Medical Students- Anesthesiology?

[EtherMD]

Every Medical Student has to ask himself/herself one very important question prior to choosing this specialty: Do I mind earning 25% more than a CRNA?

There are other qestions to ask as well but the income question is very important and you need to be honest with yourself. This is a worst case scenario for the future but one that needs to be addressed and thought about. More likely, you will earn 50% more than a CRNA but the Mid-levels
continue to gain ground every year.

After Medical School and Residency are you prepared to call Advanced Practice Nurses (CRNA) colleagues? This is what the AANA has in store for the specialty. DNP (Doctor of Nurse Practioner) is coming very soon with CRNA's believing they are completely equal to you (even more than today).

So, after all those of years of school and debt do you want to choose a field with so many CRNA's working in the area and more CRNA's with DNP's coming soon?

As long as you make the decision with your eyes open to the reality of the field and not based on false assumptions choosing Anesthesiology can be a rewarding field.

---

Members don't see this ad.

 

[opa beleza?]

I think thats really great advice.
In all honesty I entered residency almost completely clueless about the CRNA thing, I just enjoyed what I was learning. I am kind of a low risk threshold type (there are pros and cons to this) and knowing what I know now I suspect I would have chickened out and headed for rads or ortho or most likely Cards. I just wish I dug a bit deeper and learned more about what I was headed for -- even though it seems peripheral to the merits of the field itself.
Just my experience.

 

[pgg]

DNP (Doctor of Nurse Practioner) is coming very soon

Sure, but is it coming to the CRNA world?

I don't see all the existing CRNAs taking time off from their increasingly lucrative practice to go back to school. Even if the AANA wanted to make this pseudo-doctorate a requirement, they'd face a rebellion from the ranks of old, crotchety, lazy, happy-with-the-status-quo, I'm-good-enough-already members.

And where are all the future CRNAs going to get the education/training needed to turn their CRNA papers into something with d-o-c-t-o-r on it? If their seniors/teachers are CRNAs sans doctorate, who's going to teach them? Or is a DNP going to become a prerequisite for CRNA training? If so, won't that drastically reduce the number of students entering training?

I'm not one to stick my head in the sand over this, but I'm dubious. I don't see a plausible sequence of events that will result in even a pretend doctorate degree becoming commonplace amonst CRNAs ... let alone it happening "soon." But I'd like to hear your thoughts on how it might happen.

 

[proman]

People have to realize that the scenario Ether presents is essentially the worst-case possible. Realistically, I give it a < 2% chance of happening in the next 20 years. If what he describes happens, it won't just be anesthesiology. It'll be every physician and that means that CRNA payments will also be cut significantly. And, although I will do a fellowship for my personal interests, none of us need it to differentiate us from the nurses.

 

[nutmegs]

yes, I knew that coming in.

what I'm not prepared for is the current batch of private practice attendings trying to make as much money as they can in the next 10 years while thoroughly screwing those of us in the future over by refusing to make decisions that are beneficial for the specialty on the whole. sorry, just don't trust y'all. please try not to burn too many bridges for us.

 

[EtherMD]

People have to realize that the scenario Ether presents is essentially the worst-case possible. Realistically, I give it a < 2% chance of happening in the next 20 years. If what he describes happens, it won't just be anesthesiology. It'll be every physician and that means that CRNA payments will also be cut significantly. And, although I will do a fellowship for my personal interests, none of us need it to differentiate us from the nurses.

Really? In years past CRNA's didn't earn $250,000 or more plus benefits as often as they do today. With each year they continue to narrow the salary Gap between CRNA and MD/DO. I expect this trend to continue regardless of any health care reimbursement changes.

You are being foolish by not realizing that in 10 years CRNA's will be required to be a DNP. Their length of training will increase to 36-40 months for that DNP. The AANA will argue even more vehemently that its newest members are EQUAL to an MD/DO in the operating room. Your best bet is that fellowship training to show some real legal proof you are not just a more expensive CRNA with a DNP.

I fully expect that a person finishing Residency without a Fellowship in 2017 will earn 25% more than a CRNA. With a fellowship the odds improve you will earn more than that. Remember, CRNA salaries are not stagnant and will continue to increase over the next ten years while MD/DO income will remain stagnant (at best) or drop by 20-30%.

The truth of the matter is that a person finishing Residency in 2017 (Anesthesiology) would be hard pressed to justify the cost of Medical School and Residency (lost income) over the DNP CRNA route.

I am stating the truth that many of you don't want to read. Your fellow Medical Students and Academicians know very little about the economics of the private sector in the field of Anesthesiology.

By all means, complete the fellowship and support the ASA because it will help your future. But, the AANA is going to win the war because its membership can do MOST tasks of your job for less. The cases that they can't do solo or those areas that require Physician expertise leaves room for MD/DO Anesthesiologists. The problem is the AANA is producing record numbers of new graduates (Masters Degree) and opening new schools. Thus, the field will need fewer "supervisors" in the future for the new ratio of 7:1. Alternatively, you may have the opportunity to work for DNP CRNA level income.

The only "bright spot" in all of this is the fact that the AANA and CRNA schools need DNP/PhD CRNA's to train future DNP CRNA's. There are very few of them right now; but, I suspect the schools will "grandfather" certain CRNA's with years of experience to the DNP level. Or, they will allow working members with Masters degrees to bridge to a DNP over 6-12 months via online classes, night classes and weekend sessions. Either way the Nurses are very creative and will find a way to continue to produce record numbers of new graduates.

 

[i61164]

If, as you say, CRNA's are already making $250,000 and your worst case scenario is $250,000*1.25 = $312,500, then go ahead and cry me a river. There are plenty of physicians with 4 or more years of residency training making much less than that. In fact, many make about half that amount. Once your salaries drop down below $200,000 (which I doubt will ever happen), then you will have cause for alarm. As it stands, gas has one of the best returns on investment for 4 years of residency training and that will not change unless salaries fall well below $312K.

 

[EtherMD]

If, as you say, CRNA's are already making $250,000 and your worst case scenario is $250,000*1.25 = $312,500, then go ahead and cry me a river. There are plenty of physicians with 4 or more years of residency training making much less than that. In fact, many make about half that amount. Once your salaries drop down below $200,000 (which I doubt will ever happen), then you will have cause for alarm. As it stands, gas has one of the best returns on investment for 4 years of residency training and that will not change unless salaries fall well below $312K.

Arrogance. This is what the AANA is counting on from the ASA, the leadership and the next generation of MD/DO Anesthesiologists.

CRNA's average $120-$130,000 (W-2) plus benefits for 40 hours per week. If they work 55 hours per week they earn around $220,000. Those CRNA's working solo earn $250,000 or more plus benefits. Also, in 2017 if your earn $300,000 (W-2) what does that mean in today's dollars? I am not "alarmed" by CRNA salary increases as I have been paying them every year. I am not "alarmed" by solo CRNA practices as I have seen more of them sprout up.

I want to inform the uneducated about the CRNA issue and the potential problem they pose to one's income in 2017. A Medical Student needs to study this issue and consider ALL the facts prior to choosing the specialty.
Again, DNP CRNA's are coming soon to a hospital near you. The AANA will use the DNP CRNA issue to muddy the waters even more than today.
Perhaps, some Medical Students scoring high on their exams should know these facts when considering this field. Perhaps, a few will choose another area not threatened by Mid-Level Nurses.

 

[flashgordon]

Why don't those anesthesiologists who teach CRNAs stop? or not allow CRNA programs to rotate their students at the department? Then we all get fellowship trained and the world will be ours for the taking!

WTF is wrong with the AANA? Who the **** are these nurses who think they can make MEDICAL decisions? Wouldn't trust my dog's life with them...

