questions about MD vs CRNA 2015

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jw3600 said:
Don't get your panties in a bunch because no one bought your nursing propaganda that nursing school is harder than medical school.

As to the other point. That poster was literally saying that consig. expressed a negative outlook for anesthesia as a means to get newer grads to work for less....you're joking right?

Reasonable people can debate the future of gas. But to deny that there are concerning changes is either dumb or disengenious.
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I see that your reading comprehension skills still need work.
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I am not joking. How much do residents know about the business of anesthesia....little to nothing in the majority of cases. So when you go from making 50-60k a year in residency to making 250-300k first year out that sounds great, right. But the 250-300k does not sound nearly as good when the new grad is responsible for billing 600k-1mill+ a year in a busy practice. So I do not understand the predictions of 250k a year unless you are going to be employed and someone will be skimming off the top (probably with the excuse of overhead)...please feel free to explain.
 
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chocomorsel said:
Jwk, I was thinking the same thing. "Under the strictest of supervision" sounds questionable. At my last practice only the Docs put in epidurals and took care of all the OB needs. Yes we would wake up in the middle of the night and come take care of the patient. Yes, I hated it, but it was what was best for the patient.
What happens if the patient or baby crashes after epidural and the doc is at home supervising in what turns out to be an emergency? Is there time to wait as doc drives in? I can see the doc being in house along with the CRNA but leaving him/her alone seems like asking for trouble.
Strictest of supervision my ass!!! But hey, long as he is getting paid handsomely right?
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Right!:biglove:
 
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Consigliere said:
Right!:biglove:
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And there you have it folks. Why this profession is getting taken over by mid levels nurses.
Tell us Consigliere, do u supervise these nurses while they do OB in the daylight hours? Or are they on their own during that time as well under "the strictest of supervision ?
One thing I gotta give you man. At least you are transparent. You have made it clear that it is ALL ABOUT THE MONEY for you. Haven't tried to hide that fact. You've kept that real .
 
Stank811 said:
I am not joking. How much do residents know about the business of anesthesia....little to nothing in the majority of cases. So when you go from making 50-60k a year in residency to making 250-300k first year out that sounds great, right. But the 250-300k does not sound nearly as good when the new grad is responsible for billing 600k-1mill+ a year in a busy practice. So I do not understand the predictions of 250k a year unless you are going to be employed and someone will be skimming off the top (probably with the excuse of overhead)...please feel free to explain.
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There's your explanation right there.
 
chocomorsel said:
And there you have it folks. Why this profession is getting taken over by mid levels.
Tell us Consigliere, do u supervise these nurses while they do OB in the daylight hours?
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Absolutely. And I'm not the reason this profession is "getting taken over by midlevels"; that train had already left the station, kid.
 
Ok. So if they are on their own at night, why do they need your supervision in the daytime? What about OR cases? Are they on their own too at night?
What do you think is going thru their minds at night as you snooze at home? What do you think is going thru the surgeons minds? Why are you even there? To sign a bunch of charts? And of course laugh all the way to the bank at this very well paying scam you are running?
 
Jesus. The prospect of doing internal medicine for 3 years just to reapply again for another specialty that pays the same as a glorified resident (hospitalist) unless you scope ass does not excite me.
 
Carbocation1 said:
Jesus. The prospect of doing internal medicine for 3 years just to reapply again for another specialty that pays the same as a glorified resident (hospitalist) unless you scope ass does not excite me.
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Lol, wut? You know of residents that make $200-250k working 180 days?

If the prospect of internal medicine doesn't excite you, then don't do it. No one is forcing you. It's also getting a lot more competitive to get into a decent academic institution, so it's not like we're rolling out the red carpet for you.

Having the whole "reapply" thing in IM can be a plus or minus. My aspirations starting intern year are NOT the same as my aspirations now, and I thank my lucky stars I didn't have to apply to fellowship straight off the bat.
 
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chocomorsel said:
Ok. So if they are on their own at night, why do they need your supervision in the daytime? What about OR cases? Are they on their own too at night?
What do you think is going thru their minds at night as you snooze at home? What do you think is going thru the surgeons minds? Why are you even there? To sign a bunch of charts? And of course laugh all the way to the bank at this very well paying scam you are running?
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I'll forgive your ignorance and naivety and attribute it to lack of experience. Now the knowledge I'm about to spit will be invaluable so feel free to print this reply and reference it when you have a clue. Taking your angry questions in order...
We do not bill for medical direction for epidurals EVER...daytime, nighttime. WE (anesthesiologists) developed the protocols, WE are available to answer any and all questions related to said epidurals, and WE manage any and all complications (ie PDPH). Any ***** can put in an epidural - you don't need an anesthesiologist to do that. We supervise all OR cases, day and night. Yes we come in at night. I don't care what's going through the CRNAs' minds as we snooze at night....probably how well they're paid and what a good gig they have. The surgeon's love us and appreciate the fact that we are so involved in the pt's care. I am here to manage the pt's pre/intra/post operative care and prevent the potential disasters that may occur. FYI, this "very well paying scam" you accuse me of running happens to be the way the overwhelming majority of anesthetics are delivered in the USA. Get used to it because you'll some day be part of it. Redirect your supposed righteous indignation towards another worthwhile endeavor. Peace out!
 
