So, bottom line... what is the future of anesthesiology for MDs?

[aneftp]

That is very, very optimistic.

It's not. Consider other professions and inflation.

Look at average federal govt worker making close to $80k these days plus generous federal benefits.

One of my brothers is pharmacist and base is $120k. With some OT he's pushing well over $150k. And he started out at $50k back in 1997.

Crna routinely make $150k plus benefits plus no call no weekends for essentially 40 hours a week. I know many in the northeast who make 180k plus benefits. These are just the W2 crnas.

You adjust MD work hours which are typically 10-12 more hours than crnas on average per week. Plus the differential of having to take overnight call. An MD making 250k full call schedule is exactly the same per hour pay (accounting for split differential later nights and weekends) as crnas making like $150k in today's money.

It's the fat cats who are stealing the money these days. That's why many of the top dogs have sold out. Eliminate the middle guys. Even with 80% Medicare payer mix. A full time MD should be able to earn $350-400k if no one is shaving anything off the top. That's the real problem.

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[reinstatement]

MS3 here, long time lurker, trying to decide what I want to be when I grow up.

I'm really interested in anesthesia but kind of weary about joining what is portrayed as a dying field here.

There is a ton of doom and gloom all over this board but I'm a little confused by it. What am I missing here? Are working conditions getting that abusive with CRNAs? Yea PP groups are selling out, but that is hitting every specialty so how can a new grad really avoid that?

When I look at the compensation data I see anesthesia being in the mid to high 300s with surveys showing first job placement for graduating residents averaging 275 or so. So maybe this isn't the massive incomes some older attendings are used to, but in today's market there are really only a few specialties where you can net 500+ without working like a dog. And these are all much more competitive.

So what is a medical student who is otherwise competitive for any specialty and doesnt have a taste for chronic management or surgery supposed to go into?

There is EM, that's hot these days. They work less hours sure, but pulling nights/weekends/holidays when I'm 60 isn't super appealing. Not to mention they're average compensation is less than anesthesia.

So what's the scoop here because competitive medical students are avoiding anesthesia pretty intensely. There has to be a reason that a field with higher relative compensation than most, decent hours, lots of cool procedures, and complex management is having this free fall with medical students and I'm just not understanding what it is.

I am another MS3 in the same boat. Haven't liked a lot of medical school third year clerkships except anesthesia and maybe ENT. But I have already waited long enough to make a living, so there is no way I am waiting for another research year.

This is my basic questions for attending/residents. Realistically speaking "what can't a CRNA do?" in other words "What is the their actual limit?"

Is cardiac the limit? Is peds? Is regional? Is Ob? Is trauma? Is ASA3/4 the limit? I know according to the AANA there is no limit, and according to the ASA they cannot even do ASA1. But in the practical hospital/every day life, what are the limits you are seeing?

In the end, if I do Anesthesia residency and graduate in 2020, what will be left from the carcass when the cheap CRNAs are done eating away at cases?

I just don't want to finish 4 years of training and not be able to find a job.

 

[Jonassen]

I didn't realize how bad the CRNA situation was until I moved to the East Coast for residency (I'm from the Midwest originally). Every case it seemed was done by CRNAs, even the ASA 3's.

 

[chmd]

That is very, very optimistic.

Hyperbole for sure. We have multiple crnas making greater than 215k for 40 hours/week with 6 weeks vacation. I'd rather do that than similar pay for IM.

 

[scudrunner]

Exactly, I meant those fields are not for people who are not strong visual learners. I dislike memorizing path and rad pics.

Oops, my bad, I missed the not part.

Well, good luck.

 

[BLADEMDA]

MS3 here, long time lurker, trying to decide what I want to be when I grow up.

I'm really interested in anesthesia but kind of weary about joining what is portrayed as a dying field here.

There is a ton of doom and gloom all over this board but I'm a little confused by it. What am I missing here? Are working conditions getting that abusive with CRNAs? Yea PP groups are selling out, but that is hitting every specialty so how can a new grad really avoid that?

When I look at the compensation data I see anesthesia being in the mid to high 300s with surveys showing first job placement for graduating residents averaging 275 or so. So maybe this isn't the massive incomes some older attendings are used to, but in today's market there are really only a few specialties where you can net 500+ without working like a dog. And these are all much more competitive.

So what is a medical student who is otherwise competitive for any specialty and doesnt have a taste for chronic management or surgery supposed to go into?

There is EM, that's hot these days. They work less hours sure, but pulling nights/weekends/holidays when I'm 60 isn't super appealing. Not to mention they're average compensation is less than anesthesia.

So what's the scoop here because competitive medical students are avoiding anesthesia pretty intensely. There has to be a reason that a field with higher relative compensation than most, decent hours, lots of cool procedures, and complex management is having this free fall with medical students and I'm just not understanding what it is.

I do apologize if the doom and gloom (more gloom than doom by the way) seems to dominate this board way too often; I am certainly guilty of contributing my fair share to the doom and gloom here.

As long as you understand the pitfalls of the specialty prior to matching into Anesthesiology I think you can have a happy and successful career:

1. Lower pay- The glut of CRNAs combined with record numbers of Physician Anesthesiologists will force salaries down. There is a 75% probability you will end up working as an employee in this field. By the time you graduate true private practice gigs will represent only 25% of the available positions and they will be very competitive spots.

2. Fellowship- For those seeking the best PP jobs or an academic career a Fellowship is almost a necessity unless you are friends with someone in the group.
Non-Fellowship graduates will likely have less than a 10% chance of securing one of the sought after private practice gigs.