Also, why should I donate to the ASA when they've done a ****ty job educating the public regarding their anesthetic care? A nurse or physician- which would you rather have taking care of you? What's so difficult??

All joking aside, can't we all work together as a freaking TEAM????

 

[morpheus md]

Really? In years past CRNA's didn't earn $250,000 or more plus benefits as often as they do today. With each year they continue to narrow the salary Gap between CRNA and MD/DO. I expect this trend to continue regardless of any health care reimbursement changes.

You are being foolish by not realizing that in 10 years CRNA's will be required to be a DNP. Their length of training will increase to 36-40 months for that DNP. The AANA will argue even more vehemently that its newest members are EQUAL to an MD/DO in the operating room. Your best bet is that fellowship training to show some real legal proof you are not just a more expensive CRNA with a DNP.

I fully expect that a person finishing Residency without a Fellowship in 2017 will earn 25% more than a CRNA. With a fellowship the odds improve you will earn more than that. Remember, CRNA salaries are not stagnant and will continue to increase over the next ten years while MD/DO income will remain stagnant (at best) or drop by 20-30%.

The truth of the matter is that a person finishing Residency in 2017 (Anesthesiology) would be hard pressed to justify the cost of Medical School and Residency (lost income) over the DNP CRNA route.

I am stating the truth that many of you don't want to read. Your fellow Medical Students and Academicians know very little about the economics of the private sector in the field of Anesthesiology.

By all means, complete the fellowship and support the ASA because it will help your future. But, the AANA is going to win the war because its membership can do MOST tasks of your job for less. The cases that they can't do solo or those areas that require Physician expertise leaves room for MD/DO Anesthesiologists. The problem is the AANA is producing record numbers of new graduates (Masters Degree) and opening new schools. Thus, the field will need fewer "supervisors" in the future for the new ratio of 7:1. Alternatively, you may have the opportunity to work for DNP CRNA level income.

The only "bright spot" in all of this is the fact that the AANA and CRNA schools need DNP/PhD CRNA's to train future DNP CRNA's. There are very few of them right now; but, I suspect the schools will "grandfather" certain CRNA's with years of experience to the DNP level. Or, they will allow working members with Masters degrees to bridge to a DNP over 6-12 months via online classes, night classes and weekend sessions. Either way the Nurses are very creative and will find a way to continue to produce record numbers of new graduates.

The AANA and CRNAs are also counting on the current generation of attending anesthesiologists, like you, to train them.

 

[Taurus]

By all means, complete the fellowship and support the ASA because it will help your future.

So let's suppose in the year 2017, CRNA + DNP exists. Your solution is to move up the value chain and subspecialize. You make the assumption, though, that the nurses can't follow.

What if the nurses identify certain highly paid subspecialties and create their own "fellowships" for nurses?

 

[flashgordon]

What if the nurses identify certain highly paid subspecialties and create their own "fellowships" for nurses?

simple... we hire ninja assassins.

 

[Bertelman]

...Perhaps, some Medical Students scoring high on their exams should know these facts when considering this field. Perhaps, a few will choose another area not threatened by Mid-Level Nurses.

Ether, I'll admit it was a nice addition to our boards when you first started mentioning the threats of CRNAs, reimbursement, etc. It's always nice to be aware of future happenings. Sometimes, though, I really question your motives. You have made a distinct point of reiterating this threat on several different threads, many times over. I think your message is clear. No need to beat a dead horse.

By creating this thread, you have now issued a warning to all medical students to steer clear of anesthesia, or at least beware. Although the threat of CRNAs is valid, the "truth" you speak is no more conjecture than anyone else on this site, you just happen to have a few more years direct experience in the matter.

I appreciate the words of wisdom, but please stop short of warning all future anesthesia candidates about entering the field. I, for one, am truly excited to enter the field with some of the brightest students as my colleagues. The last thing this field needs right now is a "sky is falling" perception amongst superb medical students. You can argue that evidence supports your predictions, but if your personal predictions are that spot-on, I'd say you're in the wrong business. The stock market is calling.

I'm not exactly an old guy in this forum, but I've been following it long enough to know there has been an inordinate amount of text committed to the death of the specialty in the past couple months. Here's what I think:

1) This isn't the first or last time someone will bemoan the threat of CRNAs.
2) This isn't the first or last time our reimbursement has been threatened by cuts.
3) I have followed your arguments on the other threads. I don't see what is unique about this era's problems vs. 10, 20 or 30 years ago.

I have yet to understand how a practicing professional and his colleagues can sleep at night knowing that both of these threats have been more or less constant for the last several decades, yet have chosen to do little to address them. Furthermore, I am appalled that the burden of change should be placed on a group of people who are just entering the profession. It reeks of insecurity (or sour grapes) when a professional would provide so many deliberate arguments convincing others NOT to enter the field. I think you have taken this a step too far by posting a warning on this forum that all future candidates with stellar board scores reconsider entering the field. Thanks, but no thanks.

 

[Duckie24]

I've been following the many threads on this topic for quite a while now. It seems this topic is debated for several months, dies down, and then heats back up again....and has done so for the past several years.

With that said, I do think that this is a real problem that we all need to be aware of. I wonder what might happen if CRNA reimbursements continue to rise while physician reimbursements continue to fall. When the two converge, why would anyone want to hire a CRNA over an MD, assuming there are any left in the field at that time? For the same, or nearly the same, cost I would think the MD would get the job every time.

I still think that no matter what, one needs to pick their specialty based on what they enjoy. As they say, this ain't my first rodeo. I've worked before, and hated my job, and wasn't going to make that mistake again. When reimbursements go down, they only thing that will make me unhappy is if I can't pay off the loans before retirement age.

 

[Broken Ankles]

Ether, I'll admit it was a nice addition to our boards when you first started mentioning the threats of CRNAs, reimbursement, etc. It's always nice to be aware of future happenings. Sometimes, though, I really question your motives. You have made a distinct point of reiterating this threat on several different threads, many times over. I think your message is clear. No need to beat a dead horse.

By creating this thread, you have now issued a warning to all medical students to steer clear of anesthesia, or at least beware. Although the threat of CRNAs is valid, the "truth" you speak is no more conjecture than anyone else on this site, you just happen to have a few more years direct experience in the matter.

I appreciate the words of wisdom, but please stop short of warning all future anesthesia candidates about entering the field. I, for one, am truly excited to enter the field with some of the brightest students as my colleagues. The last thing this field needs right now is a "sky is falling" perception amongst superb medical students. You can argue that evidence supports your predictions, but if your personal predictions are that spot-on, I'd say you're in the wrong business. The stock market is calling.

I'm not exactly an old guy in this forum, but I've been following it long enough to know there has been an inordinate amount of text committed to the death of the specialty in the past couple months. Here's what I think:

1) This isn't the first or last time someone will bemoan the threat of CRNAs.
2) This isn't the first or last time our reimbursement has been threatened by cuts.
3) I have followed your arguments on the other threads. I don't see what is unique about this era's problems vs. 10, 20 or 30 years ago.

I have yet to understand how a practicing professional and his colleagues can sleep at night knowing that both of these threats have been more or less constant for the last several decades, yet have chosen to do little to address them. Furthermore, I am appalled that the burden of change should be placed on a group of people who are just entering the profession. It reeks of insecurity (or sour grapes) when a professional would provide so many deliberate arguments convincing others NOT to enter the field. I think you have taken this a step too far by posting a warning on this forum that all future candidates with stellar board scores reconsider entering the field. Thanks, but no thanks.

decreased interest in anesthesiology now = shorter supply later = higher salaries (or at least not the precipitous drop many are fearing). perhaps ethermd is on to something.

