job prospects in 10 years

[ThinkFast007]

just dont react to any of Nurse Nitecaps posts and eventually he'll shut up.

I think in previous posts there was something like CRNAs will only help increase Anesthesiologists revenue

Yah no idea where I heard that.

the reason in the 90's etc these CRNAs were needed was because there were very few ppl interested in going into Anesthesiology. However, clearly as the NRMP data has showed, Anesthesiology and other 'lifestyle' specialties have increased interest now. One way to prevent CRNAs from gaining ground is to increase the number of anesthesiology residencies (which will solve the reason why we needed CRNAs to begin with). THere are definitely enough applicants nowadays.

Again, ppl will say well we need the CRNAs to increase revenue. once again, not true. I think it was in teh above post where I said this. All we need is physicians to be UNITED, then we can demand and will have the leverage to negotiate better reimbursments from manged care and in turn from hospitals. Guys, it's just business strategy. These hospital paper pushers and medicare/HMOs know that docs dont aggregate and so they PREY on us. What we need is vocal anesthesiologists that can lead, and that know the business, then we can leverage better reimbursements. PERIOD.

I just wish i could post more freely on here...but now that we all know nurse nitecaps true intent (about learning how we think so that he can try to dismiss our ideas) i'm more reluctant to post on here. his strategy is pretty good...just divide and conquer all the anesthesiologists. let them fight against each other. it's nice to know that we have written proof of his mal intent now.

there is a 'private forum' and like i said, just PM me and you can get in it

---

Members don't see this ad.

 

[toughlife]

I just Tivo'd Nurse Nitecap's post.

But going back to ToughLife's post. I think he makes an EXCELLENT post. Folks, what he stated about our profession is what this boils down to. We 'newbies' must come together on this issue. Take pride in the job and be good at it. All in all, we need to stop being lazy.

If we are solid and have our knowledge base down, AND have informed individuals assuming the role of negotiating on our behalf over at the ASA and ASAPC, our profession will continue to thrive. As long as managed care exists, the paper pushers will always want to find 'cheaper' labor to replace us. However, if the ASAPAC and ASA and of course us, stand together on this issue we can have enough leverage to control what goes on in hospitals. Managed care has definitely pushed the envelope and continues to do so, again...just look at what happened to primary care docs. We could be next.

Do you guys know what managed care hates? It hates unified physicians. They know docs dont congregate and that's why they prey on us. In fact, HMOs and other managed care orgs hate multispecialty groups because they usually contain MANY doctors.

I think a united front, with active ad campaigns,etc is what we need.

See my other thread on this forum about joining the ASAPAC and the resident component of the ASA.

I totally agree. A united front along with a superb, razor-sharp ASA leadership can do wonders for the specialty. I think the fact that physicians are usually high-achievers and individualistic hurts medicine as a whole. Instead of competing with each other we need to be trying to figure out how to fight managed care, bean counters, etc. As with anything, the power is in the numbers.

 

[nitecap]

just dont react to any of Nurse Nitecaps posts and eventually he'll shut up.

I think in previous posts there was something like CRNAs will only help increase Anesthesiologists revenue

Yah no idea where I heard that.

the reason in the 90's etc these CRNAs were needed was because there were very few ppl interested in going into Anesthesiology. However, clearly as the NRMP data has showed, Anesthesiology and other 'lifestyle' specialties have increased interest now. One way to prevent CRNAs from gaining ground is to increase the number of anesthesiology residencies (which will solve the reason why we needed CRNAs to begin with). THere are definitely enough applicants nowadays.

Again, ppl will say well we need the CRNAs to increase revenue. once again, not true. I think it was in teh above post where I said this. All we need is physicians to be UNITED, then we can demand and will have the leverage to negotiate better reimbursments from manged care and in turn from hospitals. Guys, it's just business strategy. These hospital paper pushers and medicare/HMOs know that docs dont aggregate and so they PREY on us. What we need is vocal anesthesiologists that can lead, and that know the business, then we can leverage better reimbursements. PERIOD.

There we have it.
Spoken from someone that has no clue folks.

 

[drRumi]

dude...honestly as a mere lowly 3rd year med student....i have no idea WTF is going and who is telling the truth (as far as this MD vs. CRNA issue is concerened). somebody plz just tell me if im gonna have a fcking job in 10 years that pays well enough to do the shiat i want to do? its really all that simple. i have no idea what the real life situation of the MDs and CRNAs are, but i sure as hell hope its not this combative. these arguments blow. mil and jet, do u guys go thru this shiat everyday at work? seriously...

 

[ThinkFast007]

ok Jet will tell ya, he's got a 'team approach' (not ridiculing) and everything is kosher at his joint. Might be the case at HIS practice. Will it change? Especially if docs dont step up to the plate? May i suggest asking around to attendings at your institution,et al. Get 'second opinions'.

Check out the ASA newsletter dude. You are a MS3? I refer you to joining the ASA. It's like $5 and all u need is ur chair's signature. you will get the Journal of Anesthesiology and the Newsletter FREE every month.

Anywyas, i think you can still view the newsletter part if ur not a member. On there this 'growing threat' of CRNAs and their AANA is alluded to. But dont worry kido, we got your back.

This new breed of anesthesiologists that ppl are talking about on here...well we're very PROACTIVE and will become political. That way both YOu and I will have well paying, patient satisfying, fun jobs.

 

[ThinkFast007]

...
Why do you think I freq these forums man. To find out your game plans, mentality, and weaknesses. Its all about knowing your competition better than you know your inlaws, understanding how they think so you can expect their every move. Dont hate the player man, hate the game. This thread shouldnt get closed unless peeps start cursing each other. A good debate has closed very few threads as long as it doesnt get out of hand. Can you guys handle that?

I just wanted to bring back nitecap's earlier post on this thread, especially for those of you just entering the conversation so you dont think we are 'unnecessarily' attacking nitecap or anything.

Clearly, his statement shows his true colors and true intent. Once again, this is a blatant example of why we, docs and to be docs, need to be united.

Join the ASAPAC and ASA; become an advocate against this nonsense!

P.S. To all you docs and to be docs, please do not swear in this thread (i'm keeping it back too) so that we can actually keep this thread alive.

 

[djipopo]

dude...honestly as a mere lowly 3rd year med student....i have no idea WTF is going and who is telling the truth (as far as this MD vs. CRNA issue is concerened). somebody plz just tell me if im gonna have a fcking job in 10 years that pays well enough to do the shiat i want to do? its really all that simple. i have no idea what the real life situation of the MDs and CRNAs are, but i sure as hell hope its not this combative. these arguments blow. mil and jet, do u guys go thru this shiat everyday at work? seriously...

Dude, unfortunately none of us have a crystal ball to pop out and ask your question to...

The reason that this thread has evolved as it has is because these are the issues that you will have to deal with in 10 years if things keep going as they are (that is, if you do enter the field). The market still appears to be ripe for anesthesiologists but we have midlevels who are intent on taking over and increasing their stronghold, as evidenced by nitecap's statements above. I'm sure he's not the only nurse who feels that way.

The turf battle between midlevels and MD/DO's is brewing in all specialties but particularly in Anesthesiology so it's probably a good idea to read these types of threads and educate yourself before someone else cuts your paycheck, or worse, takes your job.

 

[toughlife]

how Nitecap really feels, I hope folks like JPP, MilitaryMD, oldmandave and company realize that we were right all along about CRNAs (examplified by nitecap) wanting to really take over.

So there you have it folks. And don't say, "Oh he is just a paraprofessional and militant". Think about how many of them feel that way.

So yes we newbies maybe naive, untrained, "green" in the business, but we are not stupid.


Peace out

 

[jetproppilot]

ok Jet will tell ya, he's got a 'team approach' (not ridiculing) and everything is kosher at his joint. Might be the case at HIS practice. Will it change? Especially if docs dont step up to the plate? May i suggest asking around to attendings at your institution,et al. Get 'second opinions'.

.

Great advice Think, but may I add one modifier....dont ask academic attendings because most of them are very sheltered from the private practice realm. They'll give you an opinion from an academic standpoint.

Ask some private attendings how they feel about their job and what they think the next ten years holds.

I'll withhold my opinion since I've posted it many times. If youre that interested, search my posts.

And in reference to a previous post who asked if the MD/CRNA thing is "that combative" out here, well, like I've said before, it is not.

We all come to work, do the cases in a collective fashion, then go home.

And like I said before, this SAME EXACT subject was alive and well when I emerged from training in 1996, to the point of many of us traveling to Baton Rouge more than once to lobby for ourselves.