3. AANA- we are losing and they are winning in terms of propaganda and legislative victories. The AANA plan to the DNAP continues as does the false rhetoric that both providers are equal. I expect even more militant nurse anesthesia providers in the hospitals as the years progress.

4. Medicare/Medicaid - The country is broke, health care expenditures keep rising and CMS keeps getting bigger which all leads back to numbers 1-3. The surge in ASA 4 patients requiring/requesting surgery continues to rise so your services will be needed even though compensation will be low.

5. Supervision- Your employer will want to keep pushing you to cover more and more CRNAs. The AMC/Hospital will push for 5:1 or 6:1 ratios which really does suck in terms of quality of care, level of work and overall job satisfaction.

6. Poor leadership- You will be stuck with expensive MOCA requirements forced upon you by the ABA. In addition, the ASA has been feckless in stopping the AANA encroachment on our field and that isn't likely to change anytime soon.

7. Stress- The job can be quite stressful at times especially when covering 5 CRNAs who are barely qualified to do ASA 1 and 2 cases.

8. Call- Most anesthesia jobs involve significant night and weekend work. For most of you this will NOT be a lifestyle specialty; instead, many will work as hard or harder at night and on the weekends than almost any other specialty in the hospital.

Despite items 1-8 I think Anesthesiology is a better choice than EM for many med students.

 

[aneftp]

I do apologize if the doom and gloom (more gloom than doom by the way) seems to dominate this board way too often; I am certainly guilty of contributing my fair share to the doom and gloom here.

As long as you understand the pitfalls of the specialty prior to matching into Anesthesiology I think you can have a happy and successful career:

1. Lower pay- The glut of CRNAs combined with record numbers of Physician Anesthesiologists will force salaries down. There is a 75% probability you will end up working as an employee in this field. By the time you graduate true private practice gigs will represent only 25% of the available positions and they will be very competitive spots.

2. Fellowship- For those seeking the best PP jobs or an academic career a Fellowship is almost a necessity unless you are friends with someone in the group.
Non-Fellowship graduates will likely have less than a 10% chance of securing one of the sought after private practice gigs.

3. AANA- we are losing and they are winning in terms of propaganda and legislative victories. The AANA plan to the DNAP continues as does the false rhetoric that both providers are equal. I expect even more militant nurse anesthesia providers in the hospitals as the years progress.

4. Medicare/Medicaid - The country is broke, health care expenditures keep rising and CMS keeps getting bigger which all leads back to numbers 1-3. The surge in ASA 4 patients requiring/requesting surgery continues to rise so your services will be needed even though compensation will be low.

5. Supervision- Your employer will want to keep pushing you to cover more and more CRNAs. The AMC/Hospital will push for 5:1 or 6:1 ratios which really does suck in terms of quality of care, level of work and overall job satisfaction.

6. Poor leadership- You will be stuck with expensive MOCA requirements forced upon you by the ABA. In addition, the ASA has been feckless in stopping the AANA encroachment on our field and that isn't likely to change anytime soon.

7. Stress- The job can be quite stressful at times especially when covering 5 CRNAs who are barely qualified to do ASA 1 and 2 cases.

8. Call- Most anesthesia jobs involve significant night and weekend work. For most of you this will NOT be a lifestyle specialty; instead, many will work as hard or harder at night and on the weekends than almost any other specialty in the hospital.

Despite items 1-8 I think Anesthesiology is a better choice than EM for many med students.

Blade. I do agree with almost all your points.

However I think while their is downward pressure on income. The future may hold that anesthesiologists will still be the "captain of the ship" in terms of running the Or board. But there will be more "shift work" with more crnas doing more night sharing responsibilities.

So less longer hours. More shift work. Less income.

Just my opinion.

 

[Mad Jack]

I do apologize if the doom and gloom (more gloom than doom by the way) seems to dominate this board way too often; I am certainly guilty of contributing my fair share to the doom and gloom here.

As long as you understand the pitfalls of the specialty prior to matching into Anesthesiology I think you can have a happy and successful career:

1. Lower pay- The glut of CRNAs combined with record numbers of Physician Anesthesiologists will force salaries down. There is a 75% probability you will end up working as an employee in this field. By the time you graduate true private practice gigs will represent only 25% of the available positions and they will be very competitive spots.

2. Fellowship- For those seeking the best PP jobs or an academic career a Fellowship is almost a necessity unless you are friends with someone in the group.
Non-Fellowship graduates will likely have less than a 10% chance of securing one of the sought after private practice gigs.

3. AANA- we are losing and they are winning in terms of propaganda and legislative victories. The AANA plan to the DNAP continues as does the false rhetoric that both providers are equal. I expect even more militant nurse anesthesia providers in the hospitals as the years progress.

4. Medicare/Medicaid - The country is broke, health care expenditures keep rising and CMS keeps getting bigger which all leads back to numbers 1-3. The surge in ASA 4 patients requiring/requesting surgery continues to rise so your services will be needed even though compensation will be low.

5. Supervision- Your employer will want to keep pushing you to cover more and more CRNAs. The AMC/Hospital will push for 5:1 or 6:1 ratios which really does suck in terms of quality of care, level of work and overall job satisfaction.

6. Poor leadership- You will be stuck with expensive MOCA requirements forced upon you by the ABA. In addition, the ASA has been feckless in stopping the AANA encroachment on our field and that isn't likely to change anytime soon.

7. Stress- The job can be quite stressful at times especially when covering 5 CRNAs who are barely qualified to do ASA 1 and 2 cases.

8. Call- Most anesthesia jobs involve significant night and weekend work. For most of you this will NOT be a lifestyle specialty; instead, many will work as hard or harder at night and on the weekends than almost any other specialty in the hospital.