 

[Bertelman]

decreased interest in anesthesiology now = shorter supply later = higher salaries (or at least not the precipitous drop many are fearing). perhaps ethermd is on to something.

decreased interest = return to programs not filling (like 50%) = fewer MDs in the face of more CRNAs despite greater number of anesthestics = legislators realizing it is quicker to train CRNAs = death of the specialty

Seriously, I'm not going into this specialty to bark about the difference between 350k and 450k. Sure, I'd always take the latter, but I am not willing to potentially cannibalize our specialty on a whim. I don't feel the need to talk others out of our wonderful specialty for the sake of ensuring my own salary down the road. On the contrary, I am confident I can remain competitive and achieve my goals.

 

[MacGyver]

Seriously, I'm not going into this specialty to bark about the difference between 350k and 450k. Sure, I'd always take the latter, but I am not willing to potentially cannibalize our specialty on a whim.

Interesting you should say that, because that is EXACTLY what your ancestors did and are doing currently. They're not happy with their fat 320k salary no they want more so they bump it up to 400k by getting CRNAs involved.

It was the greed of MDAs that started this whole mess.

 

[salmonella]

Sometimes I wonder if this CRNA issue is that ominous.
I had a discussion today with a super nice anesthesia attending about this whole CRNA issue. He said this CRNA thing is all hyped up by insecured anesthesiologists and that CRNA will NEVER take over the anesthesia market. We should have a secured anesthesia career in the next 40yrs or so, and someone must have to be an idiot to not enter anesthesia for money (as it is close to the highest paying specialty now, with great lifestyle). He said he never saw the point of contributing to ASA cuz it's a waste of money. He told me not to lose any sleep over CRNA problem; just study hard, apply to anesthesia residency, and in short 4-5 years, reap the super income! He's a well respected attending, so we should take his words for it.
People on this board really need to chill out and not to worry too much...

 

[mille125]

Interesting you should say that, because that is EXACTLY what your ancestors did and are doing currently. They're not happy with their fat 320k salary no they want more so they bump it up to 400k by getting CRNAs involved.

It was the greed of MDAs that started this whole mess.

it is greed of ALL doctors that have led to the rise of midlevels...NP's, PA's, CRNA's etc....

 

[mille125]

Sometimes I wonder if this CRNA issue is that ominous.
I had a discussion today with a super nice anesthesia attending about this whole CRNA issue. He said this CRNA thing is all hyped up by insecured anesthesiologists and that CRNA will NEVER take over the anesthesia market. We should have a secured anesthesia career in the next 40yrs or so, and someone must have to be an idiot to not enter anesthesia for money (as it is close to the highest paying specialty now, with great lifestyle). He said he never saw the point of contributing to ASA cuz it's a waste of money. He told me not to lose any sleep over CRNA problem; just study hard, apply to anesthesia residency, and in short 4-5 years, reap the super income! He's a well respected attending, so we should take his words for it.
People on this board really need to chill out and not to worry too much...

With all due respect, your attending is a fool..Salmonella, you need to learn that your attendings are only good for teaching you how to do an anesthetic and writing a grant.....they have no knowledge or expertise about the real world outside of the ivory towers (even though they pretend to) Again....this shows the disconnect between academic attendings and the real world....your attending has absolutely no idea what is going on in private practice...otherwise he wouldnt be so foolish and naive...This problem is worsened by the leadership in academic institutions who not only continue to train CRNA's (and student CRNA's called SRNA's) but also continue to open new schools at their institutions...talk about shortsightedness....I never understood this when I was a resident....Like most things in life, if you dont understand it, it likely comes down to MONEY...this is no different...these chairmen open up crna schools so that they get "slave labor" and manpower to run the programs so that they can sit in the big comfortable lounge chair in their office...my program was no exception...they are doing this at the expense of your future...

The records will show that I disagree with Ether on many topics. However he is completely right when he says that academic institutions should train AA's instead of CRNA's.

 

[SleepIsGood]

yes, I knew that coming in.

what I'm not prepared for is the current batch of private practice attendings trying to make as much money as they can in the next 10 years while thoroughly screwing those of us in the future over by refusing to make decisions that are beneficial for the specialty on the whole. sorry, just don't trust y'all. please try not to burn too many bridges for us.

Voice of reason.

Not only the physicians that hire them, but those that educate/produce them. These physicians should be ostracized in anesthesia circles in my opinion, they've done more bad than good for the speciality.

 

[i61164]

Arrogance. This is what the AANA is counting on from the ASA, the leadership and the next generation of MD/DO Anesthesiologists.

CRNA's average $120-$130,000 (W-2) plus benefits for 40 hours per week. If they work 55 hours per week they earn around $220,000. Those CRNA's working solo earn $250,000 or more plus benefits. Also, in 2017 if your earn $300,000 (W-2) what does that mean in today's dollars? I am not "alarmed" by CRNA salary increases as I have been paying them every year. I am not "alarmed" by solo CRNA practices as I have seen more of them sprout up.

I want to inform the uneducated about the CRNA issue and the potential problem they pose to one's income in 2017. A Medical Student needs to study this issue and consider ALL the facts prior to choosing the specialty.
Again, DNP CRNA's are coming soon to a hospital near you. The AANA will use the DNP CRNA issue to muddy the waters even more than today.
Perhaps, some Medical Students scoring high on their exams should know these facts when considering this field. Perhaps, a few will choose another area not threatened by Mid-Level Nurses.

I'm not saying that people shouldn't consider the future of the profession they choose. But it seems that these days most specialties are under attack. I have heard these same dire predictions from radiologist, surgeons, etc. If you want a specialty that is going to guarantee you a boat load of money for the next 40 years, go into plastic surgery. Good luck landing that residency though. EtherMD is saying that nurses are making up to 250K if they have their own practice. To me that means as an MD, you can make at least 250K in the worst case scenario. If making a meager 250K will make you a bitter, resentful, unhappy person, then maybe you should reconsider your specialty choice. If you like the job and would be happy with 250K, then go for it. Maybe it would have been easier and less expensive to go the nursing route and become a CRNA, but since noboby has invented a time machine yet... Anyway, I suspect that when most of you started med school, you had no idea that you would go into gas and so you can't blame yourself for not taking the easy CRNA route. Besides money, I suspect there are also some intagibles and other opportunities that your MD/DO will afford you. Good luck, future anesthesiologists.

 

[Gern Blansten]

The AANA and CRNAs are also counting on the current generation of attending anesthesiologists, like you, to train them.

I feel lucky that I am not at a program that trains CRNA "residents"(you know they don't refer to themselves as students anymore), but ether's complaints about academic institutions rings hollow. He complains about academic faculty training CRNAs, then states that they aren't well trained enough to do the jobs he needs them to do(regional etc) so that he can maximize his income. So his response is to "get them up to speed" by providing additional OJT for them. If the truth was known, Ether has probably provided more training for CRNAs than the average academic anesthesiologist. Perhaps someone else has it right about his motive. The income is slipping, so now he must eliminate future competition(ie bright new med students and residents) in order to boost salary since the CRNA route has been maxed out.

I agree that ether's original message was nice to hear from someone with experience, but the repetitive nature and the sky is falling diatribes are getting tiresome, especially in the face of the hypocrisy I mentioned above.

I agree that there are problems to be faced, but we are not the only branch of medicine facing them. Ours just seem to be a little more advanced at the current time.

On a brighter note, ether uses the derogatory term MDA much less often.

 

[chicamedica]

On the one hand I do smirk at the midlevels trying to take over our roles with much much less scientific education and rigorous training. On the other hand, as far as CRNAs go, I do see their value --> they can do the work that requires less analytical thinking that requires the advanced education we have, and meanwhile we are freed to pursue innovation and problem-solving.

