Nurses looking to replace Anesthesiologists in "collaborative model": Repost from Anesthesiology

[DrCommonSense]

I have included an article from the PRESIDENT of AANA concerning their belief for the future "cost effective" model for Anesthesiologist in the future.

Unfortunately, the model for anesthesiologists in the future very may well be "collaborative" compared to "supervising" CRNAs. If that occurs, expect anesthesiologists to be paid marginally more than CRNAs per hour (5% premium).

The VA independence in the first step towards the decline. Once the VA can "prove" independent CRNAS are equal to "MDAs" in the vast majority of cases (will only take a few years), it will be game over. They will clamor for "collaborative" models in the future hardcore after a few years of VA independence.

Future changes will likely include:

1) Collaboration model with a slight premium for Anesthesiologist who will have to take "liability" for a CRNA that gets into a difficult situation. Salaries will decline for almost all specialists to above 30-50% over PCP but particularly for Anesthesiologists this is an acute issue with VA independence.
2) Decreased reimbursement towards the Medicare payment model (33% of private insurance) as Obamacare premiums skyrocket. This will be made possible with no stipend offered for anesthesiologist practices and increased utilization of CRNAS as more "cost effective" in the future
3) AMC take over of the vast majority of practices (NAPA is the biggest example) due to PE money and Mckinsey consultants
4) Continued pushing for "independence" by healthcare "consultants" while the profits go to PE/Consultants with MBAs taking the profit margins that are left over.
5) Increased liability due to lack of tort reform in the future coupled with increased risk with coverage of "collaborative" CRNAs while not getting paid for it.

This is the opinion of big business/Hillary/militant CRNA PACs for the future who are all collaborating together to make this come to fruition after they can use the VA as "proof":

http://www.beckershospitalreview.co...-quality-anesthesia-care-at-a-lower-cost.html

Notice the article from Becker Spine is supporting strongly by the "Lewin" group that says anesthesiologists are NOT cost effect at all basically in ANY model.


The question occurs for physicians with good net worths (>3-5 million), is it worth it to continue to practice with largely decreasing reimbursement, increased liability, etc?

Would it be better to be a PCP under these systems with a slight decrease in salary but largely less liability? Remember Anesthesiology has HUGE liability risk that is largely uncontrollable in the future due to surgeons/administrators DICTATING providers to do cases or be fired when consolidation occurs, especially with an overabundance of CRNAs.

Any good MBA could tell you about NPV valuations and DCF in the future. According to an NPV analysis, even after tax income of 300K for 30 years is only equivalent to about 3 million in the bank now at a discount rate of a conservative 6%.

That is why Anesthesiologist have net worth's on average of "2.68" on the medscape survey that is equivalent to between 500-1million and 1-2 million, most in their 60s and 70s. The future will be worse.

Therefore, it might be better to get into the "lower risk" specialities in the future, even if anesthesiologist only makes a slight premium, particularly if you have ASSETS.

Also, don't trust the crap that they won't sue you over "your limits". They will get a forensic account to determine your net worth. If you have millions exposed in stocks, cash, etc, they WILL go after that if they get a big judgement (not that difficult anymore with the huge increases in lawsuits recently).

One of many my friend: http://www.chicagotribune.com/business/ct-u-of-c-malpractice-verdict-0701-biz-20160630-story.html

http://www.chicagotribune.com/busin...ctice-settlement-0223-biz-20160222-story.html

Damn that MBA or even lower risk "lower paid" specialties are looking more and more attractive these days for physicians with any money.

Even if Pain pays less, the benefit might be that you can limit your liability if you are a higher asset physician. Food for thought

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[Aether2000]

The only way out is for anesthesiology groups to decide to substitute less income (with the hiring of anesthesiologists instead of nurses to give anesthesia) for the preservation of the profession. The wildcard in some states are the AAs, but they are demanding equal pay to the CRNAs. AAs (not meaning African Americans) could be used as a tool to extract concessions from CRNAs in employment, but keeping the AAs at arms length lest they become a second wave of insurgency into the profession of anesthesiology.

 

[drusso]

This will soon happen in Pain Medicine too. The pain clinic of the future is staffed with "teams" of Pharm.D's & LCSW's "supervised" by a NP.

 

[DrCommonSense]

The only way out is for anesthesiology groups to decide to substitute less income (with the hiring of anesthesiologists instead of nurses to give anesthesia) for the preservation of the profession. The wildcard in some states are the AAs, but they are demanding equal pay to the CRNAs. AAs (not meaning African Americans) could be used as a tool to extract concessions from CRNAs in employment, but keeping the AAs at arms length lest they become a second wave of insurgency into the profession of anesthesiology.

Don't think that will work anymore.

1) Older patients won't change attitude on the subject and soon retirement. Why would they cut their salary? Academia doesn't really care either.
2) VA will setup system showing CRNAs are "safe" that will be used elsewhere for cost effective management. Read the beckerspine article from the AANA President. He is very obvious in his intentions.