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bronx43 said:
Lol, wut? You know of residents that make $200-250k working 180 days?

If the prospect of internal medicine doesn't excite you, then don't do it. No one is forcing you. It's also getting a lot more competitive to get into a decent academic institution, so it's not like we're rolling out the red carpet for you.

Having the whole "reapply" thing in IM can be a plus or minus. My aspirations starting intern year are NOT the same as my aspirations now, and I thank my lucky stars I didn't have to apply to fellowship straight off the bat.
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I meant that fellowships constitute additional training that mostly do not result in more pay than a hospitalist (i.e., a glorified resident, depending on one's institution). My bad if that was unclear.
 
Consigliere said:
I'll forgive your ignorance and naivety and attribute it to lack of experience. Now the knowledge I'm about to spit will be invaluable so feel free to print this reply and reference it when you have a clue. Taking your angry questions in order...
We do not bill for medical direction for epidurals EVER...daytime, nighttime. WE (anesthesiologists) developed the protocols, WE are available to answer any and all questions related to said epidurals, and WE manage any and all complications (ie PDPH). Any ***** can put in an epidural - you don't need an anesthesiologist to do that. We supervise all OR cases, day and night. Yes we come in at night. I don't care what's going through the CRNAs' minds as we snooze at night....probably how well they're paid and what a good gig they have. The surgeon's love us and appreciate the fact that we are so involved in the pt's care. I am here to manage the pt's pre/intra/post operative care and prevent the potential disasters that may occur. FYI, this "very well paying scam" you accuse me of running happens to be the way the overwhelming majority of anesthetics are delivered in the USA. Get used to it because you'll some day be part of it. Redirect your supposed righteous indignation towards another worthwhile endeavor. Peace out!
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Is this a positive post about anesthesiology?
 
Carbocation1 said:
I meant that fellowships constitute additional training that mostly do not result in more pay than a hospitalist (i.e., a glorified resident, depending on one's institution). My bad if that was unclear.
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Ah, I gotcha.

To be fair, with the exception of some of the higher paying specialties, not many gigs out there beat out hospital medicine when you calculate per hour pay, and the benefits of shift work. It's rough when you're on, but when I come off an easy service week, I sometimes wonder why I get paid for doing this. But keep in mind that the current system won't last. Don't look at what pays high or low now and think that this is permanent - if anything I would argue that the high paying specialties are only more likely to take big cuts in the coming years. Scopes are on the chopping block, as CMS is looking to cut colons by 20% and EGDs by 30%. It more or less spells doom for GI as one of the "ultra lucrative" specialties.
All this comparing and snickering about high and low pay is like people on the upper decks of the Titanic feeling smug compared to the people on the lower decks...we're all on the same boat and it's going down.
 
Carbocation1 said:
Jesus. The prospect of doing internal medicine for 3 years just to reapply again for another specialty that pays the same as a glorified resident (hospitalist) unless you scope ass does not excite me.
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Or you could think of your IM residency as "pre hematology oncology" training.
 
bronx43 said:
Ah, I gotcha.

To be fair, with the exception of some of the higher paying specialties, not many gigs out there beat out hospital medicine when you calculate per hour pay, and the benefits of shift work. It's rough when you're on, but when I come off an easy service week, I sometimes wonder why I get paid for doing this. But keep in mind that the current system won't last. Don't look at what pays high or low now and think that this is permanent - if anything I would argue that the high paying specialties are only more likely to take big cuts in the coming years. Scopes are on the chopping block, as CMS is looking to cut colons by 20% and EGDs by 30%. It more or less spells doom for GI as one of the "ultra lucrative" specialties.
All this comparing and snickering about high and low pay is like people on the upper decks of the Titanic feeling smug compared to the people on the lower decks...we're all on the same boat and it's going down.
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Yes, ultra-high paying specialties are all probably gonna go down a bit in the future. Some may go down a lot. Some not so much, but the trends, I agree, point lower.

This is why those GI docs SHOULD NOT be buying country club memberships and yachts. They should live a NICE, COMFORTABLE life. Save NOW, so that when incomes go lower, all is still pretty damn good. It's not that fu.cking hard to do. Just don't be a dummy. Pretty simple.
 