I dont claim to be an expert as to how things function in the anesthesia world by any means, but the way I see things at my current beginning stage, it seems that in our field, especially in private practice, many are content with just cranking out as many cases as possible (which is fine and necessary for efficiency and getting people the surgical procedures they need in a timely manner). however, if the nurses succeed in being able to train themselves to do this in a safe way, perhaps we are not doing our educations justice by limiting ourselves to doing the same thing as they are.

With our depth of education I feel we should make an effort to expand our field beyond the usual OR gas-passing sphere. Heck, anesthesiologists should be THE experts on sleep medicine (why are the pulmonologists in charge of this?). THE experts on resuscitation (why are surgeons & EM depts mostly researching this?). We should know pharmacology in depth. Neuroscience is also central to the field. In other words, anesthesiology encompasses an amazingly broad range of knowledge and skill. Why are we so narrow in our practice? We should put our educations to use!

Also, side note, it shouldn't be about the money. focus on money is what put us in this situation in the first place. That, and the fact that the US has a history of nurses giving anesthesia (prior to that it was the med student's task), until it was realized how scientific this field really is. this is in contrast to europe, where anesthesiology has been a physician-trained field from the start.

 

[EtherMD]

Ether, I'll admit it was a nice addition to our boards when you first started mentioning the threats of CRNAs, reimbursement, etc. It's always nice to be aware of future happenings. Sometimes, though, I really question your motives. You have made a distinct point of reiterating this threat on several different threads, many times over. I think your message is clear. No need to beat a dead horse.

By creating this thread, you have now issued a warning to all medical students to steer clear of anesthesia, or at least beware. Although the threat of CRNAs is valid, the "truth" you speak is no more conjecture than anyone else on this site, you just happen to have a few more years direct experience in the matter.

I appreciate the words of wisdom, but please stop short of warning all future anesthesia candidates about entering the field. I, for one, am truly excited to enter the field with some of the brightest students as my colleagues. The last thing this field needs right now is a "sky is falling" perception amongst superb medical students. You can argue that evidence supports your predictions, but if your personal predictions are that spot-on, I'd say you're in the wrong business. The stock market is calling.

I'm not exactly an old guy in this forum, but I've been following it long enough to know there has been an inordinate amount of text committed to the death of the specialty in the past couple months. Here's what I think:

1) This isn't the first or last time someone will bemoan the threat of CRNAs.
2) This isn't the first or last time our reimbursement has been threatened by cuts.
3) I have followed your arguments on the other threads. I don't see what is unique about this era's problems vs. 10, 20 or 30 years ago.

I have yet to understand how a practicing professional and his colleagues can sleep at night knowing that both of these threats have been more or less constant for the last several decades, yet have chosen to do little to address them. Furthermore, I am appalled that the burden of change should be placed on a group of people who are just entering the profession. It reeks of insecurity (or sour grapes) when a professional would provide so many deliberate arguments convincing others NOT to enter the field. I think you have taken this a step too far by posting a warning on this forum that all future candidates with stellar board scores reconsider entering the field. Thanks, but no thanks.

You may be aware of the CRNA issue in the field but others are not. I am not trying to convince anyone to go into any particular specialty. Rather, I am trying to inform young Medical Students about the threat DNP CRNA's pose to the Anesthesiology. If MD/DO Anesthesiologists end up as "Supervisors" there will be too many graduates competing for those jobs. Dr. Lema predicts the same scenario as "likely" and those scoring high on their exams have other options to consider.

Things are different today than 20 years ago and the upcoming DNP CRNA issue is a real one. The highest paid Mid-Levels in the world are CRNA's. They are unique to Anesthesia and the AANA claims its membership represents the FIRST group of actual Anesthetists in the USA. The AANA claims Nurses were giving Anesthesia long before the ASA and will continue to do so.

I will continue to inform Medical Students and Residents about the CRNA problem as long as I am allowed to post on this board.

 

[EtherMD]

I feel lucky that I am not at a program that trains CRNA "residents"(you know they don't refer to themselves as students anymore), but ether's complaints about academic institutions rings hollow. He complains about academic faculty training CRNAs, then states that they aren't well trained enough to do the jobs he needs them to do(regional etc) so that he can maximize his income. So his response is to "get them up to speed" by providing additional OJT for them. If the truth was known, Ether has probably provided more training for CRNAs than the average academic anesthesiologist. Perhaps someone else has it right about his motive. The income is slipping, so now he must eliminate future competition(ie bright new med students and residents) in order to boost salary since the CRNA route has been maxed out.

I agree that ether's original message was nice to hear from someone with experience, but the repetitive nature and the sky is falling diatribes are getting tiresome, especially in the face of the hypocrisy I mentioned above.

I agree that there are problems to be faced, but we are not the only branch of medicine facing them. Ours just seem to be a little more advanced at the current time.

On a brighter note, ether uses the derogatory term MDA much less often.

The problem with most people is that they assume everyone has a "motive" for doing something. I hold the door open for people. I say Thank You to my waiter and tip at least 20%. I give to the ASA and charity. I support my local Church. I donate to various organizations. I am on this board to post my opinion about the specialty and inform others of the upcoming DNP CRNA threat. I wish someone would have done as much for me when I was a Medical Student.

Those students reading this post need to realize I am telling the truth about the problems Anesthesiology faces in the next ten years. THe most aggressive Advanced Practice Nurse is the CRNA. The highest paid Advanced Practice Nurse is the CRNA. Once "Doctor" is added to their title the push for independent practice rights in every state will only intensify.

So, review the facts about the CRNA issue before entering the field. This way you know the POTENTIAL problems facing you upon completion of training. I truly believe SOLO MD/DO Anesthesia will be DEAD in ten years in more than 90% of Anesthesia Practices. Meanwhile, CRNA SOLO Groups will proliferate during this same time span. This is my opinoin but one a young Medical Student should read before picking this specialty.

As for this post helping me you are completely wrong. This post hurts the Specialty and me because the Academic Chairs are STILL going to fill those spots. Guess who is going to fill them? What does that mean for the "quality" of Anesthesiologists and the specialty down the road?
If in 15 years CRNA quality with DNP is "excellent" while our new graduates are "poor" how does that affect job security? Think about it.

 

[EtherMD]

Medical Students need to look at the FACTS which are unique to Anesthesiology:

1. MD/DO Practices- Some are solo and some are "Anesthesia Care Team" (ACT) CRNA's provide 95% of the Anesthesia in the ACT with AA's about 5%.
Anesthesiologists supervise the Mid-Level Providers in the ACT; but, personally perform the anesthetic 100% of the time in the solo model.

2. Economics- It is more cost effective today to supervise multiple Mid-Level Providers than do your own anesthetic. THe President of the ASA predicts the ratio of supervisor (MD/DO) to Mid-Level will increase in the future from 4:1 (today) to 7:1. I agree with him.

In addition, the law allows CRNA's to administer their own anesthetic and bill the patient in 14 states with ZERO Physician supervision. All of the other states permit CRNA's to administer an anesthetic under the supervision of a dentist or surgeon.

With the pressure the health care system is under and will face in the very near future COST-EFFECTIVE is the new mantra for politicians. CRNA's are more cost-effective and provide the "service" for 1/2 what an MD/DO charges. This places SOLO MD/DO Anesthesia at a major economic disadvantage for the future.

3. Future- If we use basic logic and reasoning the health care system of the future will want cost-effective first and quality a close second. This means Anesthesiologists will end up as supervisors to Mid-Levels IF THEY ARE USED AT ALL. How many supervisors will the USA need? The Mid-Levels are really gearing up to meet demand over the next ten years. It only takes 28 months to train an AA from start to finish. The USA could rapidly increase AA's if needed. What about MD/DO Anesthesiologists? Where will all the current and future Anesthesiologists find work? The President of the ASA, Dr. Lema, is predicting that Anesthesiologists will end up as supervisors. I agree with him.