Despite items 1-8 I think Anesthesiology is a better choice than EM for many med students.

I thought the maximum supervision that allowed Medicare reimbursement was 1:4?

 

[criticalelement]

You adjust MD work hours which are typically 10-12 more hours than crnas on average per week. Plus the differential of having to take overnight call. An MD making 250k full call schedule is exactly the same per hour pay (accounting for split differential later nights and weekends) as crnas making like $150k in today's money.

It's the fat cats who are stealing the money these days. That's why many of the top dogs have sold out. Eliminate the middle guys. Even with 80% Medicare payer mix. A full time MD should be able to earn $350-400k if no one is shaving anything off the top. That's the real problem.

You hit the head fuggin square on it's head. This is EXACTLY the issue.

 

[criticalelement]

The future may hold that anesthesiologists will still be the "captain of the ship" .

You went from an on point post to this????? cmon man. The anesthesiologist is captain of NOTHING my friend...

 

[criticalelement]

I am another MS3 in the same boat. Haven't liked a lot of medical school third year clerkships except anesthesia and maybe ENT. But I have already waited long enough to make a living, so there is no way I am waiting for another research year.

This is my basic questions for attending/residents. Realistically speaking "what can't a CRNA do?" in other words "What is the their actual limit?"

Is cardiac the limit? Is peds? Is regional? Is Ob? Is trauma? Is ASA3/4 the limit? I know according to the AANA there is no limit, and according to the ASA they cannot even do ASA1. But in the practical hospital/every day life, what are the limits you are seeing?

In the end, if I do Anesthesia residency and graduate in 2020, what will be left from the carcass when the cheap CRNAs are done eating away at cases?

I just don't want to finish 4 years of training and not be able to find a job.

There is no limit. They do everything. Or they think they do. No they are involved in all cases. Even the sick ones that are about to die.

 

[IlDestriero]

The crnas are limited by what you let them do.
Do they work in my specialty peds hospital? Yes.
Do they do complex cases? Yes.
Do they work unsupervised? No, never.
When they are doing peds hearts they are basically a scribe.
Will they fly solo in a few years? No, not here.
Do they do lines and blocks and fiberoptic airways, etc? Nope. We do them, or maybe pull a fellow in.
Can they mess up my sweet gig by driving income down? Probably.
I'll live.
OB doesn't limit them, that's for sure. That's one place where they seem to fly solo frequently, while the lazy MD is in bed, perhaps at home. I heard about that arrangement all the time. Supervising CRNAs on call, especially OB, from home in bed.
That's the shït that taints the profession, but makes them happy and rich.

 

[aneftp]

You went from an on point post to this????? cmon man. The anesthesiologist is captain of NOTHING my friend...

Everywhere I have worked the MD is in charge of running the board. Scheduling etc. that will continue to be the case in the future.

Just less fat cats (MDs and many of those MDs have sold their practices already) sitting around doing little and collecting a lot.

 

[Mad Jack]

Everywhere I have worked the MD is in charge of running the board. Scheduling etc. that will continue to be the case in the future.

Just less fat cats (MDs and many of those MDs have sold their practices already) sitting around doing little and collecting a lot.

There will still be fat cats, they just won't be doctors. And they'll be earning 7 figures for your hard work.

 

[deleted171991]

I thought the maximum supervision that allowed Medicare reimbursement was 1:4?

That's just for medical direction. For medical supervision, AFAIK the sky is the limit.

 

[Mad Jack]

That's just for medical direction. For medical supervision, AFAIK the sky is the limit.

Well that puts anesthesia off my list. No way I'm playing liability sponge for a pack of half a dozen nurses that want to play doctor, just so I can end up like the guy in Houston that's probably going to be down a few million because his CRNA couldn't do basic dosing.

 

[mega_colon]

I do apologize if the doom and gloom (more gloom than doom by the way) seems to dominate this board way too often; I am certainly guilty of contributing my fair share to the doom and gloom here.

As long as you understand the pitfalls of the specialty prior to matching into Anesthesiology I think you can have a happy and successful career:

1. Lower pay- The glut of CRNAs combined with record numbers of Physician Anesthesiologists will force salaries down. There is a 75% probability you will end up working as an employee in this field. By the time you graduate true private practice gigs will represent only 25% of the available positions and they will be very competitive spots.

2. Fellowship- For those seeking the best PP jobs or an academic career a Fellowship is almost a necessity unless you are friends with someone in the group.
Non-Fellowship graduates will likely have less than a 10% chance of securing one of the sought after private practice gigs.

3. AANA- we are losing and they are winning in terms of propaganda and legislative victories. The AANA plan to the DNAP continues as does the false rhetoric that both providers are equal. I expect even more militant nurse anesthesia providers in the hospitals as the years progress.

4. Medicare/Medicaid - The country is broke, health care expenditures keep rising and CMS keeps getting bigger which all leads back to numbers 1-3. The surge in ASA 4 patients requiring/requesting surgery continues to rise so your services will be needed even though compensation will be low.

5. Supervision- Your employer will want to keep pushing you to cover more and more CRNAs. The AMC/Hospital will push for 5:1 or 6:1 ratios which really does suck in terms of quality of care, level of work and overall job satisfaction.

6. Poor leadership- You will be stuck with expensive MOCA requirements forced upon you by the ABA. In addition, the ASA has been feckless in stopping the AANA encroachment on our field and that isn't likely to change anytime soon.

7. Stress- The job can be quite stressful at times especially when covering 5 CRNAs who are barely qualified to do ASA 1 and 2 cases.