Consigliere said:
I'll forgive your ignorance and naivety and attribute it to lack of experience. Now the knowledge I'm about to spit will be invaluable so feel free to print this reply and reference it when you have a clue. Taking your angry questions in order...
We do not bill for medical direction for epidurals EVER...daytime, nighttime. WE (anesthesiologists) developed the protocols, WE are available to answer any and all questions related to said epidurals, and WE manage any and all complications (ie PDPH). Any ***** can put in an epidural - you don't need an anesthesiologist to do that. We supervise all OR cases, day and night. Yes we come in at night. I don't care what's going through the CRNAs' minds as we snooze at night....probably how well they're paid and what a good gig they have. The surgeon's love us and appreciate the fact that we are so involved in the pt's care. I am here to manage the pt's pre/intra/post operative care and prevent the potential disasters that may occur. FYI, this "very well paying scam" you accuse me of running happens to be the way the overwhelming majority of anesthetics are delivered in the USA. Get used to it because you'll some day be part of it. Redirect your supposed righteous indignation towards another worthwhile endeavor. Peace out!
Click to expand...
Like I said, never mind. Keep playing that game well. One day when I can't beat you I will have to join in. God help me when that happens.
 
While a fellowship may not result in a "pay raise" on paper, what I've found is that a fellowship can gain you access to some of the private practice groups that are highly competitive and are still making north of 500K. I've done a job search with and without a fellowship attached, and with one has been so different. It just gives you a leg up if your fellowship gives you a skill set that group needs at that particular time.
 
Twiggidy said:
It's may not be close to death, but it MD anesthesiology may have some sort of long term maybe even terminal illness. I would not be surprised if the day comes where an entire OB floor is ran by nurses (nursing, CRNA, midwife, etc) and to be honest less call for me, more drama for them, and let's be real the patients would probably love it. I personally may not see that day, but that day will come. The safer anesthesia gets, the more nurse are going to want to do, the less need for an MD. I'm not sure if the current generation (or maybe even the next) of MDs need back up plans, but the teenagers and little kids who may have anesthesiology in the blood, may want to consider another specialty.

And so while @Consigliere has some mad hilarious quotes on SDN, overall they are something for the future docs to take into consideration. I was a dumb med student. The minute I saw CRNAs intubating in the ICU and doing A-lines in the OR, I should've ran for the radiology fields (despite what they say, that field is fine. a bit saturated, but fine)

I love anesthesiology, as it's challenging and allows somewhat of a lifestyle, but my gripes with the field are beyond CRNA vs MD. Another post, another time.
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Ran for the radiology fields? Pretty sure the fact that they have to compete against the internet is going to remove that field from the ROAD to success. And that one will transpire much more quickly, essentially as soon as a big hospital enters negotiations with a local group and one based elsewhere, it's over.

Not discounting that future anesthesiologists need to worry, but I'd say radiology is in a far worse position.
 
chocomorsel said:
Like I said, never mind. Keep playing that game well. One day when I can't beat you I will have to join in. God help me when that happens.
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58907591.jpg
 
Group advertising strict usage of only physician anesthesiologists: http://www.ncactexas.com/MDvsCRNA

So exactly who is going to administer your anesthesia?

One common misconception about anesthesiology is that a patient receives anesthesia only from a doctor; in fact, a patient's anesthetist may have far less medical training than a doctor. An anesthetist is defined as any individual that administers anesthesia. An anesthetist can be an anesthesiologist or a nurse anesthetist, typically referred to as a CRNA (Certified Registered Nurse Anesthetist).

An anesthesiologist is a doctor of medicine-a physician licensed to practice medicine and treat medical complications. Prior to becoming an anesthesiologist, such an individual has graduated with a bachelor's degree from a four-year college with a background in biology, chemistry, physics, and mathematics, after which he or she completes four years of medical school. Graduation from medical school is followed by four years of specialized training in anesthesiology. Additionally, some anesthesiologists have advanced training in pediatric anesthesia, cardiothoracic anesthesia, obstetric anesthesia, and critical care medicine. The American Board of Anesthesiology provides board certification for anesthesiologists.

A Certified Registered Nurse Anesthetist (CRNA) has earned a bachelor's degree in nursing, after which two additional years are spent in formal training of anesthesiology. A CRNA is not licensed to practice medicine, and cannot introduce himself or herself as a doctor. To confuse matters, CRNAs may not even use the term "nurse"; rather, they may say they are "with anesthesia" or part of an "anesthesia care team."

Compared to CRNAs, the extensive training of an anesthesiologist implies an important role in surgery. Not only does the anesthesiologist carefully regulate critical life functions during surgery, he or she must also make immediate diagnoses and prompt treatments of any medical problems that arise during the perioperative period.