Will a Medical Student finishing training in 2013 find a job? How much will it pay if there is a SURPLUS of Board Certified Anesthesiologists looking for these jobs? Or, will the new graduate get stuck for a few years working for Mid-Level provider income?

The FACT remains that during the SHORTAGE years of late 1990's when the Residency Programs were producing fewer graduates than today NO PATIENT IN THE USA went without surgery/anesthesia. This "shortage" benefited those working in the field. What will a "surplus" due to the field? Think about it.

 

[nutmegs]

You may be aware of the CRNA issue in the field but others are not. I am not trying to convince anyone to go into any particular specialty. Rather, I am trying to inform young Medical Students about the threat DNP CRNA's pose to the Anesthesiology. If MD/DO Anesthesiologists end up as "Supervisors" there will be too many graduates competing for those jobs. Dr. Lema predicts the same scenario as "likely" and those scoring high on their exams have other options to consider.

Things are different today than 20 years ago and the upcoming DNP CRNA issue is a real one. The highest paid Mid-Levels in the world are CRNA's. They are unique to Anesthesia and the AANA claims its membership represents the FIRST group of actual Anesthetists in the USA. The AANA claims Nurses were giving Anesthesia long before the ASA and will continue to do so.

I will continue to inform Medical Students and Residents about the CRNA problem as long as I am allowed to post on this board.

you're the one who wants to decrease residency sizes too, right? for the record here.

 

[EtherMD]

you're the one who wants to decrease residency sizes too, right? for the record here.

I have stated previously that the Residency levels should be reduced to the mid 1990's level. This reduction of about 10-15% would help to ensure EVERY new graduate is in demand upon completion of training. In addition, if and when the ratio increases to 7:1 for supervison the reduction MAY help prevent a glut in the market place.

Or, do you prefer to graduate new Anesthesiologists who must struggle to find a job? New Physicians that compete against each other and more experienced, newly displaced, Board Certified Anesthesiologists for the available jobs.

Most specialties are very careful about "over-producing" too many graduates.
This keeps the law of supply vs. demand working on YOUR side. In my opinion, the best approach is to take the high road and "err" on the side of caution. New graduates deserve the same economic opportunity many of us enjoy today in the USA.

The Mid-Levels are here to stay. The ASA and Dr. Lema know this is economic reality. In fact, the AANA has plans to increase its numbers greatly. A sensible approach is to scale back the number of new graduates to the mid-1990's. Regardless of my opinion, the Academic Chairs won't do this because it will cost them money via your slave labor.

Do the Academic Chairs care about your career? Do they care about your future? Are they willing to reduce the number of positions if needed to maintain quality? In the past, the answers to these questions have been "No" and I doubt things have changed much.

It is kind of ironic that so many of you are skeptical of private practice guys trying to give you some advice/opinions because you believe the rhetoric of the academicians without a second thought. Why do you trust them so much? Years after you finish training and are looking for work will they care?
The fact is that each Medical Student needs to look out for his/her best interest. I invite every one of them to review the facts, ask questions and by all means think carefully about the pros/cons of the specialty. Their future may depend on it.

 

[Taurus]

One of your key assumptions is that supervision is required by an anesthesiologist. Will DNP CRNA's require supervision anymore? You can bet that the AANA will put up a huge fight for DNP CRNA's to be viewed at the same level as anesthesiologists.

 

[nutmegs]

I have stated previously that the Residency levels should be reduced to the mid 1990's level. This reduction of about 10-15% would help to ensure EVERY new graduate is in demand upon completion of training. In addition, if and when the ratio increases to 7:1 for supervison the reduction MAY help prevent a glut in the market place.

Or, do you prefer to graduate new Anesthesiologists who must struggle to find a job? New Physicians that compete against each other and more experienced, newly displaced, Board Certified Anesthesiologists for the available jobs.

Most specialties are very careful about "over-producing" too many graduates.
This keeps the law of supply vs. demand working on YOUR side. In my opinion, the best approach is to take the high road and "err" on the side of caution. New graduates deserve the same economic opportunity many of us enjoy today in the USA.

The Mid-Levels are here to stay. The ASA and Dr. Lema know this is economic reality. In fact, the AANA has plans to increase its numbers greatly. A sensible approach is to scale back the number of new graduates to the mid-1990's. Regardless of my opinion, the Academic Chairs won't do this because it will cost them money via your slave labor.

Do the Academic Chairs care about your career? Do they care about your future? Are they willing to reduce the number of positions if needed to maintain quality? In the past, the answers to these questions have been "No" and I doubt things have changed much.

It is kind of ironic that so many of you are skeptical of private practice guys trying to give you some advice/opinions because you believe the rhetoric of the academicians without a second thought. Why do you trust them so much? Years after you finish training and are looking for work will they care?
The fact is that each Medical Student needs to look out for his/her best interest. I invite every one of them to review the facts, ask questions and by all means think carefully about the pros/cons of the specialty. Their future may depend on it.

I simply prefer for people who are tempted to take your career counseling advice to know that.

 

[EtherMD]

One of your key assumptions is that supervision is required by an anesthesiologist. Will DNP CRNA's be required to be supervised anymore? You can bet that they will put up a huge fight to be viewed at the same level as anesthesiologists. They will argue why should doctorate-level nurses require supervision.

This is the same old battle with the Nurses but they have a little more ammo.
A Nurse with a DNP or PhD is not a MEDICAL DOCTOR. He/She did not go to MEDICAL SCHOOL and did not do a Residency/Fellowship. The patients keep getting older and sicker each year. The DNP's may get a few more "opt-out" states but NO COUNTRY in the DEVELOPED WORLD lets Nurses work UNSUPERVISED in O.R.'s of major hospitals. The USA will not go that "low" but will INCREASE the supervisory ratio to 7:1 from 4:1. This gives the Mid-Levels more "independence" but at the same time they still have "back-up" in the operating room. Many of them really do need the back-up.

Or, do you believe a CRNA with DNP can FULLY replace a Board Certified MD/DO? If so, you bought the rhetoric/propoganda hook, line and sinker from the AANA. The DNP CRNA is just one more propoganda tool in the AANA's belt.

 

[EtherMD]

I simply prefer for people who are tempted to take your career counseling advice to know that.

I am not "counseling" anyone about his/her career. I am stating problems the specialty is facing or may face in the near future. Medical Students should know the TRUTH about Anesthesiology and not just embrace the fairy tales that we work 40 hours per week and have a "great lifestyle."

Sorry Dorothy but you are not in Kansas anymore. IT is time to wake up and deal with the real world.

 

[EtherMD]

Okay, with all the "negatives" out there on the table I thought a few positives about the field might give a little balance:

1. Income- The Specialty enjoys good income and ranks in the upper quartile. THIS the primary reason the Nurses want to muscle in on our turf.
Even with changes to the system the specialty is likely to remain in the upper half or better of Medical Specialties.

2. Cases/Procedures- We get to avoid long, boring rounds and do "cool" procedures. The specialty is very procedure oriented yet still retains a significant "cognitive" process to dealing with problems/situations.

3. Short Term- Unless you do Pain Management or Critical Care our patient contact is short term management.

4. Predictable Schedule- I know months in advance my call, my weekends off and my vacation. The GROUP Practice helps ensure everyone can have a life.

5. Hours- The specialty lets you choose the "route/path" you want to follow as far as money vs. hours. Those wanting to make more money get a job in a busy Group working a lot of hours and doing/supervising a lot of cases. Those who don't mind earning less money can find work in a laid back Group or as an employee with a much easier schedule. There is plenty of part-time work and day-time only jobs.


This specialty is worth fighting for. We have "issues" that need to be dealt with and resolved if the field is going to maintain items 1-5. A Medical Student can still do very well by choosing Anesthesiology as a career choice.
But, look at all the facts when picking your specialty and take off the rose colored glasses.