 

[cfdavid]

Think about our society right now. Extremely litigious. You have one hospital move to all CRNAs, and an adverse outcome occurs. Whether it was the CRNA's fault or not, the family is going to sue purely for the fact that an anesthesiologist was not available at that hospital when there are plenty of them to be hired around town. With a typical "bleeding heart" jury, they will win as well. This is not arguing whether it is right or wrong, just a reality check on how our jobs will always be safe. It does not matter to a jury of lay people what statistics show. A hospital won't take that kind of liability. Can you imagine the settlements a hospital would pay out for morbidity/mortality from a PA acting alone without physician oversight in an ER?? Even if it was only acute care, you might as well start adding zero's after that first digit.

In a sense we have moved from the "practice" of medicine to the "business" of medicine. For hospitals to proctect the bottom line, they NEED anesthesiologists around.

Interesting point.

 

[toughlife]

Great advice Think, but may I add one modifier....dont ask academic attendings because most of them are very sheltered from the private practice realm. They'll give you an opinion from an academic standpoint.

Ask some private attendings how they feel about their job and what they think the next ten years holds.

I'll withhold my opinion since I've posted it many times. If youre that interested, search my posts.

And in reference to a previous post who asked if the MD/CRNA thing is "that combative" out here, well, like I've said before, it is not.

We all come to work, do the cases in a collective fashion, then go home.

And like I said before, this SAME EXACT subject was alive and well when I emerged from training in 1996, to the point of many of us traveling to Baton Rouge more than once to lobby for ourselves.

How many nurse anesthetists were there in '96 vs. today?

 

[cfdavid]

I was asked to post something that I PM'd one of the other guys. So, here goes.

Coming to medicine from the business world, where I worked in sales for 9 years, one thing was always certain; change.
We were constantly thinking about how we could realign our company and reinvent our value proposition to our customers. It sounds like business school jargon, but it's important to do that.

Doctors are good at many things, but oftentimes they/we don't do very well at marketing our skills and assets. Afterall, we're too busy learning the sciences and studying disease processes.

ANY successful organization must constantly strive to maximize value to their customers. From an anesthesiologist's perspective, let's consider our customers the patients and surgeons. Also, hospital administrators are big decision makers, obviously.

But doctors tend to be complacent and, frankly, arrogant in thinking that market dynamics (and how to successfully deal with them) somehow don't apply to medicine. After all, we're too busy saving lives to worry about that nonsense...... But this mentality WILL hurt us in the long run. Because the truth is that we're just as subject to constantly changing market conditions as is the IT guy that has to justify his existence to those that control budgets.

So, how do we do this? It's important to keep in mind that to advertise the value that an MD/DO anesthesiologist brings to their customers is NOT the same thing as criticizing anyone else. In fact, it could even backfire, because mid-levels do play an important role in healthcare. They're not going away, and it's important that we, as professionals, learn to deal with them.

However, there's nothing wrong with advertising the unique strengths that MD/DO anesthesiologist bring to the table. Hell, I'm just a soon-to-be MS1, so I can't rattle of all of those things. But, those of you in practice sure could.

**A critical mistake in business is the arrogant assumption that an organization's customers automatically understand the value that their "suppliers" bring to the table. Yes, even surgeons, our MD/DO colleagues, may not be fully conscious of what, specific, value an MD/DO anesthesiologist brings to the table. So, perhaps a "friendly reminder" campaign could be directed at that specific customer (surgeons) that reminds them of everything that an MD/DO offers them.

It's important to target the campaign at the customer. So, the ASA could advertise the safety and liability limiting aspects of the anesthesiologist, and the other services that the hospital benefits from (revenue wise) as a result of their staff MD/DO anesthesiologists.

As for the public, another, different, campaign could be initiated that simply educate them of the amount of training that an MD/DO goes through in order to become the professional anesthesiologists that they are. We want the public to be conscious of our skills and how that relates to their concerns w/r/t surgery etc.

None of these campaigns would even mention the market forces that perhaps could (and are) work against us. But, we must educate our customers so that they KNOW what we bring to the table. And every customer has their own set of concerns. So, it's critical to cater the approach to those specific concerns.

It's not scare tactics or muck-rucking, but simply good advocating on behalf of our interests. And it's good business sense.

***Disclaimer: I keep saying "we", but you know what I mean. lol

 

[cfdavid]

One more thing. The above "strategy" is not something that should only be done reactively (when times are bad). It should happen constantly, relentlessly, and proactively.

Also, it's WAY more effective to educate the customer on why he should prefer your services or product, rather than telling him why he shouldn't use the competition.

 

[ThinkFast007]

I was asked to post something that I PM'd one of the other guys. So, here goes.

Coming to medicine from the business world, where I worked in sales for 9 years, one thing was always certain; change.
We were constantly thinking about how we could realign our company and reinvent our value proposition to our customers. It sounds like business school jargon, but it's important to do that.

Doctors are good at many things, but oftentimes they/we don't do very well at marketing our skills and assets. Afterall, we're too busy learning the sciences and studying disease processes.

ANY successful organization must constantly strive to maximize value to their customers. From an anesthesiologist's perspective, let's consider our customers the patients and surgeons. Also, hospital administrators are big decision makers, obviously.

But doctors tend to be complacent and, frankly, arrogant in thinking that market dynamics (and how to successfully deal with them) somehow don't apply to medicine. After all, we're too busy saving lives to worry about that nonsense...... But this mentality WILL hurt us in the long run. Because the truth is that we're just as subject to constantly changing market conditions as is the IT guy that has to justify his existence to those that control budgets.

So, how do we do this? It's important to keep in mind that to advertise the value that an MD/DO anesthesiologist brings to their customers is NOT the same thing as criticizing anyone else. In fact, it could even backfire, because mid-levels do play an important role in healthcare. They're not going away, and it's important that we, as professionals, learn to deal with them.

However, there's nothing wrong with advertising the unique strengths that MD/DO anesthesiologist bring to the table. Hell, I'm just a soon-to-be MS1, so I can't rattle of all of those things. But, those of you in practice sure could.

**A critical mistake in business is the arrogant assumption that an organization's customers automatically understand the value that their "suppliers" bring to the table. Yes, even surgeons, our MD/DO colleagues, may not be fully conscious of what, specific, value an MD/DO anesthesiologist brings to the table. So, perhaps a "friendly reminder" campaign could be directed at that specific customer (surgeons) that reminds them of everything that an MD/DO offers them.
.......lol

Thanks Cfdavid. I think your post elucidates the importance of a positive campaign/advertising on behalf of the Anesthesiologist. It's just makes sense, and good business sense. Although we are talking about patient care, it still makes logical sense to 'remind' our customers of the positive attributes of Anesthesiologists. It's not spin doctoring, cuz we are talking the truth afterall.

CFdavid, I think we just found the director of marketing for the ASA

 

[ThinkFast007]

.....
And like I said before, this SAME EXACT subject was alive and well when I emerged from training in 1996, to the point of many of us traveling to Baton Rouge more than once to lobby for ourselves.

I can respectfully appreciate what you have said above.

The fact of the matter though is, and I'm quoting here from a managed care textbook, " ....Druing the 1980's the number of HMOs more than doubled and enrollment increased 400 percent, from 9 million in 1980 to 36 million in 1985. It reached 51 million in 1994, and is expected to surpase 100 million by 2000". I'll give you the source if you PM me.

At any rate, Jet, the issue that has changed now is managed care is increasingly prevalent. Contracts as you know are negotiated upon cost/benefit analysis and cost-effectiveness analysis just ot mention a few. Times have changed. A primary care doc cant just hang a shingle up anymore and expect to have pts waiting in line. As stated above, the only way physicians can increase leverage is by politics and by increasing their own leverage via numbers. The nurses have learned that and have gotten as far as they did politically because of that.

I'm not sure if you read the ASA newletter, but check it out. If it wasnt for the activisim by certain members of the ASA, the SGR provision wouldnt have been intact any longer.

As ToughLife pointed out. THe difference b/w docs and say business ppl, is that we are too individualistic. If we use a collaborative approach to negotiate contracts, etc physicians would be much better off in the future.

I know you the daddy-o of Anesthesiology, but hey gramps , stuff is really changing. CRNAs have increased in size and when hospitals see what can mk their bottom line better...they'll shift over to using them...unless of course we prevent that.

I'm just happy to be receiving all the PMs I have soo far, requesting more information about joining a 'private forum'. I think it's great that more docs to be like everyone reading these posts are becoming MORE involved. I hope that everyone becomes involved and our presence is seen with much more unity when we all negotiate at the table.

Respectfully,

Thinkfast007

 

[MacGyver]

I have NEVER said that MDAs will get shut out of jobs that CRNAs take instead

HOWEVER, over the long term WAGE SUPPRESSION IS GUARANTEED if CRNAs continue to accumulate political wins and scope of practice expansions.

If somehthing doesnt change soon, I envision a future 20 years from now when CRNAs and MDAs both make the same amount of money and compete for the same jobs. CRNAs would gladly work for 100k per year. What other nursing field AVERAGES 100k per year? They would gladly take that because they have no other options.

The consequences for MDAs would be disastrous. The number of med students matching would plummet overnight.

