Some observations from the ASA

[militarymd]

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I didn't go to many clinical stuff, but rather focused on many of the practice management, staffing, kind of stuff......

Here are some of the themes that I detected amongst our ASA leaders.

- there is a shortage of anesthesia providers both mds and nurses.

- there will be continued and ongoing need to anesthetize people both in the OR and outside the OR

- there is a trend towards Part Time work...and trend towards emphasis on life outside of work.

.....all of the above would make you think that we are going to be sought after commodities....more work...less people willing to work...


- here's the kicker....the OTHER ongoing theme is that REIMBURSEMENT will continue to go down....

Seems there is a disconnect here???

More work to be done...less people to do it....but less payment....

Maybe I'm wrong, but that's I heard at the meetings.

 

[fastosprintini]

hi mil,
who said there is a shortage of physicians and nurses?
shouldn't that shortage be reflected in increasing offers on gaswork.com?
were those official statements or soundbites on corridors ?
curious , fasto

 

[militarymd]

hi mil,
who said there is a shortage of physicians and nurses?
shouldn't that shortage be reflected in increasing offers on gaswork.com?
were those official statements or soundbites on corridors ?
curious , fasto

according to a study conducted by the Rand corp commissioned by the asa

 

[dhb]

In academics they often believe there is a shortage of physicians i would argue that their is a shortage of cheap labor: the worst paying spots always fill last...

I do agree on the part time issue especially since more and more women enter the field. The classes coming out of my med school now are > 70% female.

 

[MDEntropy]

I didn't go to many clinical stuff, but rather focused on many of the practice management, staffing, kind of stuff......

Here are some of the themes that I detected amongst our ASA leaders.

- there is a shortage of anesthesia providers both mds and nurses.

- there will be continued and ongoing need to anesthetize people both in the OR and outside the OR

- there is a trend towards Part Time work...and trend towards emphasis on life outside of work.

.....all of the above would make you think that we are going to be sought after commodities....more work...less people willing to work...


- here's the kicker....the OTHER ongoing theme is that REIMBURSEMENT will continue to go down....

Seems there is a disconnect here???

More work to be done...less people to do it....but less payment....

Maybe I'm wrong, but that's I heard at the meetings.

This isn't simple supply demand economics.

There is a disconnect. And you already know what it is. Regulation. The more regulation, the less you see the expected correlation.

Health insurance reform is the wild card here. Insurance companies are in the cross hairs. It looks like they will get hit, and when they are, this will be passed on to hospitals and physicians.

This reform will increase non-ER primary care access significantly. This additional access will be used minimally. But even if this increased access to primary care is used more than expected, it won't make Americans healthier. Americans will continue to smoke, eat big macs, feel entitled and age. Access won't change this but it will catch a few more cancers at an early stage.

Consequently, more care for Americans will be needed. And you're gonna give it to them...at whatever rate you are told to accept.

 

[deleted126335]

.

 

[cchoukal]

This reform will increase non-ER primary care access significantly. This additional access will be used minimally. But even if this increased access to primary care is used more than expected, it won't make Americans healthier. Americans will continue to smoke, eat big macs, feel entitled and age. Access won't change this but it will catch a few more cancers at an early stage.

Consequently, more care for Americans will be needed. And you're gonna give it to them...at whatever rate you are told to accept.

These are two extremely insightful observations and both will be ignored by policy-makers.

 

[omegaman]

Right now there are fewer anesthesiologist jobs available than there have been any time in the last 10 to 15 years. I think that the fear of health care reform has caused employers to cut down on hiring. Another disturbing trend is the growth of AMC (anesthesia management companies) who operate almost exclusively under the anesthesia team model. Thus a place that used to employ four anesthesiologists now employs one and four CRNA's and sends half of the practice's revenue to the absentee out of state AMC owner.

Once the health care reform debate is over the market will improve. If reform passes salaries will go down, but many anesthesiologist will retire and more insured people will increase demand for OR services thus greater demand for anesthesiologists. If health care reform fails groups will start hiring again but at a progressively slowing rate due to the constant growth of AMCs.

The ASA represent the employers of anesthesiologists not working anesthesiologists, so they will be shouting about a shortage of anesthesiologists until there are so many anesthesiologists that anesthesiologists are lined up around the block to take a minimum wage job.

If the RAND study said anything other than that there was a shortage of anesthesiologists, you know the ASA would have changed the criteria or hired someone else until they got the results the ASA wanted that there is a shortage of anesthesiologists.

 

[periopdoc]

I think that the fear of health care reform has caused employers to cut down on hiring.

I have only interviewed at what I consider to be top notch jobs at this point. Every one of them has told me that they will not be hiring until after the health care reform issue is settled and they know what the ramifications will be. They have also told me that "with your qualifications someone else will have hired you before we start hiring." Someone just hire me already.