8. Call- Most anesthesia jobs involve significant night and weekend work. For most of you this will NOT be a lifestyle specialty; instead, many will work as hard or harder at night and on the weekends than almost any other specialty in the hospital.

Despite items 1-8 I think Anesthesiology is a better choice than EM for many med students.

I agree with 1-8, but the problem is that every specialty in medicine has this going on in some form or fashion. Some to a greater extent, but everyone is dealing with this. The question shouldn't be whether anesthesia is suffering from increasing administrative pressures, CRNA encroachment, decreasing reimbursement, etc. The question should be whether anesthesia, when compared to the other options in medicine, is a better option than IM+fellowship, EM, surgery sub specialty, derm, family, psych...

From the outside looking in, most of you guys make it sound like anesthesia is completely screwed and no intelligent medical student with other options would be wise to get into the field. My question to all the residents/attendings here is are you really worse off than the other fields of medicine? Because a superficial review of the data shows a field with hours that are about average for most physicians and an income that is among the highest for physicians. The only ding I can find is that job openings aren't as plentiful as they used to be.

 

[deleted171991]

I agree with 1-8, but the problem is that every specialty in medicine has this going on in some form or fashion. Some to a greater extent, but everyone is dealing with this. The question shouldn't be whether anesthesia is suffering from increasing administrative pressures, CRNA encroachment, decreasing reimbursement, etc. The question should be whether anesthesia, when compared to the other options in medicine, is a better option than IM+fellowship, EM, surgery sub specialty, derm, family, psych...

From the outside looking in, most of you guys make it sound like anesthesia is completely screwed and no intelligent medical student with other options would be wise to get into the field. My question to all the residents/attendings here is are you really worse off than the other fields of medicine? Because a superficial review of the data shows a field with hours that are about average for most physicians and an income that is among the highest for physicians. The only ding I can find is that job openings aren't as plentiful as they used to be.

I kind of promised myself not to get into this kind of discussions anymore, so I'll make one exception just t0 point out what you seem to be missing here: in most other specialties, you are the man, not his servant.

If this were not a service specialty, one could stand out by just being a great physician, and patients would sooner or later follow. As an anesthesiologist, it's mostly about artistic impression. If you do a great job technically, nobody will know about it (except for you). But have even the slightest expected complication (PONV, sore throat, lip cut etc.), and everybody will. As long as the patient survives unharmed and happy, all that matters is basically how much the surgeon and your boss like you.

One can be a genius technically, but it won't matter unless one has the right (read sales-type) personality to go with it (and most doctors just don't, whatever they lie to themselves or others about it). It's not about being friendly; it's about bending over backwards, and convincing the surgeons about your greatness. Success in this specialty is about keeping the surgeons happy, not (just) the patients. And even when the surgeons are happy, it's like when the upstairs masters were happy 100 years ago; if you open your mouth and want a bigger slice of the pie, your masters will just find another (no)body to take your place, regardless of your anesthetic genius. Why? Because you have zero pull with the patients. I actually had an educated middle-aged patient ask me in the PACU, after a perfect GA, just a few days ago, what exactly I did except for sitting on my butt watching monitors, because it seemed to him that it was no big deal.

New grads are getting pretty bad offers, and it's not just about being exploited as a junior attending. It's the reality of a market where being an employee is the future, where competing with CRNAs for basically the same job is the future, where being just a (no)body is the future. With anesthesia residency mills and CRNA diploma mills producing graduates at a higher rate than what the market can absorb, it's becoming a dog eat dog environment, unless one goes to a BFE location (which will not make one popular with one's family). And there is no sign or hope for improvement. Where do you think this entire delirium with the PSH is coming from? In many places around the country, there are just too many anesthesiologists; either they will either learn how to do some other non-anesthesia crap, or they will move away to a place where almost no man has gone before, or they will eat **** every day, or they will be unemployed. Period. And very few, if any, fellowships will change that outlook, now when every ***** and his grandmother has one. It won't happen tomorrow, maybe not even in 10 years, but I wouldn't bet against it, especially with my career.

Also, if you want lazy administrators taking 40% of what you make and dictating how you practice (including many unsafe ways), then this is for you. Bean counters simply don't care about malpractice risks, because it's included in their budget for "business losses". They will take risks on your license, they will skim all the profits resulting from those risks, but you will be the bad guy in court, and you will be the one on the hook for whatever damages are beyond your coverage limits (not to speak about just having your career destroyed). It's such a joy to be legally responsible for all the crap a bunch of midlevels can do in your absence and without your knowledge. (It's not like they have a well-documented plan to follow, as in internal medicine.) So, if you love playing Russian roulette with your career every single week (if not day) of your life, then this is for you. (See the threads about malpractice in GI procedures, about how one would not survive a day in those jobs without cutting corners. They will apply to more and more anesthesiologists, in more and more clinical settings. You will be told to either get it done, even if risky for the patient, or find another job.)

People love comparing this to what happened to lawyers in the last decades, and how nobody starts as a partner in a law firm, and how one works one's way up to success, but they are missing the big point: we are not like lawyers, we are like paralegals. We are not the rainmakers, the surgeons are. We are (more and more) easily replaceable. The reason we have made a ton of money during the past decades was the anesthesia provider shortage. That's now gone, and it will stay like that. There is absolutely no reason to believe otherwise. Every single year will be worse than the previous, until we stop churning out providers. (Like that will ever happen, with independent CRNAs everywhere, literally specializing to take our place, including getting "doctorates" to smoke and mirror the general public.)