So yes, MDAs will always ahve jobs available to them, the real question is what will the going wage be?

 

[jetproppilot]

I was asked to post something that I PM'd one of the other guys. So, here goes.

Coming to medicine from the business world, where I worked in sales for 9 years, one thing was always certain; change.
We were constantly thinking about how we could realign our company and reinvent our value proposition to our customers. It sounds like business school jargon, but it's important to do that.

Doctors are good at many things, but oftentimes they/we don't do very well at marketing our skills and assets. Afterall, we're too busy learning the sciences and studying disease processes.

ANY successful organization must constantly strive to maximize value to their customers. From an anesthesiologist's perspective, let's consider our customers the patients and surgeons. Also, hospital administrators are big decision makers, obviously.

But doctors tend to be complacent and, frankly, arrogant in thinking that market dynamics (and how to successfully deal with them) somehow don't apply to medicine. After all, we're too busy saving lives to worry about that nonsense...... But this mentality WILL hurt us in the long run. Because the truth is that we're just as subject to constantly changing market conditions as is the IT guy that has to justify his existence to those that control budgets.

So, how do we do this? It's important to keep in mind that to advertise the value that an MD/DO anesthesiologist brings to their customers is NOT the same thing as criticizing anyone else. In fact, it could even backfire, because mid-levels do play an important role in healthcare. They're not going away, and it's important that we, as professionals, learn to deal with them.

However, there's nothing wrong with advertising the unique strengths that MD/DO anesthesiologist bring to the table. Hell, I'm just a soon-to-be MS1, so I can't rattle of all of those things. But, those of you in practice sure could.

**A critical mistake in business is the arrogant assumption that an organization's customers automatically understand the value that their "suppliers" bring to the table. Yes, even surgeons, our MD/DO colleagues, may not be fully conscious of what, specific, value an MD/DO anesthesiologist brings to the table. So, perhaps a "friendly reminder" campaign could be directed at that specific customer (surgeons) that reminds them of everything that an MD/DO offers them.

It's important to target the campaign at the customer. So, the ASA could advertise the safety and liability limiting aspects of the anesthesiologist, and the other services that the hospital benefits from (revenue wise) as a result of their staff MD/DO anesthesiologists.

As for the public, another, different, campaign could be initiated that simply educate them of the amount of training that an MD/DO goes through in order to become the professional anesthesiologists that they are. We want the public to be conscious of our skills and how that relates to their concerns w/r/t surgery etc.

None of these campaigns would even mention the market forces that perhaps could (and are) work against us. But, we must educate our customers so that they KNOW what we bring to the table. And every customer has their own set of concerns. So, it's critical to cater the approach to those specific concerns.

It's not scare tactics or muck-rucking, but simply good advocating on behalf of our interests. And it's good business sense.

***Disclaimer: I keep saying "we", but you know what I mean. lol

I dont disagree with any of what you posted, nor am I naive to the encroachment on MDs by non-physicians in MANY fields. I am very aware of it.

I also agree with all of you that being proactive for our specialty on the political level is important.

And I'm not trying to convince anyone of anything....I have an opinion, just like everyone else....just so happens I'm one of several attendings that share experiences/opinions on SDN.

After having said all that, I maintain my opinion on this subject. Not out of naietivity (sic?) but out of experience.

Just like you, I dont have a crystal ball.


Will our job scopes change? Maybe.

But like I've always said, with rare exception (there are exceptions. they are rare.) surgeons want anesthesiologists. Can they have them all the time? No. Would they have them if they were available? Yes.

Anesthesiologists will remain the czars of anesthesia. Yes, change is possible. Proactivity is good/necessary.

But no such Crna-takeover exists.

 

[jetproppilot]

how Nitecap really feels, I hope folks like JPP, MilitaryMD, oldmandave and company realize that we were right all along about CRNAs (examplified by nitecap) wanting to really take over.

So there you have it folks. And don't say, "Oh he is just a paraprofessional and militant". Think about how many of them feel that way.

So yes we newbies maybe naive, untrained, "green" in the business, but we are not stupid.


Peace out

Never have thought of you guys as stupid.

 

[nitecap]

Explain to me how MD reimburstments will go down with CRNA reimburstment wont. Under Medicare part B Anesthesiologist and CRNA's are reimbursted near equal for many procedures. SO how with MD salaries drop and CRNA salaries not.

There is much talk in our community that salaries overall will fall from the higher levels they have been at recently. Also prediction that in the next 20 yrs that supply and demand will even out, salaries drop which will result in less students entering the field and less programs opening and more closing. In other words the Market will determine salaries, jobs, and demand despite cuts in reimburstments which all healthcare workes can expect without a doubt. As the ACT continues to dominate salaries will stay reasonable however. Hey though its nice to be in such high demand as in all fields when you are pumping out more product than you have in decades eventually supply will = demand and the attractiveness of job offers will decrease.

 

[anest2005]

All this talk is really, really pissing me off. This is a debate being conducted on a online message board by medical students vs. CRNA students. None (well maybe a few) of you honestly have any clue what it is like in the real world. Why? Because thos of us in our mid to late 30's (or beyond) have already gone through residency. We have husbands/wives/children/houses. We don't really have time to "chat online" or debate the same issues that we have debated 100 times already. It gets very old...very fast. People were saying the EXACT same thing when I was applying in the early 90's. I went to Penn for anesthesia, got an amazing job, and have been loving my life ever since. Every year this debate seems to be perpetuated by the next group of medical students/CRNA students. In private practice we all get along - beautifully. We work as a team - just like the PAs who heavily support the surgeons at the private medical center where I work. Everyone is critical, and vital to providing great patient care. So stop with stupid threads that degrade into a doomsday argument. Get over it. There are MORE than enough jobs out there for everyone. And, in the next 10 years there will almost certainly be a shortage of anesthesia providers. I'm making $400,000/yr. Will I always earn this income? No. Logically it doesn't make sense. I'm earning more than the surgeons...a lot more than some of them. I don't have the overhead of an office, rent, utilities, nurses, managers. I LOVE what I do on a daily basis. Will I always earn this much money? No. Probably not. Physician salaries are falling across the board. Anethesia will almost certainly see future pay cuts - like every other medical field.

Sure, I certainly support proactive physicians who lobby the government, and would love that the ASA have a stronger voice. Almost certainly salaries will fall (or at least remain stagnant - i.e. a fall in the real wage when accounted for inflation) over the next 10-15 years.

But here ARE the questions that you must ask yourself. The same questionS that I asked myself > 10 years ago. There will ALWAYS be jobs for anesthesiologists in this country. Yes, the average income may fall (there truly is no reason why I should make so much money right now). But, here is the question...

1. DO YOU LOVE THE FIELD? (If so, procede to question #2. If not, find a different medical career).

2. WOULD YOU BE WILLING TO DO ANESTHESIA FOR $300,000/YR, $200,000/YR, $150,OOO/YR?

In reference to #2... I LOVE my job. I enjoy getting up every day and going to work. My father worked 75 hours a week (2 blue collar jobs) while I grew up. He busted his ass every day, and hated his jobs. He did it for us. Like I said above, I LOVE anesthesia. Truly I do. I would be willing to work for substantially less, and still have no regrets. If tomorrow my salary fell to $150,000 (which, by the way is the salary of the CRNAs in my practice) I would still get up every day and be happy. That is a heck of a lot of money for my 40 hr/week, no weekends, 4 weeks of vacation a year, job. That's more than my parents ever earned, working twice as hard.

And, even if my income dropped that much overnight I would still love my job, and never regret my decision to go into anesthesia. Every day I am happier and happier that I went into anesthesia. Not to disparage other fields, but the surgeons I work with (and obviously I work with quite a few), in general are disappointed with how their careers have ended up. They work far longer hours, have patients in the hospital (meaning no weekends off, unless someone covers for them), and must suffer through clinic. They bill more for a 3 hour lap colectomy than I do, but in the end most of them make only $200-$250K since they have so much overhead (office rent, utilities, staff...etc). Last year I took off 6 months when our first child was born. Sure, I didn't earn any income those months, but I didn't lose any income either. A surgeon needs to have a constant supply of income, as their stream of expenses is constant as well. They can't just take off 6 months and not expect that their office rent won't be due, and can't tell their front desk manager to come back in 6 months without paying him/her for that lost time.

Many (not to overgeneralize) of the surgeons I work with no longer find fulfillment in their jobs. They (like every medical field) are finding reimbursements falling (a lap chole, which takes about an hour or less, once reimbursed $2000, not it's around $800 for medicare). Many are divorced, and trust me, very few enjoy their lives quite as much as me. I love work, but equally I love going home and not worrying that I'll get called into the hospital by some family wanting to speak with me.

I make great money. But, I would be willing to do my job for far less, because I love what I do. I love anesthesia, and always will. If you feel the same, then these stupid debates become meaningless. Sorry for the long post, but this is reality. I'll come back in 6 months, a year, 5 years and find people STILL debating the same thing.