I suspect that the flood gates are going to open in the next 6-8 months and practices will start hiring again. The practices I am familiar with have essentially had a hiring freeze on since Nov/ Dec of last year and are getting tired of running lean. It doesn't look like there will be significant change from the D.C. front, and the economy has stabilized somewhat even if it isn't growing yet.

just my random thoughts.

- pod

 

[deleted50478]

Whatever unconstitutional load of garbage gets shoved down our throats by unresponsive sell-out politicians will not go into effect for a few years, so it's a little early for a hiring freeze. Also, hopefully all the responsible government officials will be voted out of office and their Marxist plans reversed before they can rape future generations with ever increasing debt any more. Talk about taxation without representation...

 

[deleted126335]

.

 

[Coastie]

I didn't go to many clinical stuff, but rather focused on many of the practice management, staffing, kind of stuff......

Here are some of the themes that I detected amongst our ASA leaders.

- there is a shortage of anesthesia providers both mds and nurses.

- there will be continued and ongoing need to anesthetize people both in the OR and outside the OR

- there is a trend towards Part Time work...and trend towards emphasis on life outside of work.

.....all of the above would make you think that we are going to be sought after commodities....more work...less people willing to work...


- here's the kicker....the OTHER ongoing theme is that REIMBURSEMENT will continue to go down....

Seems there is a disconnect here???

More work to be done...less people to do it....but less payment....

Maybe I'm wrong, but that's I heard at the meetings.

Since our payments are tied to govt and not the market, I could see this.

 

[militarymd]

Here's something else for you all to chew on.

Most anesthesia groups supplement their income with "subsidies" from the hospital that they contract with....

The AMC's certainly do that.

Think about how that fits into this "future"....a "future" where the ASA is advocating cranking out more and more anesthesiologists.

A "future" where the "need" is not necessarily defined by "efficient" use...but perhaps by having a md sit around doing the second room for a spine surgeon....ie 50% utilization of the anesthesiologist....while the hospital and surgeon maximizes their time utilization.

 

[Dejavu]

Whatever unconstitutional load of garbage gets shoved down our throats by unresponsive sell-out politicians will not go into effect for a few years, so it's a little early for a hiring freeze. Also, hopefully all the responsible government officials will be voted out of office and their Marxist plans reversed before they can rape future generations with ever increasing debt any more. Talk about taxation without representation...

Why don't you tell us how you really feel

 

[omegaman]

👍 Agree with everything except many anesthesiologists being on the cusp of retirement. The carnage in the financial and real estate markets, coupled with looming tax increases will keep many docs working far longer than they anticipated- even if only part time.

Fox news had been using the figure that 40% of doctors will retire or leave medicine once health care reform passes. Talking to the doctors where I work many of the over 50 year old physicians are considering retiring if the government ratchets down salaries. We also have a number of Docs who put off retirement due to the crash of 2000- 2001 or the crash of 2008- 2009 who are just waiting for their portfolio to improve before retiring, but they probably would leave if salaries went down.

 

[ozzie20]

so pair healthcare reform with the market crash, we starting to see a mini-downturn in jobs available for anesthesiologists?

 

[GasDaddy]

from what i'm seeing, groups aren't hiring as aggressively, even when they have a need. it is panic driven, purely. like mentioned before, the changes that will come will take atleast years to be implemented before we see an impact. so they are acting way too early and who knows how that dynamic will impact things.

 

[deleted126335]

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[maceo]

I think a lot of them are crying wolf. The fifty somethings need to provide for 3 decades or so of retirement, not to mention paying for a lot more of their personal healthcare out of pocket, either because of means testing or because of wanting better than what the future average health care will be. Not to mention supporting boomerang kids who can't find work in a down economy. Probable increased tax rates for those who have saved anything. That's is going to take a large amount of coin that most docs simply don't have. Do I think docs will cut back and sacrifice less of their lives to work? YES. Retire in droves? NO.

when i see an anesthesiologist over the age of 62 working I get pissed off. Retire already you greedy bastard.. scale down your liveing arse.

 

[GasDaddy]

when i see an anesthesiologist over the age of 62 working I get pissed off. Retire already you greedy bastard.. scale down your liveing arse.

haha. dude, i've seen attendings in their 70's. They are fun to work with, but I can agree on many levels that they need to give the younger folks a chance. scale down for sure.

 

[jwk]

No disconnect. Working harder to maintain your income only goes so far. If your hourly rate drops below a certain point, The time becomes more valuable. Particularly for the night and weekend work.

BIG problem that nobody wants to pay attention to. It will be just like the VA - 10-12 rooms until 3pm, one room after 3pm regardless of how much work is left to be done.

 

[pgg]

haha. dude, i've seen attendings in their 70's. They are fun to work with, but I can agree on many levels that they need to give the younger folks a chance. scale down for sure.

So long as the geriatric anesthesiologists aren't nodding off during cases, using methoxyflurane, or fracturing their hips while moving patients, why shouldn't they be able to work as long as they want?

Old MDs aren't a threat to us.