North Central Anesthesia Consultants is comprised only of anesthesiologists. These anesthesiologists provide direct and continual anesthetic care of the patient—there are no nurses or other assistants conducting anesthesia. In the same manner, a doctor is personally performing the surgery; a doctor is personally performing the anesthetic.

While these qualities may reflect any group of anesthesiologists, the doctors of NCAC deliver distinctively efficient, safe, and compassionate care. Our strong training backgrounds make us eminently qualified to perform a variety of anesthetic techniques, but our many years of practicing medicine makes North Central Anesthesia Consultants a premier anesthesia provider.

So, who is going to administer your anesthesia? You and your family have chosen a surgeon to perform a procedure. Who administers your anesthesia is also your choice.
 
Are other groups or hospitals advertising using doctors as opposed to nurses for anesthesia? Radiology groups advertise the extensive training of their radiologists all the time.
 
I think what we saw with Howard U letting go of its CRNA staff and replacing them with MDs is a sign of things to come.
 
Great Z's said:
This is indeed sobering news for anesthesiologists. No matter how much the ASA is trying to spin this as a win for us, it actually implies that hospitals value our work no greater than the CRNA's. In the future, anesthesiologists may have to get used to receiving the equivalent incomes of nurses if they want to be gainfully employed.
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Future for the specialty:

CRNA with DNP= 1x Salary ($140,000 W-2, 40 hours per week)

MD (A) without fellowship: 1.5 X CRNA salary ($210,000 W-2)

MD (A) is forced to take call and cover after hours so the salary gap is much closer than than indicated.

Make hay while the sun shines ladies and gentlemen. The cheaper provider may end up being you.
 
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mja75 said:
I stated nothing to the contrary of that article.
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Perhaps, but what you said is contrary to the reality of modern anesthesia practice.
Replacing all your CRNAs and going MD only is a money loser for most groups, and will have to drive individual income down.
That's one of the reasons that AMCs can decrease costs and under bid all MD groups. They can offer 1:3 or 4 coverage with cheaper CRNAs, and have to pay fewer MDs (less than partner income) and skim a healthy profit.
 
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IlDestriero said:
Perhaps, but what you said is contrary to the reality of modern anesthesia practice.
Replacing all your CRNAs and going MD only is a money loser for most groups, and will have to drive individual income down.
That's one of the reasons that AMCs can decrease costs and under bid all MD groups. They can offer 1:3 or 4 coverage with cheaper CRNAs, and have to pay fewer MDs (less than partner income) and skim a healthy profit.
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I'm in agreement with all that you wrote. My only point in saying "sign of things to come" was that it's not all doom and gloom in anesthesiology; a major organization (Howard) demonstrated that they saw value in adding and not subtracting MDs.
 
mja75 said:
I'm in agreement with all that you wrote. My only point in saying "sign of things to come" was that it's not all doom and gloom in anesthesiology; a major organization (Howard) demonstrated that they saw value in adding and not subtracting MDs.
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Yes, but at what (hourly) salaries and call schedule?
 
Until we actually know what they are paying the anesthesiologist we are all speculating. My guess is that they are being payed well and bring added value to the system.
 
jwk said:
I'm not sure how long you've been doing anesthesia, but anesthetists (AA and CRNA) have been doing ICU intubations and A-lines for many decades - this is not something new. If that's your measure, you need to gain some more perspective.
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So these are some of the most invasive bedside procedures and it has been hard for me to understand why they let these be performed by non-physicians. Do these academic programs let IM residents do any of these or just the CRNAs they are training?
 
cbrons said:
So these are some of the most invasive bedside procedures and it has been hard for me to understand why they let these be performed by non-physicians. Do these academic programs let IM residents do any of these or just the CRNAs they are training?
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You can train a monkey to do almost any procedure. (Not really, but you get the gist.) All it takes is some knowledge of regional anatomy and some hand-eye coordination. That's why I ROTFL when people suggest that CRNAs will never do regional anesthesia or pain procedures.

It's not the procedures that make the difference between a doctor and a nurse. It's the knowledge base and judgment, especially when managing complicated patients. It drives me nuts when I see medical students rotating through the ICU and concentrating just on developing procedural skills.
 
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The reason why CRNAs shouldn't do pain is because, to actually practice pain management you should be completing focused physicals, reviewing films yourself, making a DDX and developing a treatment plan. That's medicine, not just being a needle jockey. They claim they're just following the plan of the referring physician, ie "try course of ESIs." So they do.
When I did some pain in the .mil, I got consults all the time with that kind of "plan". There were very few cases where that would be an appropriate plan. Most had other problems and needed a different plan. Or were just malingering. But that's not a problem in the civilian world, right?
 
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