-Anest2005

 

[drRumi]

I have NEVER said that MDAs will get shut out of jobs that CRNAs take instead

HOWEVER, over the long term WAGE SUPPRESSION IS GUARANTEED if CRNAs continue to accumulate political wins and scope of practice expansions.

If somehthing doesnt change soon, I envision a future 20 years from now when CRNAs and MDAs both make the same amount of money and compete for the same jobs. CRNAs would gladly work for 100k per year. What other nursing field AVERAGES 100k per year? They would gladly take that because they have no other options.

The consequences for MDAs would be disastrous. The number of med students matching would plummet overnight.

So yes, MDAs will always ahve jobs available to them, the real question is what will the going wage be?

so who's gonna train these CRNAs if the MDs get driven out? which brings me to my next question: If the MDs feel threatened by the CRNAs biting at our ankles, why are we continuing to train these trolls? my understanding is, and it might be completely wrong, that MDs are providing the training for CRNAs? am i wrong?

 

[stephend7799]

I dont disagree with any of what you posted, nor am I naive to the encroachment on MDs by non-physicians in MANY fields. I am very aware of it.

I also agree with all of you that being proactive for our specialty on the political level is important.

And I'm not trying to convince anyone of anything....I have an opinion, just like everyone else....just so happens I'm one of several attendings that share experiences/opinions on SDN.

After having said all that, I maintain my opinion on this subject. Not out of naietivity (sic?) but out of experience.

Just like you, I dont have a crystal ball.


Will our job scopes change? Maybe.

But like I've always said, with rare exception (there are exceptions. they are rare.) surgeons want anesthesiologists. Can they have them all the time? No. Would they have them if they were available? Yes.

Anesthesiologists will remain the czars of anesthesia. Yes, change is possible. Proactivity is good/necessary.

But no such Crna-takeover exists.

what does (sic?) mean in the above paragraph?

 

[drRumi]

All this talk is really, really pissing me off. This is a debate being conducted on a online message board by medical students vs. CRNA students. None (well maybe a few) of you honestly have any clue what it is like in the real world. Why? Because thos of us in our mid to late 30's (or beyond) have already gone through residency.

exactly wtf is your point? a debate between medical students and CRNA students about their possible future professions ...wow, ur right...what an absurd idea. you're absolutely right. we should just shut up and not talk and debate about questions we have about our future until our mid to late 30's (or beyond) and have already gone through residency. genius idea. thanks for you contribution. we're all so sorry that we pissed you off...because apparently you know all this and how dare we try to understand this by discussing it.

 

[nitecap]

MD's are providing some training but CRNA's are as well. It all depends what type of practice that SRNA's clinical site is made up of. If its a Medically directed ACT practice than yes a MD many times may be the one training the SRNA. Though he can bill for the SRNA that he is over. Also many times in ACT practices the SRNA may be trained by both the CRNA or MD. MD may do a little teaching on induction and leave to come back in an hour and teach a little more while during the case the CRNA may be doing teaching as well.

I have tons of SRNA friends that train within ACT private practice groups claiming things are going great. Many times it helps the group out as a whole by providing more clinicians to ease a heavy load, helps with their recruiting of CRNA's with many retaining the very students that they trained for 1.5yrs free of any expenses to the group, also they can bill for the SRNA using a 1MD:2SRNA ratio, another thing it adds is a teaching compenent to MD's that enjoy teaching but dont have the option since they dont work at an academic facility. Most SRNA's claim that all are happy and that many of these groups contrary to your negativities about this are requesting more and more SRNA's since things are working so well. SRNA clinical sites are popping up all over the country in places you wouldnt imagine.

 

[jetproppilot]

what does (sic?) mean in the above paragraph?

It means I didnt know if I spelled naietivity right.

 

[cloud9]

what does (sic?) mean in the above paragraph?

Plagiarized shamelessly from wikipedia:

Sic is a Latin word meaning "thus" or "so", used inside brackets — (sic) or [sic] — to indicate that an unusual (or incorrect) spelling, phrase, or other preceding quoted material is intended to be read or printed exactly as shown and is not a transcription error.

This may be used either to show that an uncommon or archaic usage is reported faithfully (for instance, quoting the U.S. Constitution, "The House of Representatives shall chuse [sic] their Speaker...") or to highlight an error, often for purposes of ridicule or irony (for instance, "Dan Quayle famously changed a student's spelling to 'potatoe' (sic)").

In folk etymology, "sic" is sometimes mistakenly assumed to be an abbreviation of "spelled incorrectly", "spelling is correct", or even "sorry, incorrect".

 

[Pooh & Annie]

My concern isn't necessarily the whole MD vs CRNA thing. What bugs me is that every medical specialty has been smart enough to limit residency programs so that the market won't be flooded. Anesthesiology residencies are no different, and the demand has been great. The demand is so great that CRNAs are in great demand too, which is fine with me, because everyone is sharing the spoils right now. But CRNA schools are producing larger quantities of CRNAs at an alarming rate. Is it that they're willing to sacrifice their salaries for power? Anesthesiologists have been smart enough to increase residency positions MODESTLY to offer more providers for the current demand. It's too bad the CRNA credentialing groups don't follow suit.

 

[nitecap]

A study was done before Sept 11th, 2001 by the AANA concerning the CRNA work force. The study which I cant find at present since the AANA has launched a new website took into account the ages of all CRNA's, factored in predicted retirement ages and the number of graduates entering the profession. The study concluded that the number of practicing CRNA's would decrease over the next 2 decades if the current level of those entering the profession stayed the same since many present CRNA's would reach the retirement age. With an anesthesia provider shortage already evident and demand very high they opened more programs to increase the number of grads entering the work force to at least offset those that will be leaving.

Still CRNA's 30 yo and younger only make up 3% of the entire work force though that number is growing at a rapid rate, while 4% of CRNA are 65yo or greater, 8% 60-64, 15% 55-59, 21% 50-54. These numbers clearly show the rationale for increasing numbers with 48% of the current workforce probrably retiring within the next 15-20yrs.

Sept 11th and the recent Hurricanes have admitting effected this data shown in recent surveys not only of CRNA but of pretty much the entire US workforce. People lost tons of money they were planning to retire on and most saying that their expected dates of retirement will most likely be delayed so they can make up for losses. Factoring these longer retirement expectancys is in the works at present to estimate supply.

The increase in numbers is not all about power as you guys may think though as stated on this very forum strength in numbers doesnt hurt. According to your associate Dr. Grogono you have responded to increased demand as well.

I to worry about a flood of the markey but hey what can I do at my level, not much but sit back and see how it all turns out.

I myself like the increased demand. I have a good while b/f graduation and get weekly calls from recruiters and locum agencies already. One can only pray it keeps up. Also the AANA has little control over whether a program opens up. Yes the programs would have tp meet flawlessly all guidelines and standards set fourth by the Council on Accredidation of Nurse Anesthesia programs but if indeed all those guidelines are met and maintain one can open a program. I myself question this lack of the prof. Org to regulate this directly but was explained that supply and demand has always worked its magic and as demand decreased programs usually end up shutting down or at least dropping numbers.

 

[stephend7799]

Plagiarized shamelessly from wikipedia:

Sic is a Latin word meaning "thus" or "so", used inside brackets — (sic) or [sic] — to indicate that an unusual (or incorrect) spelling, phrase, or other preceding quoted material is intended to be read or printed exactly as shown and is not a transcription error.

This may be used either to show that an uncommon or archaic usage is reported faithfully (for instance, quoting the U.S. Constitution, "The House of Representatives shall chuse [sic] their Speaker...") or to highlight an error, often for purposes of ridicule or irony (for instance, "Dan Quayle famously changed a student's spelling to 'potatoe' (sic)").

In folk etymology, "sic" is sometimes mistakenly assumed to be an abbreviation of "spelled incorrectly", "spelling is correct", or even "sorry, incorrect".

very nice cloud9...
impressive explanation even if you shamelessly copied it..
shows initiative
you are probably are doing well in your endeavors.


S.F.D.

 

[toughlife]

All this talk is really, really pissing me off. This is a debate being conducted on a online message board by medical students vs. CRNA students. None (well maybe a few) of you honestly have any clue what it is like in the real world. Why? Because thos of us in our mid to late 30's (or beyond) have already gone through residency. We have husbands/wives/children/houses. We don't really have time to "chat online" or debate the same issues that we have debated 100 times already. It gets very old...very fast. People were saying the EXACT same thing when I was applying in the early 90's. I went to Penn for anesthesia, got an amazing job, and have been loving my life ever since. Every year this debate seems to be perpetuated by the next group of medical students/CRNA students. In private practice we all get along - beautifully. We work as a team - just like the PAs who heavily support the surgeons at the private medical center where I work. Everyone is critical, and vital to providing great patient care. So stop with stupid threads that degrade into a doomsday argument. Get over it. There are MORE than enough jobs out there for everyone. And, in the next 10 years there will almost certainly be a shortage of anesthesia providers. I'm making $400,000/yr. Will I always earn this income? No. Logically it doesn't make sense. I'm earning more than the surgeons...a lot more than some of them. I don't have the overhead of an office, rent, utilities, nurses, managers. I LOVE what I do on a daily basis. Will I always earn this much money? No. Probably not. Physician salaries are falling across the board. Anethesia will almost certainly see future pay cuts - like every other medical field.