 

[SexPanther]

Okay, with all the "negatives" out there on the table I thought a few positives about the field might give a little balance:

1. Income- The Specialty enjoys good income and ranks in the upper quartile. THIS the primary reason the Nurses want to muscle in on our turf.
Even with changes to the system the specialty is likely to remain in the upper half or better of Medical Specialties.

2. Cases/Procedures- We get to avoid long, boring rounds and do "cool" procedures. The specialty is very procedure oriented yet still retains a significant "cognitive" process to dealing with problems/situations.

3. Short Term- Unless you do Pain Management or Critical Care our patient contact is short term management.

4. Predictable Schedule- I know months in advance my call, my weekends off and my vacation. The GROUP Practice helps ensure everyone can have a life.

5. Hours- The specialty lets you choose the "route/path" you want to follow as far as money vs. hours. Those wanting to make more money get a job in a busy Group working a lot of hours and doing/supervising a lot of cases. Those who don't mind earning less money can find work in a laid back Group or as an employee with a much easier schedule. There is plenty of part-time work and day-time only jobs.


This specialty is worth fighting for. We have "issues" that need to be dealt with and resolved if the field is going to maintain items 1-5. A Medical Student can still do very well by choosing Anesthesiology as a career choice.
But, look at all the facts when picking your specialty and take off the rose colored glasses.

It's always nice to smell some roses now and then.

 

[proman]

Ether,

You've mentioned the potential supervisory ratios changing. How many times do you go in during cases during a 4:1 ratio? From what I've seen, 4:1 keeps you very busy and very rarely does the anesthesiologist regularly check up on rooms (more like q45min + induction + extubation). It seems to me that going to 7:1 would essentially eliminate any time to check in on rooms and that realistically you could only be there for inductions. What are your thoughts on how this would change the practice (not politics) of the specialty?

 

[Voodoo]

EtherMD, would you please stop trying to scare everyone?

This crap about DNP's is not too new ... for those of you who aren't aware, there was some huge initiative by the ANA to have all graduate nursing degrees converted into clinical doctorates by the year 2008. There was some huge hullabaloo about how CRNA's were going to start receiving clinical doctorates by that time, as well. What ended up happening is that the ASA started lobbying, people started realizing that this was just plain old misrepresentation of educational status towards patients, and it was shot down, like it will be in the next 20 years or [insert time frame 'till armageddon here].

I really do appreciate your passion towards the subject, but I think that your idea of limiting the number of people in the profession is absolutely wrong. I see a large number of academic institutions starting to push young residents into fellowships under the guise of "job security." All they're doing is just keeping med students away by asking them to do 1+ additional years of training. Limiting anesthesiologists in the job market may temporarily keep or boost salaries, but will eventually lead to the decline of the field, and fewer advances in anesthetic safety and care. It's a similar attitude that the Anesthesiologists of yerster-year had when they allowed this whole mess to occur in the first place.

My $0.02

 

[salmonella]

The easiest way to get rid of CRNAs is by training more anesthesiologists (two or may be three times of the current yearly graduates) and flood the market, kick all the CRNAs out. That way anesthesiologists will once again have complete control of everywhere from OR to critical care. To do this we'll all have to take a slight salary cut, so hospitals will have no more financial incentives to hire CRNAs. This may sound painful now, but in the long run it will save our profession.

If we decrease program size, like Ether suggested, we are basically asking more CRNAs and AAs to replace us. This strategy of backing off probably isn't the most ideal; Instead, we need to push forward aggressively, increase number of anesthesiologists and regain the market that belongs to us. Plus, more students are interested in anesthesia nowadays. We don't want to kill their dreams of getting residency spots by making anesthesia too competitive.

 

[Bertelman]

I am not "counseling" anyone about his/her career.

Oh, really?

Every Medical Student has to ask himself/herself one very important question prior to choosing this specialty: Do I mind earning 25% more than a CRNA?
...
Perhaps, some Medical Students scoring high on their exams should know these facts when considering this field. Perhaps, a few will choose another area not threatened by Mid-Level Nurses.

Thanks for raising the warning flag to all current medical students. You waltz in with assertions, predictions and conjecture about the future. You currently have no solid proof that any of this will happen, yet you choose to scare others - nay, the BEST CANDIDATES - from this pursuit. Unsatisfied with the resolution of several other threads on this identical topic, you have now created this, an explicit warning to all that this profession is a dead-end road.

As long as you make the decision with your eyes open to the reality of the field and not based on false assumptions choosing Anesthesiology can be a rewarding field.

Would you prefer us base our decisions on your equally questionable predictions?

There are other qestions to ask as well but the income question is very important and you need to be honest with yourself.

I believe you are overestimating the value new grads place on income. Remember your first job? I'm not talking about anesthesia. Your FIRST job. You probably made $2 an hour. Felt pretty good, huh? As a soon-to be resident, I can confidently say that a salary of $250k would make me wet my pants. In one year I will have surpassed all previous income from every job I have ever worked. Wow. You know what is scary, though? Being in private practice, with pipe dreams of making 500k like the good 'ole days, and realizing this cash cow is leaving the station. I'm gonna take a stab at this and say the reason you spend so much time on our board is not to warn others (whom you have never met), but to guarantee your own future.

I am not "alarmed" by CRNA salary increases as I have been paying them every year.

Wait, I don't understand...you mean you have supported their sustenance, "released the hounds", yet now are upset at the strides they have made? Don't look at us for a shoulder to cry on. We were in high school when you were using CRNAs to squeeze a few more lap choles into the schedule. It's not our fault.

Sorry Dorothy but you are not in Kansas anymore. IT is time to wake up and deal with the real world.

But YOU'RE not dealing with the real world. You are trying to shape the future at the expense of others. How about YOU deal with the real world and accept a big decrease in reimbursement? Or accept responsibility for driving this specialty to where it stands today?

Do the Academic Chairs care about your career? Do they care about your future? Are they willing to reduce the number of positions if needed to maintain quality? In the past, the answers to these questions have been "No" and I doubt things have changed much.

It is kind of ironic that so many of you are skeptical of private practice guys trying to give you some advice/opinions because you believe the rhetoric of the academicians without a second thought. Why do you trust them so much? Years after you finish training and are looking for work will they care?
The fact is that each Medical Student needs to look out for his/her best interest. I invite every one of them to review the facts, ask questions and by all means think carefully about the pros/cons of the specialty. Their future may depend on it.

I'll be honest, I don't trust academicians any more than I trust you. But I'll say this- the faculty members that train me will have done much more for the specialty and my future than you ever have. You chose a lucrative private practice job instead of training future docs. Who would you trust- an academic anesthesiologist that has spent three years training you to become the best possible physician, or a character named EtherMD on an anonymous internet forum, with no visible credentials? For all I know, you are the president of the AAAA, trying to drum up support to increase the number of AA schools.

If you are sincerely interested in improving our future, here's a word of advice. As residents, we are probably the LEAST likely candidates to effect change in this arena. Cast your spell on the ASA, the RRC, whomever. The last question on my mind when I begin my first day as a CA-1 in 15 months will be, "Hey, Dr. PD, when do you plan on decreasing the number of residency positions to ensure our future in the face of a perceived threat from mid-levels, likely cuts in medicare reimbursement, and unpredictable changes in legislature? I'd really like you to get on that!"

By the way, your argument here is not logical. You claim that reducing residency positions will maintain quality, yet in other posts you warn that the most board-worthy applicants consider other fields. So, you are actually suggesting a two-fold plan: DECREASE the numbers of anesthesiologists and DECREASE their perceived intelligence. Brilliant. Sounds like a rock-solid plan for the future of our specialty. Tell me where to sign up.

 

[nutmegs]

Oh, really?