Btw, I do love a bunch of stuff about my job (otherwise I wouldn't keep doing it). But it's like eating grapefruit with sugar, except that there is more and more fruit, and less and less sugar.

Blade is pretty level-headed, and with his hand on the pulse of the (Florida?) market, so if you don't believe me, believe him.

 

[mega_colon]

I kind of promised myself not to get into this kind of discussions anymore, so I'll make one exception just t0 point out what you seem to be missing here: in most other specialties, you are the man, not his servant.

If this were not a service specialty, one could stand out by just being a great physician, and patients would sooner or later follow. As an anesthesiologist, it's mostly about artistic impression. One can be a genius technically, but it won't matter unless one has the right (read sales-type) personality to go with it (and most people just don't, whatever they lie to themselves or others about it). It's not about being friendly; it's about bending over backwards, and convincing the surgeons about your greatness. Success in this specialty is about keeping the surgeons happy, not (just) the patients. And even when the surgeons are happy, it's like when the upstairs masters were happy 100 years ago; if you open your mouth and want a bigger slice of the pie, your masters will just find another (no)body to take your place, regardless of your anesthetic genius. Why? Because you have zero pull with the patients. I actually had an educated middle-aged patient ask me in the PACU, after a perfect GA, just a few days ago, what exactly I did except for sitting on my butt watching monitors, because it seemed to him that it was no big deal.

New grads are getting pretty bad offers, and it's not just about being exploited as a junior attending. It's the reality of a market where being an employee is the future, where competing with CRNAs for basically the same job is the future, where being just a (no)body is the future. With anesthesia residency mills and CRNA diploma mills producing graduates at a higher rate than what the market can absorb, it's becoming a dog eat dog environment, unless one goes to a BFE location (which will not make one popular with one's family). And there is no sign or hope for improvement. Where do you think this entire delirium with the PSH is coming from? In many places around the country, there are just too many anesthesiologists; either they will either learn how to do some other non-anesthesia crap, or they will move away to a place where almost no man has gone before, or they will eat **** every day, or they will be unemployed. Period. And very few, if any, fellowships will change that outlook, now when every ***** and his grandmother has one. It won't happen tomorrow, maybe not even in 10 years, but I wouldn't bet against it, especially with my career.

Also, if you want lazy administrators taking 40% of what you make and dictating how you practice (including many unsafe ways), then this is for you. Bean counters simply don't care about malpractice risks, because it's included in their budget for "business losses". They will take risks on your license, they will skim all the profits resulting from those risks, but you will be the bad guy in court, and you will be the one on the hook for whatever damages are beyond your coverage limits (not to speak about just having your career destroyed). It's such a joy to be legally responsible for all the crap a bunch of midlevels can do in your absence and without your knowledge. (It's not like they have a well-documented plan to follow, as in internal medicine.) So, if you love playing Russian roulette with your career every single week (if not day) of your life, then this is for you. (See the threads about malpractice in GI procedures, about how one would not survive a day in those jobs without cutting corners. They will apply to more and more anesthesiologists, in more and more clinical settings. You will be told to either get it done, even if risky for the patient, or find another job.)

People love comparing this to what happened to lawyers in the last decades, and how nobody starts as a partner in a law firm, and how one works one's way up to success, but they are missing the big point: we are not like lawyers, we are like paralegals. We are not the rainmakers, the surgeons are. We are (more and more) easily replaceable. The reason we have made a ton of money during the past decades was the anesthesia provider shortage. That's now gone, and it will stay like that. There is absolutely no reason to believe otherwise. Every single year will be worse than the previous, until we stop churning out providers. (Like that will ever happen, with independent CRNAs everywhere, literally specializing to take our place.)

Btw, I do love a bunch of stuff about my job (otherwise I wouldn't keep doing it). But it's like eating grapefruit with sugar, except that there is more and more fruit, and less and less sugar.

Blade is pretty level-headed, and with his hand on the pulse of the (Florida?) market, so if you don't believe me, believe him.

I'm not trying to start an argument or question anyone's knowledge. I was asking questions because it appeared there was a disconnect between the doom and gloom here and the job market/compensation averages I see published.

Thanks for your insight, I'll take my application elsewhere.

 

[deleted171991]

I'm not trying to start an argument or question anyone's knowledge. I was asking questions because it appeared there was a disconnect between the doom and gloom here and the job market/compensation averages I see published.

Thanks for your insight, I'll take my application elsewhere.

And I am not trying to convince anybody about anything. Many students think anesthesia is easy (because we make it look like that), the lifestyle is good (because anesthesiologists smile and are friendly, and don't get paged at home), the money is good (just look at those MGMA numbers), and overlook all the trouble coming our way. And it can be the right specialty for the right person, as long as one knows what one is getting into. I must admit I didn't.

The averages that you see include everybody, such as senior people, many of them partners. That will be much rarer in the future. The compensation numbers that you should be interested in are those of recent grads, and employees, especially ones who have signed new contracts recently. And those numbers should be much less, especially when corrected to hours worked, and will stay like that or get worse, because a recent grad or current employee has minimal chances to make partner in the future.

I can't compare anesthesiology with other specialties, but I would look for one with a better future market, and where one can shine even as a solo provider (if one is good at one's job).

 

[Carbocation1]

I don't want my patients to follow me, know me, rate my competence as a physician, or have anything to do with me outside of the workplace. I prefer to be under the radar and do my job to the best of my ability while giving my patients 100% in the perioperative setting. I don't want to be the important, esteemed cardiologist who everyone in the town reveres. I don't want to sew people up or manage self-inflicted chronic health issues. I want to have an interesting job I really enjoy where I get help people in their most vulnerable states, have a good lifestyle, and make ~350K per annum. I believe being a physician anesthesiologist fits the aforementioned criteria.