Sure, I certainly support proactive physicians who lobby the government, and would love that the ASA have a stronger voice. Almost certainly salaries will fall (or at least remain stagnant - i.e. a fall in the real wage when accounted for inflation) over the next 10-15 years.

But here ARE the questions that you must ask yourself. The same questionS that I asked myself > 10 years ago. There will ALWAYS be jobs for anesthesiologists in this country. Yes, the average income may fall (there truly is no reason why I should make so much money right now). But, here is the question...

1. DO YOU LOVE THE FIELD? (If so, procede to question #2. If not, find a different medical career).

2. WOULD YOU BE WILLING TO DO ANESTHESIA FOR $300,000/YR, $200,000/YR, $150,OOO/YR?

In reference to #2... I LOVE my job. I enjoy getting up every day and going to work. My father worked 75 hours a week (2 blue collar jobs) while I grew up. He busted his ass every day, and hated his jobs. He did it for us. Like I said above, I LOVE anesthesia. Truly I do. I would be willing to work for substantially less, and still have no regrets. If tomorrow my salary fell to $150,000 (which, by the way is the salary of the CRNAs in my practice) I would still get up every day and be happy. That is a heck of a lot of money for my 40 hr/week, no weekends, 4 weeks of vacation a year, job. That's more than my parents ever earned, working twice as hard.

And, even if my income dropped that much overnight I would still love my job, and never regret my decision to go into anesthesia. Every day I am happier and happier that I went into anesthesia. Not to disparage other fields, but the surgeons I work with (and obviously I work with quite a few), in general are disappointed with how their careers have ended up. They work far longer hours, have patients in the hospital (meaning no weekends off, unless someone covers for them), and must suffer through clinic. They bill more for a 3 hour lap colectomy than I do, but in the end most of them make only $200-$250K since they have so much overhead (office rent, utilities, staff...etc). Last year I took off 6 months when our first child was born. Sure, I didn't earn any income those months, but I didn't lose any income either. A surgeon needs to have a constant supply of income, as their stream of expenses is constant as well. They can't just take off 6 months and not expect that their office rent won't be due, and can't tell their front desk manager to come back in 6 months without paying him/her for that lost time.

Many (not to overgeneralize) of the surgeons I work with no longer find fulfillment in their jobs. They (like every medical field) are finding reimbursements falling (a lap chole, which takes about an hour or less, once reimbursed $2000, not it's around $800 for medicare). Many are divorced, and trust me, very few enjoy their lives quite as much as me. I love work, but equally I love going home and not worrying that I'll get called into the hospital by some family wanting to speak with me.

I make great money. But, I would be willing to do my job for far less, because I love what I do. I love anesthesia, and always will. If you feel the same, then these stupid debates become meaningless. Sorry for the long post, but this is reality. I'll come back in 6 months, a year, 5 years and find people STILL debating the same thing.

-Anest2005

Easy for you to say when you are sitting on a 400K/yr salary. You're not gonna convince me that you love your job unless you are wiling to do the same job for 50K a year.

 

[ThinkFast007]

Anesth2005

Welcome, I see that this is your first post. I suspect you could be nitecap or some of the other trolls lurking on SDN, trying to advance the AANA agenda (precisely what they want PHYSICIANS to do).

Nevertheless, I'll give you the benefit of the doubt and say you may be an attending. See, the problem with medicine is somehow docs dont like talking about making money. IT's sad that the trial lawyer that's going to sue you one day in fact advertises money as his lure to win clients a jackpot full of $$ . Why is it that every other profession has seen only increases in their salary? People are lured into becoming nurses, pharmacists, etc cuz of teh money potential. Why is it that in every other profession, if you do 'post grad' (let's say an MBA,etc) that the sky's the limit? I agree, money should not be one's ONLY motivation to go into Anesthesiology or any medical profession. Most of us on here LOVE the intellectual challenges, acute care, and professional/personal life Anesthesiology will provide us in the future.

You say you will work for 150k? is that pre or post taxes? Interesting. My student loans after inflation will be about 355K, it's now about 150k. Did you happen to factor in inflation into your potential modest income of 150k? did you factor in all the other expenses, ie car, house, school expenses for your kid, oh and did i mention student loans?? 150k is laughable for someone that spent on avg >8yrs working their butts of when compared to the avg Joe in order to partake in one of the greatest priveleges of all--patient care/medicine. do you realize how LITTLE 150k is? seriously, i dont think I could find another private practice anesthesiologist that would drop a 400K salary to 150K right now. IF I could, heck when I have a practice one day, I wanta hire that guy!!

I dont plan on spending my life paying my loans off. also after inflation in say 10yrs, just regular hosp staff (RNs, resp therapists,etc) will be mking >100k.

you said this went on in the 90s? again, the 90s never had managed care as strong as it did now, trying to squeeze every dollar out of a doc. dont u think that docs should stand up? Ppl say that docs are overpaid, u know where that $$ went?.....dude pharmacists now mk over 100K? Insurance companies' CEOs are driving around in Maybachs? why, cuz they were able to get docs to just open up their wallets! they take med school grads as easy prey, with NO business savvy and just use it to their advantage. sure you made your killing of >400k q year, are you at all concerned about the future physicians (ie YOUR colleagues) and their pay?

Is it all about money? NO. but do I want to have my potential income shot down because some nurse, because of their 'cheap labor', brings my income down to 150k? Bad business sense my friend. If indeed you are a physician, I can respect your clinical skills, surely not your business skills. It's time for docs to stand up, and stand united. EVERY other profession including these nurses, like Nurse Nitecap, can do it with their organizations, why cant we?

Hey I like how this thread is going so far...we need to keep it up. And yes, this is a 'online chat' room perhaps, but with how this movement is going we'll be able to actualize this into the 'real world'. Sure there will be some bumps on the road and ppl that will try to put out our fire, but hey we're stronger than that.

Hey, if you want to be working for even 50k, that's cool. But that's your opinion and that is precisely why nurses have been gaining more turf in this matter. The rest of us are here to see that our patients get the quality healthcare that they PAID for and deserve by having board certified ANESTHESIOLOGISTS take part in their care.


p.s. Nurse Nitecap, dude, dont quote some data that some biased AANA journal wrote. See in med school we learned something called operator bias, clearly something that journal engages in with their propaganda. Your back on Tivo Block. oh and dont try mking up accounts to back you up buddy boy

 

[cfdavid]

All this talk is really, really pissing me off. This is a debate being conducted on a online message board by medical students vs. CRNA students. None (well maybe a few) of you honestly have any clue what it is like in the real world. Why? Because thos of us in our mid to late 30's (or beyond) have already gone through residency. We have husbands/wives/children/houses. We don't really have time to "chat online" or debate the same issues that we have debated 100 times already. It gets very old...very fast. People were saying the EXACT same thing when I was applying in the early 90's. I went to Penn for anesthesia, got an amazing job, and have been loving my life ever since. Every year this debate seems to be perpetuated by the next group of medical students/CRNA students. In private practice we all get along - beautifully. We work as a team - just like the PAs who heavily support the surgeons at the private medical center where I work. Everyone is critical, and vital to providing great patient care. So stop with stupid threads that degrade into a doomsday argument. Get over it. There are MORE than enough jobs out there for everyone. And, in the next 10 years there will almost certainly be a shortage of anesthesia providers. I'm making $400,000/yr. Will I always earn this income? No. Logically it doesn't make sense. I'm earning more than the surgeons...a lot more than some of them. I don't have the overhead of an office, rent, utilities, nurses, managers. I LOVE what I do on a daily basis. Will I always earn this much money? No. Probably not. Physician salaries are falling across the board. Anethesia will almost certainly see future pay cuts - like every other medical field.

Sure, I certainly support proactive physicians who lobby the government, and would love that the ASA have a stronger voice. Almost certainly salaries will fall (or at least remain stagnant - i.e. a fall in the real wage when accounted for inflation) over the next 10-15 years.

But here ARE the questions that you must ask yourself. The same questionS that I asked myself > 10 years ago. There will ALWAYS be jobs for anesthesiologists in this country. Yes, the average income may fall (there truly is no reason why I should make so much money right now). But, here is the question...

