capitation WORKS. This is what the NHS does in the UK does and their healthcare system works fine. People hate HMOs, but they work.

Everyone in this thread demanding that unlimited amounts of money be spent on healthcare for the very sickest is basically a crazy Calvinist who is so afraid of death/potential lack of salvation that they want to hold on to life at any cost. Life ends, nature is unfair sometimes, get over it. Also lol at the guy who compared cost containment to Action T4. Grow up.

Try again, liar: http://www.dailymail.co.uk/news/art...r-plan-deny-treatment-youve-fair-innings.html

 

[DermViser]

That's pretty par for the course for @CheGuevaraMD .

 

[bronx43]

You obviously don't know why Medicare came to pass. An entire segment of our population was given a promise that Medicare would be for them, which they PAY INTO THEIR ENTIRE LIVES. The promise was made that Medicare would be there for them, at the time they are MOST VULNERABLE.
There are certain segments of the population who are vulnerable and shouldn't have their care cut, just bc you believe their lives are not "worth" it, i.e. the elderly, the disabled - both young and old, and children.

Lol, thank you for that. I know the origins of Medicare, but I enjoyed your explanation.

How is this even a response to my post, and what is your argument?

 

[CheGuevaraMD]

AHHH EVERYTHING THAT DOESN'T INVOLVE GIVING ME UNLIMITED MONEY FOR CLINICAL CARE IS ACTION T4! I AM LITERALLY AN INSANE PERSON!!!!!

 

[DermViser]

Lol, thank you for that. I know the origins of Medicare, but I enjoyed your explanation.

How is this even a response to my post, and what is your argument?

Yeah, he's so "free market" that he wants single-payer healthcare. You're a genius.

 

[CheGuevaraMD]

Yeah, he's so "free market" that he wants single-payer healthcare. You're a genius.

In a discussion about Medicare costs and care for old people, we are already discussing a single payer system.

 

[DermViser]

AHHH EVERYTHING THAT DOESN'T INVOLVE GIVING ME UNLIMITED MONEY FOR CLINICAL CARE IS ACTION T4! I AM LITERALLY AN INSANE PERSON!!!!!

No, just unbelievably heartless.
Wait, never mind, that's par for the course for a communist.

 

[bronx43]

Yeah, he's so "free market" that he wants single-payer healthcare. You're a genius.

Did you even read posts that you respond to? Or do you simply enjoy typing non-sequiturs?

 

[Dwindlin]

Yeah, he's so "free market" that he wants single-payer healthcare. You're a genius.

Your reading comprehension needs some work. He's for cost containment, mechanism is a secondary concern, and likely could be accomplished by several methods.

 

[Dwindlin]

No, just unbelievably heartless.
Wait, never mind, that's par for the course for a communist.

Seriously. You keep calling him a communist, when you are the one espousing collectivist ideology.

 

[bronx43]

Yeah... someone should close this thread. It has descended into total idiocy thanks to one specific poster.