Compared to other options that are available to the medical student in 2015, anesthesiology is the lesser of all evils.

 

[deleted171991]

I don't want my patients to follow me, know me, rate my competence as a physician, or have anything to do with me outside of the workplace. I prefer to be under the radar and do my job to the best of my ability while giving my patients 100% in the perioperative setting. I don't want to be the important, esteemed cardiologist who everyone in the town reveres. I don't want to perform sew people up or manage self-inflicted chronic health issues. I want to have an interesting job I really enjoy where I get help people in their most vulnerable states, have a good lifestyle, and make ~350K per annum. I believe being a physician anesthesiologist fits the aforementioned criteria.

Would you still do it if it meant supervising 3+ CRNAs all the time, working 60-70 hours/week (including call), with 4-5 weeks of vacation, for 250-300 now, with increasing responsibilities and decreasing hourly compensation every single year, especially if adjusted to inflation? I would, even for much less, but would you?

And if you don't want call and weekends (because you want "lifestyle"), you'd get ~200 now (and much less in the future, when any CRNA can take your job, once technology progresses even more and anesthesia becomes even safer). The problem is not just now, the problem is with the future, based on the huge changes that we saw in the last 5-10 years, and keep coming.

The problem with MGMA averages is that they clump together a lot of data, over a big area, without correcting for hours worked or location. The latter define significantly what we call lifestyle.

Compared to other options that are available to the medical student in 2015, anesthesiology is the lesser of all evils.

That's something you guys know best. Choosing a specialty should be like consenting to elective heart surgery; just make sure you have considered all the possible outcomes.

 

[Carbocation1]

Would you still do it if it meant supervising 3+ CRNAs all the time, working 60-70 hours/week (including call), with 4-5 weeks of vacation, for 250-300 now, with increasing responsibilities and decreasing hourly compensation every single year, especially if adjusted to inflation?

And if you don't want call and weekends (because you want "lifestyle"), you'd get ~200 now (and much less in the future, when any CRNA can take your job, once technology progresses even more and anesthesia becomes even safer). The problem is not just now, the problem is with the future, based on the huge changes that we saw in the last 5-10 years, and keep coming.

The problem with averages is that they clump together a lot of data, over a big area, without correcting for hours worked or location. Because the latter will define significantly what we call lifestyle.

That's something you guys know best. Choosing a specialty should be like consenting to elective heart surgery; just make sure you have considered all the possible outcomes.

We don't need a physician to keep patients alive while in a coma-like state but we need them to diagnose acne (derm)? Diagnosing skin lesions is something that could very easily be replaced/supplemented by a mobile application.

Also, I don't think for a second that specialized nurse "operators" can't perform surgery. Google et. al is making surgery so easy that any monkey could perform it: http://www.wired.com/2015/03/google-robot-surgery/
http://www.nytimes.com/2014/10/23/s...lop-second-generation-of-surgical-robots.html

 

[Jonassen]

We don't need a physician to keep patients alive while in a coma-like state but we need them to diagnose acne (derm)? Diagnosing skin lesions is something that could very easily be replaced/supplemented by a mobile application.

Also, I don't think for a second that specialized nurse "operators" can't perform surgery. Google et. al is making surgery so easy that any monkey could perform it: http://www.wired.com/2015/03/google-robot-surgery/
http://www.nytimes.com/2014/10/23/s...lop-second-generation-of-surgical-robots.html

Haha... no.

Any monkey might perform surgery, but the patient is still going to see the surgeon first to get the case scheduled. The technology is nowhere there for autonomous surgical robots. Anyone going into surgery now will never see that mainstreamed in their 30 year career. The high costs of surgery isn't the surgeon, it's the OR room, the ancillary staff, and the anesthesiologist. Most surgeons are only in the OR twice a week. The rest of their time is in clinic or seeing consults. Surgeons aren't the OR monkeys.

 

[Consigliere]

Crna routinely make $150k plus benefits plus no call no weekends for essentially 40 hours a week. I know many in the northeast who make 180k plus benefits. These are just the W2 crnas.

And I know of several making $185k + since they are my employees.

 

[Consigliere]

OB doesn't limit them, that's for sure. That's one place where they seem to fly solo frequently, while the lazy MD is in bed, perhaps at home. I heard about that arrangement all the time. Supervising CRNAs on call, especially OB, from home in bed.
That's the shït that taints the profession, but makes them happy and rich.

Clearly written by someone who doesn't do OB.

 

[mega_colon]

Would you still do it if it meant supervising 3+ CRNAs all the time, working 60-70 hours/week (including call), with 4-5 weeks of vacation, for 250-300 now, with increasing responsibilities and decreasing hourly compensation every single year, especially if adjusted to inflation? I would, even for much less, but would you?

And if you don't want call and weekends (because you want "lifestyle"), you'd get ~200 now (and much less in the future, when any CRNA can take your job, once technology progresses even more and anesthesia becomes even safer). The problem is not just now, the problem is with the future, based on the huge changes that we saw in the last 5-10 years, and keep coming.

The problem with MGMA averages is that they clump together a lot of data, over a big area, without correcting for hours worked or location. The latter define significantly what we call lifestyle.

That's something you guys know best. Choosing a specialty should be like consenting to elective heart surgery; just make sure you have considered all the possible outcomes.

No I wouldn't. If you're a medical student who could see themselves being happy in multiple specialties other than gas, it would be silly to choose what you have described.

 

[Mad Jack]

And I know of several making $185k + since they are my employees.