1. DO YOU LOVE THE FIELD? (If so, procede to question #2. If not, find a different medical career).

2. WOULD YOU BE WILLING TO DO ANESTHESIA FOR $300,000/YR, $200,000/YR, $150,OOO/YR?

In reference to #2... I LOVE my job. I enjoy getting up every day and going to work. My father worked 75 hours a week (2 blue collar jobs) while I grew up. He busted his ass every day, and hated his jobs. He did it for us. Like I said above, I LOVE anesthesia. Truly I do. I would be willing to work for substantially less, and still have no regrets. If tomorrow my salary fell to $150,000 (which, by the way is the salary of the CRNAs in my practice) I would still get up every day and be happy. That is a heck of a lot of money for my 40 hr/week, no weekends, 4 weeks of vacation a year, job. That's more than my parents ever earned, working twice as hard.

And, even if my income dropped that much overnight I would still love my job, and never regret my decision to go into anesthesia. Every day I am happier and happier that I went into anesthesia. Not to disparage other fields, but the surgeons I work with (and obviously I work with quite a few), in general are disappointed with how their careers have ended up. They work far longer hours, have patients in the hospital (meaning no weekends off, unless someone covers for them), and must suffer through clinic. They bill more for a 3 hour lap colectomy than I do, but in the end most of them make only $200-$250K since they have so much overhead (office rent, utilities, staff...etc). Last year I took off 6 months when our first child was born. Sure, I didn't earn any income those months, but I didn't lose any income either. A surgeon needs to have a constant supply of income, as their stream of expenses is constant as well. They can't just take off 6 months and not expect that their office rent won't be due, and can't tell their front desk manager to come back in 6 months without paying him/her for that lost time.

Many (not to overgeneralize) of the surgeons I work with no longer find fulfillment in their jobs. They (like every medical field) are finding reimbursements falling (a lap chole, which takes about an hour or less, once reimbursed $2000, not it's around $800 for medicare). Many are divorced, and trust me, very few enjoy their lives quite as much as me. I love work, but equally I love going home and not worrying that I'll get called into the hospital by some family wanting to speak with me.

I make great money. But, I would be willing to do my job for far less, because I love what I do. I love anesthesia, and always will. If you feel the same, then these stupid debates become meaningless. Sorry for the long post, but this is reality. I'll come back in 6 months, a year, 5 years and find people STILL debating the same thing.

-Anest2005

I appreciate your passion for your career. That's cool as hell. I have a huge interest in anesthesia and feel that it would be right up my alley (I admit I need more exposure). You're lucky to have found a career that you feel that way about.

However, I feel that reimbursement and salary/income is important. Especially for non-trads who's opportunity cost of attending medical school is high relative to a 23 year old. And regardless of age, the debt that today's med student assumes is substantial. So, it makes sense to want to maximize income in order to better handle that debt, and still live a nice life.

Also, like a previous poster said, it's perfectly normal for us neophytes to want to debate the prospects of our futures. I agree with ThinkFast in that the next generation should be more aware and active in our lobby.

 

[nitecap]

Anesth2005

Welcome, I see that this is your first post. I suspect you could be nitecap or some of the other trolls lurking on SDN, trying to advance the AANA agenda (precisely what they want PHYSICIANS to do).

Nevertheless, I'll give you the benefit of the doubt and say you may be an attending. See, the problem with medicine is somehow docs dont like talking about making money. IT's sad that the trial lawyer that's going to sue you one day in fact advertises money as his lure to win clients a jackpot full of $$ . Why is it that every other profession has seen only increases in their salary? People are lured into becoming nurses, pharmacists, etc cuz of teh money potential. Why is it that in every other profession, if you do 'post grad' (let's say an MBA,etc) that the sky's the limit? I agree, money should not be one's ONLY motivation to go into Anesthesiology or any medical profession. Most of us on here LOVE the intellectual challenges, acute care, and professional/personal life Anesthesiology will provide us in the future.

You say you will work for 150k? is that pre or post taxes? Interesting. My student loans after inflation will be about 355K, it's now about 150k. Did you happen to factor in inflation into your potential modest income of 150k? did you factor in all the other expenses, ie car, house, school expenses for your kid, oh and did i mention student loans?? 150k is laughable for someone that spent on avg >8yrs working their butts of when compared to the avg Joe in order to partake in one of the greatest priveleges of all--patient care/medicine. do you realize how LITTLE 150k is? seriously, i dont think I could find another private practice anesthesiologist that would drop a 400K salary to 150K right now. IF I could, heck when I have a practice one day, I wanta hire that guy!!

I dont plan on spending my life paying my loans off. also after inflation in say 10yrs, just regular hosp staff (RNs, resp therapists,etc) will be mking >100k.

you said this went on in the 90s? again, the 90s never had managed care as strong as it did now, trying to squeeze every dollar out of a doc. dont u think that docs should stand up? Ppl say that docs are overpaid, u know where that $$ went?.....dude pharmacists now mk over 100K? Insurance companies' CEOs are driving around in Maybachs? why, cuz they were able to get docs to just open up their wallets! they take med school grads as easy prey, with NO business savvy and just use it to their advantage. sure you made your killing of >400k q year, are you at all concerned about the future physicians (ie YOUR colleagues) and their pay?

Is it all about money? NO. but do I want to have my potential income shot down because some nurse, because of their 'cheap labor', brings my income down to 150k? Bad business sense my friend. If indeed you are a physician, I can respect your clinical skills, surely not your business skills. It's time for docs to stand up, and stand united. EVERY other profession including these nurses, like Nurse Nitecap, can do it with their organizations, why cant we?

Hey I like how this thread is going so far...we need to keep it up. And yes, this is a 'online chat' room perhaps, but with how this movement is going we'll be able to actualize this into the 'real world'. Sure there will be some bumps on the road and ppl that will try to put out our fire, but hey we're stronger than that.

Hey, if you want to be working for even 50k, that's cool. But that's your opinion and that is precisely why nurses have been gaining more turf in this matter. The rest of us are here to see that our patients get the quality healthcare that they PAID for and deserve by having board certified ANESTHESIOLOGISTS take part in their care.


p.s. Nurse Nitecap, dude, dont quote some data that some biased AANA journal wrote. See in med school we learned something called operator bias, clearly something that journal engages in with their propaganda. Your back on Tivo Block. oh and dont try mking up accounts to back you up buddy boy

So do non board cert. Anesthesiologist not deserve the big bucks? Just curious, you seem to be isolating a few of your assoc though yourself havent even set foot in the OR. Pretty funny. From MSIV to president of the ASA.

So where is the bias in a AANA surveying the ages and expected retirement dates on the CRNA work force. Guess we should have let the ASA do it. And if you claim Bias of this like I stated all the studies the ASA does or funds are irrelevant to say the least. And ignoring me? I sense signs of weakness thinkslow. You disappoint me, thought you were as hardcore as toughlife, JWK and I. Guess not.

 

[cfdavid]

It means I didnt know if I spelled naietivity right.

I thought they were banning nativity scenes at most municipalities. lol
Just kidding jet.

(you're like, "who the f*ck is this chump all prolific and shiat on this forum all the sudden" "he just got into med school" lol)

Hey, did you go see Running Scared???

 

[cfdavid]

I have a few experiences with CRNA's. I dated one for two years. I dated another for 1 date.

Girl #1, let's call her Princess (jokingly, ofcourse), said to me "yeah, they don't have it too bad, making $400k while we do all the work and they drink all the coffee".

Not kidding, she said (wrote in an email actually) that.

When I told the other one that I had shadowed an MD and AA down at Case Western, she said, "yeah, we don't like those AA's. they're taking our jobs."

What's the point? I know it's anecdotal, but perhaps this lends some credo to what others have said about the AANA mentality.

 

[nitecap]

Yeah and I dated 5 anesthesiologists and 5 Anesthesia residents. Knocked 2 of them up and married then divorced another. The alamoney is paying for anesthesia school.

Dave just cuz you did didnt get any a$$ doesnt mean you have to call these girsl out when they arent around to defend.

The mentality and judgements placed by anesthesia residents or med students that have no clue is even worse than the mentality of a CRNA that at least practices.


At least they can make their opinions based on actual experience dealing with the issue. Opposed to think that has no clue.

 

[cfdavid]

Yeah and I dated 5 anesthesiologists and 5 Anesthesia residents. Knocked 2 of them up and married then divorced another. The alamoney is paying for anesthesia school.

Dave just cuz you did didnt get any a$$ doesnt mean you have to call these girsl out when they arent around to defend.

The mentality and judgements placed by anesthesia residents or med students that have no clue is even worse than the mentality of a CRNA that at least practices.


At least they can make their opinions based on actual experience dealing with the issue. Opposed to think that has no clue.

Well, I did call the date chick out when she said it, cause it was to my face.

As for Princess (unbelievably high maintenance), she wrote it after we had broken up. It was an email and I didn't want to get into it.