Thanks for raising the warning flag to all current medical students. You waltz in with assertions, predictions and conjecture about the future. You currently have no solid proof that any of this will happen, yet you choose to scare others - nay, the BEST CANDIDATES - from this pursuit. Unsatisfied with the resolution of several other threads on this identical topic, you have now created this, an explicit warning to all that this profession is a dead-end road.



Would you prefer us base our decisions on your equally questionable predictions?



I believe you are overestimating the value new grads place on income. Remember your first job? I'm not talking about anesthesia. Your FIRST job. You probably made $2 an hour. Felt pretty good, huh? As a soon-to be resident, I can confidently say that a salary of $250k would make me wet my pants. In one year I will have surpassed all previous income from every job I have ever worked. Wow. You know what is scary, though? Being in private practice, with pipe dreams of making 500k like the good 'ole days, and realizing this cash cow is leaving the station. I'm gonna take a stab at this and say the reason you spend so much time on our board is not to warn others (whom you have never met), but to guarantee your own future.



Wait, I don't understand...you mean you have supported their sustenance, "released the hounds", yet now are upset at the strides they have made? Don't look at us for a shoulder to cry on. We were in high school when you were using CRNAs to squeeze a few more lap choles into the schedule. It's not our fault.



But YOU'RE not dealing with the real world. You are trying to shape the future at the expense of others. How about YOU deal with the real world and accept a big decrease in reimbursement? Or accept responsibility for driving this specialty to where it stands today?



I'll be honest, I don't trust academicians any more than I trust you. But I'll say this- the faculty members that train me will have done much more for the specialty and my future than you ever have. You chose a lucrative private practice job instead of training future docs. Who would you trust- an academic anesthesiologist that has spent three years training you to become the best possible physician, or a character named EtherMD on an anonymous internet forum, with no visible credentials? For all I know, you are the president of the AAAA, trying to drum up support to increase the number of AA schools.

If you are sincerely interested in improving our future, here's a word of advice. As residents, we are probably the LEAST likely candidates to effect change in this arena. Cast your spell on the ASA, the RRC, whomever. The last question on my mind when I begin my first day as a CA-1 in 15 months will be, "Hey, Dr. PD, when do you plan on decreasing the number of residency positions to ensure our future in the face of a perceived threat from mid-levels, likely cuts in medicare reimbursement, and unpredictable changes in legislature? I'd really like you to get on that!"

By the way, your argument here is not logical. You claim that reducing residency positions will maintain quality, yet in other posts you warn that the most board-worthy applicants consider other fields. So, you are actually suggesting a two-fold plan: DECREASE the numbers of anesthesiologists and DECREASE their perceived intelligence. Brilliant. Sounds like a rock-solid plan for the future of our specialty. Tell me where to sign up.

thanks for saying everything I didn't have the time & patience to lay out.

 

[EtherMD]

I appreciate your response. Remember, you are interpreting my posts the way you want to read them a bit. You assume a great deal when stating I have an "agenda" to "dumb down the profession" and "scare away Medical Students". That is not my intention at all. I am simply trying to explain LIKELY problems the specialty will face in the next 10-15 years. These "problems" were listed in a lecture by the President of the ASA, Dr. Lema, three months ago. I agree with him.

Medical Students need to be aware of these issues PRIOR to selecting the specialty. This way they enter the field with their eyes open and MAY be able to help the specialty at an earlier age than those who preceeded them.
Unfortunately, the specialty needs your input and suggestions while in training because many decisions are NOT in your best interest.

For example, does your Residency program train SRNA's? Student Nurse Anesthetists who may COMPETE against you one day? How does this HELP you in the future? Does your Residency program train AA's? Mid-Levels who MUST work under the supervision of a Board Certified Anesthesiologist. Why not train them instead?

Does your program encourage active political involvement and explain that Nurse Anesthetist can bill Independently? That a CRNA gets paid the same amount of money from Medicare as a Board Certified Anesthesiologist?

As for MD/DO's replacing ALL the CRNA's in the market place it will NEVER happen. First, there are about 40,000 CRNA's. Second, many academic programs CONTINUE to train them and will keep doing so. Third, Nurses will always work for less money than you do. Even if they take a 50% pay cut they will keep working as a CRNA.

By returning to the numbers of the mid 1990's the specialty can regain "balance." This small reduction would maintain quality and hedge the law of supply vs. demand in YOUR favor. But, the Academic Chairs won't do this because they LIKE the cheap labor MORE Residents mean to them. The Chairs have their own best interest in mind by training MORE Residents and SRNA's. If the Chairs reduced the Residency slots by 10% and trained AA's instead of SRNA's then they would be acting in YOUR best interest; or, at least trying to do so.

One last thing about the "extra" year called fellowship. Even though the academic chairs want you to do this extra year to benefit them I firmly believe it benefits you even more. This additional year makes you a true sub-specialist with advanced skills beyond the average Anesthesiologist. A smart move to help ensure your economic surivival in the future.

 

[EtherMD]

Ether,

You've mentioned the potential supervisory ratios changing. How many times do you go in during cases during a 4:1 ratio? From what I've seen, 4:1 keeps you very busy and very rarely does the anesthesiologist regularly check up on rooms (more like q45min + induction + extubation). It seems to me that going to 7:1 would essentially eliminate any time to check in on rooms and that realistically you could only be there for inductions. What are your thoughts on how this would change the practice (not politics) of the specialty?

I agree with your post. At 7:1 the MD/DO would not be there except for some inductions and problems. But, this 7:1 ratio gives those pesky DNP CRNA's the "room to act more independently" that they will demand. I do not prefer 7:1 and am not advocating that ratio. 5:1 is pretty close to the maximum ratio for "close" supervision. Anything more than that and you are a problem solver and help start the tough cases.

 

[EtherMD]

Here are my Wizard of Oz fixes to the field:

1. The Mid-Levels are brougt back in the line. Through the use of many more AA's the AANA backs off its "opt-out" hunt for more states and Independent practice. The AANA accepts supervision as the standard of care in all major hospitals.

2. The Academic Chairs start a dozen more AA programs and reduce the number of residency slots by 10%. "Quality" bcomes more important than quantity.

3. Beefed up Certificate- The ASA and the Chairs beef up your certificate/certification to include Basic TEE, Perioperative Medicine, U/S guidance and critical care medicine. You get the critical care medicine training as part of the standardized four year residency. All CATEGORICAL Positions will include this as part of the training.

4. ASA starts a TV/Internet/radio public message campaign in 2007. The monkey ads are a huge hit.

5. Republican candidate wins the White House. Socialized Medicine postponed for at least 4 more years. New administration works with existing insurance carriers to get "basic" coverage for all working Americans.

 

[Flycatcher]

EtherMD, would you please stop trying to scare everyone?

Agreed. Ether, like others here I have appreciated your thoughtful and honest (as you see the situation) posts here, but I think there's something to be said for an occasional moratorium on doomsaying. Match Day was barely a week ago, but even when it was a day ago, there was no respite from your ill prognoses for Anesthesiology. Isn't a time when a lot of people here are understandably happy and excited about getting into residency, even in the "doomed" field of Anesthesiology, a good time to pause and just says "Congratulations" or "Good luck," rather than another thread or post on the narrowing gap between MD and CRNA salaries?

As a rule, medical students and residents of any degree or field aren't stupid people. I think the vast majority of posters here are capable of reading your many posts and assessing the information within, along what we learn or hear from other sources. We wouldn't have made it through medical school or matched if we lacked or were even average in those cognitive skills. There's time and a need in the future (however limited) for us to figure out how to save our field, if necessary, but many posters here just learned for certain that Anesthesiology would in fact be our field, after years of hard work and months of stressing. How about just letting the moment last, congratulating and wishing well to whose who matched, and leaving us for a little while to our dreams of a future of $500k salaries and 40 hour work-weeks... er, I mean our dreams of an intellectually rewarding and personally satisfying career in Anesthesiology?