CRNAs at my old hospital started at $75 an hour and maxed at $90, plus were eligible for overtime. At 60 hours per week (anesthesiologist hours), a starting CRNA would make (60*75+20*37.5)*48+4*40*75=$264,000/year. And that's in a state where they don't even function independently.

 

[Postictal Raiden]

CRNAs at my old hospital started at $75 an hour and maxed at $90, plus were eligible for overtime. At 60 hours per week (anesthesiologist hours), a starting CRNA would make (60*75+20*37.5)*48+4*40*75=$264,000/year. And that's in a state where they don't even function independently.

They get paid overtime? That's ridiculous

 

[Consigliere]

They get paid overtime? That's ridiculous

It's actually quite normal.

 

[pgg]

OB doesn't limit them, that's for sure. That's one place where they seem to fly solo frequently, while the lazy MD is in bed, perhaps at home. I heard about that arrangement all the time. Supervising CRNAs on call, especially OB, from home in bed.
That's the shït that taints the profession, but makes them happy and rich.

It's worse than that; there isn't any supervision at all usually, even from home in bed.

Lots of places in the general area I lived in before I left CA had CRNAs taking solo OB call ... no supervision, no backup from anesthesiologists. They took 1st call in the main hospital I locum'd at too. Occasionally I'd be 2nd call and the surgeon would call me 1st because he wanted a doctor.

The silver lining is that the nurse's case is the nurse's case. No supervision, no direction, not even explicit "firefighter" duty (though I think the administration thought that was the deal). We as physicians had no responsibility for their patients.

Once I got called by a frantic periop nurse because the #1 fully credentialed independent CRNA doing a section had a high spinal. He converted to a general anesthetic after inducing with a full 200 mg stick of propofol. You can't make this stuff up.

Bad outcomes? Well, it's a tort-reform state with capped punitive damages, and in an underserved rural area with a lot of uninsured illegal immigrants who generally don't sue, I guess someone did the math, Fight Club style, and decided the carnage was at acceptable rates. And maybe it is.

 

[aka_tigerj]

I am another MS3 in the same boat. Haven't liked a lot of medical school third year clerkships except anesthesia and maybe ENT. But I have already waited long enough to make a living, so there is no way I am waiting for another research year.

This is my basic questions for attending/residents. Realistically speaking "what can't a CRNA do?" in other words "What is the their actual limit?"

Is cardiac the limit? Is peds? Is regional? Is Ob? Is trauma? Is ASA3/4 the limit? I know according to the AANA there is no limit, and according to the ASA they cannot even do ASA1. But in the practical hospital/every day life, what are the limits you are seeing?

In the end, if I do Anesthesia residency and graduate in 2020, what will be left from the carcass when the cheap CRNAs are done eating away at cases?

I just don't want to finish 4 years of training and not be able to find a job.

In my hometown, CRNAs are able to do cardiac cases unsupervised...but this is literally out in no man's land... so yea

 

[criticalelement]

I don't want my patients to follow me, know me, rate my competence as a physician, or have anything to do with me outside of the workplace. I prefer to be under the radar and do my job to the best of my ability while giving my patients 100% in the perioperative setting. I don't want to be the important, esteemed cardiologist who everyone in the town reveres. I don't want to sew people up or manage self-inflicted chronic health issues. I want to have an interesting job I really enjoy where I get help people in their most vulnerable states, have a good lifestyle, and make ~350K per annum. I believe being a physician anesthesiologist fits the aforementioned criteria.

Compared to other options that are available to the medical student in 2015, anesthesiology is the lesser of all evils.

if after reading ffp last post which happens to be a gem you want to go into anesthesia, great. Just dont go into it un initiated

 

[criticalelement]

...

 

[Wiscoblue]

In my hometown, CRNAs are able to do cardiac cases unsupervised...but this is literally out in no man's land... so yea

They do heart surgery in no mans land? I can't imagine they can get a heart surgeon but not an anesthesiologist. The Crna is probably intubating the patient and standing by for instructions from the surgeon who also is placing lines and interpreting tee.

 

[deleted171991]

They do heart surgery in no mans land? I can't imagine they can get a heart surgeon but not an anesthesiologist. The Crna is probably intubating the patient and standing by for instructions from the surgeon who also is placing lines and interpreting tee.

You wanna bet the CRNA is also placing (at least some of) the lines?

Monkey see, monkey do.

 

[sevoflurane]

In my hometown, CRNAs are able to do cardiac cases unsupervised...but this is literally out in no man's land... so yea

Weak hospital system, poor patient care. I would never want my dog there for surgery.

 

[deleted50478]

That's that Rural Pass Through the crnas lobby to keep doctors from receiving while acting so proud that they provide a significant percentage of rural care. That hospital is paid to provide suboptimal care and the unsuspecting patient doesn't even know he's getting inferior care at full price.

 

[chudat]

so what do you think is the best route for those of us who matched into anesthesia??

 

[Consigliere]

so what do you think is the best route for those of us who matched into anesthesia??

Transfer to another speciality.

 

[projectpat]

Weak hospital system, poor patient care. I would never want my dog there for surgery.

Speaking of dogs... Will MDs have job opportunities to provide anesthesia in veterinary settings? Obviously this will be after CRNAs replace all MDs, then all CRNAs replaced by robot anesthesia machines, which will ultimately led to the activation of SkyNet

 

[projectpat]

.

 

[aneftp]

That's that Rural Pass Through the crnas lobby to keep doctors from receiving while acting so proud that they provide a significant percentage of rural care. That hospital is paid to provide suboptimal care and the unsuspecting patient doesn't even know he's getting inferior care at full price.