But, as for their "actual experiences", I highly doubt those comments were representative of what an MD/DO actually does. I read it as vindictive, perhaps jealous, and frankly immature. Did I mention unprofessional?

 

[leopold stotch]

Yeah and I dated 5 anesthesiologists and 5 Anesthesia residents. Knocked 2 of them up and married then divorced another. The alamoney is paying for anesthesia school.

you serious dawg?

 

[ThinkFast007]

Hey everyone, we're really getting underneath this NITECAP guy's skin by COMPLETELY ignoring him. I forgot what the dx is for ppl that always need attention to feel reaffirmed.

check out his PM to me about a few minutes ago, entitled: "weakness"

"Ignoring me is a sign of weakness man. To scared to get crushed in debate? I understand man. Its ok to admit defeat, one day you will toughen up, until then people will continue to walk over you despite any title you may have."


What do I have to say to that. Nothing. The dude is obviously a troll trying to pick a fight on a DOCTOR forum. It's cool. I'm not going to lower myself to his standards and attack him...cuz that's what he wants us to do inorder to get this thread closed. I guess I was a little late catching on to his tactics before. Now I realize how he usually gets these threads closed.

Let's continue to keep it clean on here and take the high road. I'm biting my nails too, refraining from swearing etc... but hey we can do it, why, because we know guys like his TRUE INTENT as previously stated by him (by of course a slip of the tongue).

 

[me454555]

You say you will work for 150k? is that pre or post taxes? Interesting. My student loans after inflation will be about 355K, it's now about 150k. Did you happen to factor in inflation into your potential modest income of 150k? did you factor in all the other expenses, ie car, house, school expenses for your kid, oh and did i mention student loans?? 150k is laughable for someone that spent on avg >8yrs working their butts of when compared to the avg Joe in order to partake in one of the greatest priveleges of all--patient care/medicine. do you realize how LITTLE 150k is?

I hope you realize that the avg FP and IM docs make about that per year and they have the same amount of loans you do.

This whole thread is kinda funny and after reading this bs for the last 4 years on SDN I've come to one conclusion, we're in the same boat together. CRNAs have to realize that if MD/DO salaries fall, theirs will as well. You say anesthesiologist will be making 150k in the future? That means that CRNAs will be making 80k, its just the way things work in business. If a BMW and Kia cost the same amount of money who would buy the Kia? The only way for the Kia to generate sales would be to drop the price.

Its the same concept here. Instead of fighting w/each other over these turf wars, we should be figuring out ways to keep these salaries high for all of us. CRNAs provide valuable support to MDAs and as Jet has pointed out, his practice wouldn't run as smoothly w/out them. MDAs provide the necessary supervision to CRNAs for those times when things get too out of control. Both help each other out and we can mutually benefit for a common good, our paychecks

 

[ThinkFast007]

I hope you realize that the avg FP and IM docs make about that per year and they have the same amount of loans you do.

This whole thread is kinda funny and after reading this bs for the last 4 years on SDN I've come to one conclusion, we're in the same boat together. CRNAs have to realize that if MD/DO salaries fall, theirs will as well. You say anesthesiologist will be making 150k in the future? That means that CRNAs will be making 80k, its just the way things work in business. If a BMW and Kia cost the same amount of money who would buy the Kia? The only way for the Kia to generate sales would be to drop the price.

Its the same concept here. Instead of fighting w/each other over these turf wars, we should be figuring out ways to keep these salaries high for all of us. CRNAs provide valuable support to MDAs and as Jet has pointed out, his practice wouldn't run as smoothly w/out them. MDAs provide the necessary supervision to CRNAs for those times when things get too out of control. Both help each other out and we can mutually benefit for a common good, our paychecks

hey, i'm not sure what you are? please Identify urself. CRNA or. Anesthesiologist (please refrain from using the term MDA...as I believe it was VolatileAgent who first corrected me when I used it. It's a term that the AANA uses to describe an "Anesthesiologist". "Anesthesiologist" is a term that fits what they do: study and practice "anesthesiology").

Second. The point is not 150k, that was somethign someone threw out there. The point is a UNIFIED physician front to further the interests of physicians, which subsequently will allow for better patient care and leverage. That's the whole point. As to salary etc. Sure it's important and some of us do want to maintain the caliber of compensation it is today. As to Jet's viewpoint. It's respected. It's not however, how everyone works. Furthermore, as seen by Nurse Nitecaps posts on here, it's rather evident what the CRNAs true intent is. Someone here help me, but i dont know what they call ppl that act really nice and do whatever you want, only to learn the craft and run their own practice later on...as of now, it's called a CRNA.

oh and the thing about if doctors get reimbursed 150k the nurses will get 80k. NOT true at all. This is a world of managed care we live in. If the managed care organizations perceive that the same work can be done by 'cheaper labor', then they can reimburse both anesthesiologists and CRNAs at the same 'capitated' rate. Using the numbers you provided (150 and 80) a difference of 70K is seen. Do you really think that FP/Interns and their threat, NPs/PAs have a 70K difference in pay? Absolutely not. I can attest to this because a friend of mine's mom is a NP. Her salary (w/o working working overtime) is 125k plus or minus depending on incentives. So, as you can appreciate under managed care, there is no vast difference in pay b/w Physician and midlevel.

So why do doctors have to act? Docs must act via public ads and campaigning so that patients will DEMAND docs and demand better quality of care. The managed care companies must appreciate the difference of a doctor and a midlevels work. their perception is based on our action.

Hey, we're all adults here, we can all agree to disagree. Again, political action, and public know-how about this situation is what will help this cause.

 

[nitecap]

hey, i'm not sure what you are? please Identify urself. CRNA or. Anesthesiologist (please refrain from using the term MDA...as I believe it was VolatileAgent who first corrected me when I used it. It's a term that the AANA uses to describe an "Anesthesiologist". "Anesthesiologist" is a term that fits what they do: study and practice "anesthesiology").

Second. The point is not 150k, that was somethign someone threw out there. The point is a UNIFIED physician front to further the interests of physicians, which subsequently will allow for better patient care and leverage. That's the whole point. As to salary etc. Sure it's important and some of us do want to maintain the caliber of compensation it is today. As to Jet's viewpoint. It's respected. It's not however, how everyone works. Furthermore, as seen by Nurse Nitecaps posts on here, it's rather evident what the CRNAs true intent is. Someone here help me, but i dont know what they call ppl that act really nice and do whatever you want, only to learn the craft and run their own practice later on...as of now, it's called a CRNA.

oh and the thing about if doctors get reimbursed 150k the nurses will get 80k. NOT true at all. This is a world of managed care we live in. If the managed care organizations perceive that the same work can be done by 'cheaper labor', then they can reimburse both anesthesiologists and CRNAs at the same 'capitated' rate. Using the numbers you provided (150 and 80) a difference of 70K is seen. Do you really think that FP/Interns and their threat, NPs/PAs have a 70K difference in pay? Absolutely not. I can attest to this because a friend of mine's mom is a NP. Her salary (w/o working working overtime) is 125k plus or minus depending on incentives. So, as you can appreciate under managed care, there is no vast difference in pay b/w Physician and midlevel.

So why do doctors have to act? Docs must act via public ads and campaigning so that patients will DEMAND docs and demand better quality of care. The managed care companies must appreciate the difference of a doctor and a midlevels work. their perception is based on our action.

Hey, we're all adults here, we can all agree to disagree. Again, political action, and public know-how about this situation is what will help this cause.

At least we are keeping it clean guys which is a drastic change comparing to past posters who havnt been able to keep their cool during debate/aurgument or whatever you wanna call it. Its nothing personal here, just differences in opinions and beliefs and tons of pride.

As well i am not a "troll". Been here a while and will continue to be here to correct innacurrate portrayals from folks that have no clue what they are talking about. trolls dont have hundreds of posts, Think my anesthesia knowledge though young at this point in our respective careers is greater than yours as well is my knowledge of real world perioperative processes and how things work. The role I play here is the same role JWK plays on our forum refuting comments he doesnt aggree with and he feels are inacurrate.

Also I am not here to bad mouth the profession of anesthesiology, however I am here to defend mine. I respect what you do and aknowledge your commitment to your profession. BUt some things we will never agree upon and this is just one of them. Comments refering to replacement of CRNA's and CRNA incompentence from people that have never been in the OR need to be refuted as It effects my lively hood as well. I have loans, will have 150k at least to pay so school is not cheap. Per semester my CRNA school is more expensive than the med school we are within so we share some of the same worries about many things. Not to mention my wife or soon to be wife is in CRNA school as well. Both are private programs to total we will be at 300k but hopefully together make at least that much.Yes much of this is about money, was making 75k as a RN and I dont want 150k in loans if salaries are going to drop to 80 for CRNA's. We have much of the same worries really. The same threat you feel about us we feel toward AA's that you guys promote as replacements so really my posts and feelings about these issues are just as relavant as yours.