 

[EtherMD]

Agreed. Ether, like others here I have appreciated your thoughtful and honest (as you see the situation) posts here, but I think there's something to be said for an occasional moratorium on doomsaying. Match Day was barely a week ago, but even when it was a day ago, there was no respite from your ill prognoses for Anesthesiology. Isn’t a time when a lot of people here are understandably happy and excited about getting into residency, even in the "doomed" field of Anesthesiology, a good time to pause and just says "Congratulations" or "Good luck," rather than another thread or post on the narrowing gap between MD and CRNA salaries?

As a rule, medical students and residents of any degree or field aren't stupid people. I think the vast majority of posters here are capable of reading your many posts and assessing the information within, along what we learn or hear from other sources. We wouldn’t have made it through medical school or matched if we lacked or were even average in those cognitive skills. There's time and a need in the future (however limited) for us to figure out how to save our field, if necessary, but many posters here just learned for certain that Anesthesiology would in fact be our field, after years of hard work and months of stressing. How about just letting the moment last, congratulating and wishing well to whose who matched, and leaving us for a little while to our dreams of a future of $500k salaries and 40 hour work-weeks... er, I mean our dreams of an intellectually rewarding and personally satisfying career in Anesthesiology?

Good Luck and Congradulations. However, I started this thread for the uninformed and uneducated MSII and MSIII. I inteneded to explain the problems/negatives of the field to them. In addition, please feel free to post the positives and emphasize the strength's of the specialty.

Also, you are free to ignore this thread and my posts. Is there someone holding a gun to your head making you read my comments? All you have to do is not click on this thread to avoid reading anything negative. It is not like I am on EVERY thread making negative comments about the field. Anesthesiology has been good to me. I hope it will be as good to you.

 

[Flycatcher]

I started this thread for the uninformed and uneducated MSII and MSIII. I intended to explain the problems/negatives of the field to them.

If this thread was started solely for the benefits of MSIIs and IIIs, I didn't know that and don't see how I could have known that. The thread title is addressed to "medical students" broadly rather than a specific class-year. Nor does anything in the initial post indicate that focus, except possibly the line about "prior to choosing a specialty" (although some slackers like myself don't make their choice until MSIV/ their last year)

If Anesthesiology has been good to you, it's curious that you would create a thread solely for the purpose of "explaining the problems/negatives of the field," only adding a perfunctory list of positives as an afterthought over a day later. I'm finishing an MD/PhD program and could post at length about the negative aspects of the joint degree, from actually getting it in med school to actually using it in a career. But I would definitely say that on the balance, "the MD/PhD has been good to me." And when I discuss it, much less were I to open a thread about it, I discuss both its positive and negative aspects and most likely emphasize the positive.

you are free to ignore this thread and my posts. Is there someone holding a gun to your head making you read my comments? All you have to do is not click on this thread to avoid reading anything negative. It is not like I am on EVERY thread making negative comments about the field.

Not every, but it's not been a few, either. It's something of a straw man to say all I have to do is not click on the thread, if only at the start, as most of the negative threads have "innocuous" titles, like this one does. And of course anyone of us can just ignore your posts; I've done that to plenty of posts, not just yours. But I'd like to think we can all strive to post in ways that don't often cause the rest of the "community" to avert its eyes and scroll past wherever our screen names crop up, and one way to do that is to know when to just let an issue drop after you've made your point multiple times. Even on Internet forums, I believe there is something to be said for saying your piece and then moving on.

And on that note, I've certainly said my piece by now, so I'll set a good example myself and drop out of this exchange.

 

[badgas]

I can see where flycatcher is coming from. The constant CRNA threads can get a bit old to most of us. However, I think that what Ether is doing is great. I personally appreciate the fact that he puts his time and knowledge out there when a new thread pops up about CRNA and political issues. The reason that anesthesia has got itself into this mess in the first place can be attributed to people not wanting to think about or do anything about some of the unpleasant issues. Now is the time to educate students, residents and even some attendings on what is going on. With stronger and stronger resident classes graduating each year, maybe some of us can get up off our asses and stop this mess before it goes past the point of no return. So thank you ether... I hope you keep putting the time and effort into the informative posts.

 

[opa beleza?]

Agreed. Ether, like others here I have appreciated your thoughtful and honest (as you see the situation) posts here, but I think there's something to be said for an occasional moratorium on doomsaying. Match Day was barely a week ago, but even when it was a day ago, there was no respite from your ill prognoses for Anesthesiology. Isn’t a time when a lot of people here are understandably happy and excited about getting into residency, even in the "doomed" field of Anesthesiology, a good time to pause and just says "Congratulations" or "Good luck," rather than another thread or post on the narrowing gap between MD and CRNA salaries?

As a rule, medical students and residents of any degree or field aren't stupid people. I think the vast majority of posters here are capable of reading your many posts and assessing the information within, along what we learn or hear from other sources. We wouldn’t have made it through medical school or matched if we lacked or were even average in those cognitive skills. There's time and a need in the future (however limited) for us to figure out how to save our field, if necessary, but many posters here just learned for certain that Anesthesiology would in fact be our field, after years of hard work and months of stressing. How about just letting the moment last, congratulating and wishing well to whose who matched, and leaving us for a little while to our dreams of a future of $500k salaries and 40 hour work-weeks... er, I mean our dreams of an intellectually rewarding and personally satisfying career in Anesthesiology?

WRONG. Match day is just the beginning of what could be a long tough uphill battle. Never stop talking and pushing. Eventually solutions can come from discussion. If you want to dream, thats cool go do that. We are here to figure this out, so get on board or stay the hell out of the way --- never tell someone to halt their efforts -- remember only a portion of the group just matched, the others (the med studs) are either deciding what to do or are debating how to fight for what should be theirs (residents). Real work is rare, don't F it up when someone is willing to commit time to it.

 

[Taurus]

I think Ether is doing a service. How many attendings who are in the trenches would take the time to share their knowledge and experiences with us? Most of them are too busy figuring how to pad their incomes with CRNA's while giving a damn about future generations of anesthesiologists. He's giving us an unvarnished view of things to come and not sugarcoating it like most attendings would if you ask them straight to their face.

But this is just talk and I'm tired of talk. I want to see action. I want to see more AA schools open, CRNA programs converted to AA ones, anything to beat back this CRNA tide.

 

[Be a Pro]

Agreed. Ether, like others here I have appreciated your thoughtful and honest (as you see the situation) posts here, but I think there's something to be said for an occasional moratorium on doomsaying. Match Day was barely a week ago, but even when it was a day ago, there was no respite from your ill prognoses for Anesthesiology. Isn’t a time when a lot of people here are understandably happy and excited about getting into residency, even in the "doomed" field of Anesthesiology, a good time to pause and just says "Congratulations" or "Good luck," rather than another thread or post on the narrowing gap between MD and CRNA salaries?

As a rule, medical students and residents of any degree or field aren't stupid people. I think the vast majority of posters here are capable of reading your many posts and assessing the information within, along what we learn or hear from other sources. We wouldn’t have made it through medical school or matched if we lacked or were even average in those cognitive skills. There's time and a need in the future (however limited) for us to figure out how to save our field, if necessary, but many posters here just learned for certain that Anesthesiology would in fact be our field, after years of hard work and months of stressing. How about just letting the moment last, congratulating and wishing well to whose who matched, and leaving us for a little while to our dreams of a future of $500k salaries and 40 hour work-weeks... er, I mean our dreams of an intellectually rewarding and personally satisfying career in Anesthesiology?

Hey buddy, Congratulations on the match!!!! Now get back to work and protect the field you are so proud of entering...