It's amazing (and ironic) that the AANA continues to lobby AGAINST anyone else getting rural pass through medicare dollar.....afterall AANA always pushes for "access" and one of the reasons CRNAs are needed to practice independently is "access".

So they want to limit access by restricting medicare pass through to physician anesthesiologists.

 

[chudat]

How would i go about transferring to another specialty? Cannot stand IM, neuro, family, scores arent good enough for surgery, maybe ED or radiology? If so, how would i even start the process?

241/252 DO matched first choice acgme university anesthesia last yr

 

[deleted126335]

It's amazing (and ironic) that the AANA continues to lobby AGAINST anyone else getting rural pass through medicare dollar.....afterall AANA always pushes for "access" and one of the reasons CRNAs are needed to practice independently is "access".

So they want to limit access by restricting medicare pass through to physician anesthesiologists.

Not amazing at all. One of the duties of a professional organization is to advocate for its members.

 

[IlDestriero]

How would i go about transferring to another specialty? Cannot stand IM, neuro, family, scores arent good enough for surgery, maybe ED or radiology? If so, how would i even start the process?

241/252 DO matched first choice acgme university anesthesia last yr

I realize that scores are up from 15-20 years ago when I took the USMLE, but that's not a bad score.
I would think you'd be competitive for surgery.

 

[Carbocation1]

I thought anesthesiologists don't bring in any revenue to the hospital? Is this an indirect measurement?

Wednesday, April 22, 2015

All Work, No Pay

Here are the latest numbers for anesthesiologists' salaries as compiled by the physician placement firm Jackson & Coker. This is based on the income of over 31,000 anesthesiologists that the company his hired out.

The average annual salary is $355,413. The average benefits is $71,083. This produces a total compensation of $426,495. Hospitals can afford this income because an anesthesiologist brings in an annual revenue of about $1,352,120.

When calculated on an hourly basis, the average anesthesiologist earns $171. Add in the benefits and the average total compensation works out to $205 per hour. An anesthesiologist will bring in revenue of about $650 per hour.

It's easy to see that anesthesiologists bring in a lot of money to hospitals. Meanwhile, despite all the hard work and potential medical malpractice, about two thirds of the money goes to somebody else besides the physician. That speaks volumes about the state of medicine in the country today.

http://www.blog.greatzs.com/2015/04/all-work-no-pay.html

 

[aneftp]

Not amazing at all. One of the duties of a professional organization is to advocate for its members.

This is where the ASA needs to use the AANA words against them. They can't have it both ways. AANA can't say patients need access (through rural pass through program) but turn around and limit access by restricting the rural pass through program.

 

[bronx43]

All of them suck. Unless you miraculously get into derm, optho, urology, ENT, an established plastic surgery practice, or radiation oncology I would stick with anesthesia. The benefit anesthesia has over all of them is not having to deal with patients and the bull****/baggage that comes with them. Dealing with patients is seriously a pain in the ass and it's almost worth the risk of staying put just for that added benefit alone. If you really want to make a ton of money, I would look into an MBA to go corporate or work for a consulting group running their healthcare policy dept. Also, all the wealthy physicians made their money in the business of medicine (MRI centers, surgery centers, starting insurance companies/HMOs, starting groups, opening ER clinics, etc) rather than what specialty they went into. Anesthesia at least affords you the free time to pursue other business ventures.

Optho? No thanks... highly saturated market unless you want to go to BFE. Rad onc? Are they even going to be around in 15 years, let alone suffer huge market losses with upcoming changes in cancer treatment? Plastic surgery? Sure it's still profitable, but nothing like it was in the early 2000s. I've got a bridge to sell to any new grad that thinks he/she can move out to LA and become the next Dr. 90210. Saturated market + high overhead + recession = bad news. ENT, derm, urology, ortho are fine. For now...

MBA? Hasn't this horse already been beat to death, decayed, and been used as fertilizer already? Only someone with no idea about the business world can think that people get a PAY RAISE going into corporate. How many positions at even fortune 500 companies pay more than $350k? Not many, and certainly none that are open to you new grads. Perhaps if you stick with the company for a decade, you have a shot, but otherwise - no. Consulting group? Lol, ok. I honestly rather do psychiatry than management/health care consulting. Two by two matrix? LOL. Shi*test job in the world. Pay's crap too for what they have to go through, unless you somehow value Starwood points more than actual money.

Honestly, in the coming decades, there will be no more "OMGAMAZINGBBQ" specialties. It will likely suck across the board for everyone. Sure, some specialties will suck slightly less than others, but the golden era of medicine in this country is over, and has been over for many years. The thing you should focus on in the future is how to actually add value and maximize your value add. Everyone (not just doctors) will have to work a lot harder for a lot less. From a global macroeconomics and finance standpoint, the infinite growth paradigm of the 20th century simply won't convert to the next 50 years.

 

[Jonassen]

I had debated between anesthesia, rads and ortho. Ended up going to ortho, but honestly ortho isn't rainbows and unicorns either. The residency is brutal and the job market isn't as great as advertised either (it's great if you like BFE). Sometimes I wonder if I wouldn't have been more happy and balanced if I went into anesthesia. Ultimately it's a job. Doing anesthesia in BFE and doing ortho in BFE, in the end you're still in BFE shopping at Walmart on the weekend.

If I had to do this again, I think I would have a picked a specialty that sacrificed some money but had better demand in the major cities (like psych or ED).

My game plan is to work 10 years in BFE while the kids are still young and would enjoy the outdoors, make bank, pay off all debt and amass enough savings for a nice house in the coast, and then debate if I still want to work fulltime anymore.