I have been chill lately until awoken by hot head residents to be, not even started their residency yet. If it is so aggrevating to you all that I post then tone it down. It should be well understood that Throwing around replacement, incompetency and comments as such will automatically get a come back from me or others here which just increases the beef b/t us.

If you dont want threads closed than dont provoke. And if you must provoke keep it clean and at least be man enough the continue the debate or discussion b/t us. How do you put someone on ignore that you are taking shots at? Its weak no doubt about that. So again you want calm, i can give that but misconceptions and inaccuracys will be called out and trashed. Its just the right and respectable thing to do regarding my interests.

Bottom line we are both safe and proven providers. And to the green peeps that post here that think that CRNA/AA's just tube and start lines and things you are badly wrong. In ACT many times that is about all the Anesthesiologist is around for , Intubation and line placement. Thats just how it goes when your practice is providing services to 2 hospitals totalling 65 OR suites or more in many cases which enables you to make your 400k. We would have been practicing for 100yrs now if we were unsafe and would provide the majority of compat anesthesia to our boys in the middle east right now, plain and simple.

Im all for lobbying on a unified from against decreases in medicare reimburstments which would be way more effective, we are in this business for much of the same reasons you very residents and MD's give. Lifestyle, Money, satisfaction with the field, job availability, flexibility, ability to move any where you want and prob find a job ect ect. As my wife is in CRNA school as well these issues that we debate will effect my family greatly therefore my passion is multiplied 10 fold. IF your reimursment rates go down then so does mine and my salary and that of my wifes as well.

 

[ThinkFast007]

just curious. Last I checked Nurse Nitecap was a SRNA, aka student. So i wonder what his 'real world' experience is about. I guess he's claiming that student nurses have better experiences and know-how than student doctors?

Funny, especially when this is a STUDENT DOCTOR forum. hey try preachin' to the allnurses.com website. Again his intent is clear as day, he just wants to learn what we're doing, in order to try to 'outsmart' us. no point arguing with this troll.

Where's Lvspro's avatar again...guys nitecap is on it, he's teh squirrel in it.

 

[lvspro]

Where's Lvspro's avatar again...guys nitecap is on it, he's teh squirrel in it.

I can't stop the humping!!!

 

[toughlife]

hey, i'm not sure what you are? please Identify urself. CRNA or. Anesthesiologist (please refrain from using the term MDA...as I believe it was VolatileAgent who first corrected me when I used it. It's a term that the AANA uses to describe an "Anesthesiologist". "Anesthesiologist" is a term that fits what they do: study and practice "anesthesiology").

Second. The point is not 150k, that was somethign someone threw out there. The point is a UNIFIED physician front to further the interests of physicians, which subsequently will allow for better patient care and leverage. That's the whole point. As to salary etc. Sure it's important and some of us do want to maintain the caliber of compensation it is today. As to Jet's viewpoint. It's respected. It's not however, how everyone works. Furthermore, as seen by Nurse Nitecaps posts on here, it's rather evident what the CRNAs true intent is. Someone here help me, but i dont know what they call ppl that act really nice and do whatever you want, only to learn the craft and run their own practice later on...as of now, it's called a CRNA.

oh and the thing about if doctors get reimbursed 150k the nurses will get 80k. NOT true at all. This is a world of managed care we live in. If the managed care organizations perceive that the same work can be done by 'cheaper labor', then they can reimburse both anesthesiologists and CRNAs at the same 'capitated' rate. Using the numbers you provided (150 and 80) a difference of 70K is seen. Do you really think that FP/Interns and their threat, NPs/PAs have a 70K difference in pay? Absolutely not. I can attest to this because a friend of mine's mom is a NP. Her salary (w/o working working overtime) is 125k plus or minus depending on incentives. So, as you can appreciate under managed care, there is no vast difference in pay b/w Physician and midlevel.

So why do doctors have to act? Docs must act via public ads and campaigning so that patients will DEMAND docs and demand better quality of care. The managed care companies must appreciate the difference of a doctor and a midlevels work. their perception is based on our action.

Hey, we're all adults here, we can all agree to disagree. Again, political action, and public know-how about this situation is what will help this cause.

what is slimeball?

 

[ThinkFast007]

slimeball?

sounds about accurate. I love how he's tried to get us docs and student docs to turn on ourselves, he's just kinda ancy (actually scared) that we're finally united.

 

[toughlife]

hey, i'm not sure what you are? please Identify urself. CRNA or. Anesthesiologist (please refrain from using the term MDA...as I believe it was VolatileAgent who first corrected me when I used it. It's a term that the AANA uses to describe an "Anesthesiologist". "Anesthesiologist" is a term that fits what they do: study and practice "anesthesiology").

Second. The point is not 150k, that was somethign someone threw out there. The point is a UNIFIED physician front to further the interests of physicians, which subsequently will allow for better patient care and leverage. That's the whole point. As to salary etc. Sure it's important and some of us do want to maintain the caliber of compensation it is today. As to Jet's viewpoint. It's respected. It's not however, how everyone works. Furthermore, as seen by Nurse Nitecaps posts on here, it's rather evident what the CRNAs true intent is. Someone here help me, but i dont know what they call ppl that act really nice and do whatever you want, only to learn the craft and run their own practice later on...as of now, it's called a CRNA.

oh and the thing about if doctors get reimbursed 150k the nurses will get 80k. NOT true at all. This is a world of managed care we live in. If the managed care organizations perceive that the same work can be done by 'cheaper labor', then they can reimburse both anesthesiologists and CRNAs at the same 'capitated' rate. Using the numbers you provided (150 and 80) a difference of 70K is seen. Do you really think that FP/Interns and their threat, NPs/PAs have a 70K difference in pay? Absolutely not. I can attest to this because a friend of mine's mom is a NP. Her salary (w/o working working overtime) is 125k plus or minus depending on incentives. So, as you can appreciate under managed care, there is no vast difference in pay b/w Physician and midlevel.

So why do doctors have to act? Docs must act via public ads and campaigning so that patients will DEMAND docs and demand better quality of care. The managed care companies must appreciate the difference of a doctor and a midlevels work. their perception is based on our action.

Hey, we're all adults here, we can all agree to disagree. Again, political action, and public know-how about this situation is what will help this cause.

Yo thinkfast, you are right on this one.

me454555. How much less does an independent CRNA make vs. an MD/DO doing a lap chole?

There goes your claim about them always making less than we do.

 

[ThinkFast007]

Yo thinkfast, you are right on this one.

.

hahhaa.

see, i've had some 'spare time' to say the least to tk a few courses on managed care. I know we're not in primary care, but here's what issurance companies look at when determining reimbursement for them:

1)History
2) Exam (focused, versus mutli organ system)
3)Medical Decision Making (ie low risk, high risk, etc)
4) Time spent (but if u want to bill for time spent, you must document that over 50% of the time spent was used to educate a pt or on 'teaching')

after taking those things into consideration, you bill the insurance company as to what 'level' the pt is in (1 to 5). If the pt interaction is deemed a level 5, then the reimbursement is higher.

What's my point? Nowhere do I see the distinction, or a box to tic off to indicate whether the provider is a DOCTOR or NP/PA. The the INSurance company care if it's a doctor or NP? So what does that mean? IF the same work is perceived to be done, billing has the potential to be the same atleast in the managed care organization's eye.

I dont know about you all. but that is extremely worrisome!

 

[nitecap]

Yo thinkfast, you are right on this one.

me454555. How much less does an independent CRNA make vs. an MD/DO doing a lap chole?

There goes your claim about them always making less than we do.

For a lap chole reimbustsment for a independent contractor CRNA and Anesthesilogist will be almost equal if not exactly equal. The time units and units aloted for that particular case are the same. You guys can make mega bucks since you can supervise others and bill for there services all at one time.

 

[sabre518]

I have loans, will have 150k at least to pay so school is not cheap. Per semester my CRNA school is more expensive than the med school we are within so we share some of the same worries about many things.

On average medical schools are a touch more expensive than SRNA program. Some will always be cheaper, and some will be more expensive. So this is a push. But medical school is 4yrs vs SRNA school's 2yrs.

Also, as a critical care nurse, with a BSN degree (equivalent to a 4 year college program), will earn on average 10k more than a resident.

Bottom line, it costs A LOT more to train an anesthesiologist than a CRNA. I am not disagreeing that it still cost a chunk of change to train a CRNA. In fact, I applaud the fact that someone would continue their education past getting a nursing degree. That should be financially rewarded, no doubt here. But not at the same level as the longer, AND more expensive education that anesthesiologists have.

I fear, however, that the AANA is pushing for equal compensation for CRNA's and anesthesiologists. You can correct me here if you want. But to me it would seem the same as paying a gourmet chef and a cook from applebee's the same amount for a meal. It might be just as good, but it just doesn't happen. Sorry for the corny analogy, that's the first thing I thought of.