 

[pgg]

BIG problem that nobody wants to pay attention to. It will be just like the VA - 10-12 rooms until 3pm, one room after 3pm regardless of how much work is left to be done.

Don't forget the 45 minute turnovers because the OR staff know they're done at 3 regardless.

 

[foxtrot]

I have only interviewed at what I consider to be top notch jobs at this point. Every one of them has told me that they will not be hiring until after the health care reform issue is settled and they know what the ramifications will be. They have also told me that "with your qualifications someone else will have hired you before we start hiring." Someone just hire me already.

I suspect that the flood gates are going to open in the next 6-8 months and practices will start hiring again. The practices I am familiar with have essentially had a hiring freeze on since Nov/ Dec of last year and are getting tired of running lean. It doesn't look like there will be significant change from the D.C. front, and the economy has stabilized somewhat even if it isn't growing yet.

just my random thoughts.

- pod

I hear you periop. It took me almost 9 months to find a descent job in a place I wanted to practice. It all depends on the city you are vying for of course. The bigger the city, the worse your offer (unless you know someone). Once again, the ASA is out of touch. This "shortage of anesthesiologis" bit is a bunch of b.s. If that were the case, gasworks and locum tenens would be flooded with jobs (and they are not). It is rare to see a private practice group advertising on gasworks. It is mainly crappy jobs from recruiters or the same jobs that have been advertising for a year. Even the academic centers are getting competitive. I applied for an academic position in a nice, mid-sized southern city and I was told I was competing with close to 20 other well qualified candidates. I was shocked. Moral of story, start job hunting early and don't buy a home during your first job because you may have to practice in a place that is not ideal.

 

[foxtrot]

Don't forget the 45 minute turnovers because the OR staff know they're done at 3 regardless.

Man, I miss the VA.

 

[CristaGalli]

It is really hard for me to make a lot of sense of what you all are discussing, as a 4th yr med student, but of course I am very interested. So I'll ask a couple of basic questions to guide me:

1. If you were in my shoes (4th yr or 3rd yr), would you go into anesthesiology? pls answer from an economic standpoint (no need for its my true passion responses)
2. Is the future as bad as it looks for anesthesiolgy, or is this a reflection of the whole medical field in general?
3. What does lower salary in the future mean compared to now? Ballpark figures pls
4. Is this cRNA problem really a major issue? I hear mixed answers from everyone?

I understand these are complicated questions to answer, and y'all are not fortune tellers, so pls answer at your convenience

 

[omegaman]

It is really hard for me to make a lot of sense of what you all are discussing, as a 4th yr med student, but of course I am very interested. So I'll ask a couple of basic questions to guide me:

1. If you were in my shoes (4th yr or 3rd yr), would you go into anesthesiology? pls answer from an economic standpoint (no need for its my true passion responses)
2. Is the future as bad as it looks for anesthesiolgy, or is this a reflection of the whole medical field in general?
3. What does lower salary in the future mean compared to now? Ballpark figures pls
4. Is this cRNA problem really a major issue? I hear mixed answers from everyone?

I understand these are complicated questions to answer, and y'all are not fortune tellers, so pls answer at your convenience

If Heath Care reform passes we are entering new and uncharted territory. One can only speculate about what will happen and how fast. You can look to Canada and Western Europe to see how their systems work, or to the government's model for government provided heath care at the VA, the Indian Heath System, the Military and any one of the numerous public hospitals. The best guess is that all physicians salaries will go down to primary care levels.

 

[militarymd]

It is really hard for me to make a lot of sense of what you all are discussing, as a 4th yr med student, but of course I am very interested. So I'll ask a couple of basic questions to guide me:

1. If you were in my shoes (4th yr or 3rd yr), would you go into anesthesiology? pls answer from an economic standpoint (no need for its my true passion responses)
2. Is the future as bad as it looks for anesthesiolgy, or is this a reflection of the whole medical field in general?
3. What does lower salary in the future mean compared to now? Ballpark figures pls
4. Is this cRNA problem really a major issue? I hear mixed answers from everyone?

I understand these are complicated questions to answer, and y'all are not fortune tellers, so pls answer at your convenience

As someone who believes that the future of this specialty is to limit the number of people trained, my comments are the following:

- don't do it..I don't want another one coming out of the pipeline wanting a job.

- don't do it....you will be another one in the pipeline coming out and competing for a job.

- don't do it.....based on statistics...you are likely one of the lower 4/5 of performers...so I don't want someone like you as a colleague.

as opposed to the NIKE commercials.....just DON'T do it.

 

[hanjoko]

As someone who believes that the future of this specialty is to limit the number of people trained, my comments are the following:

- don't do it..I don't want another one coming out of the pipeline wanting a job.

- don't do it....you will be another one in the pipeline coming out and competing for a job.

- don't do it.....based on statistics...you are likely one of the lower 4/5 of performers...so I don't want someone like you as a colleague.

as opposed to the NIKE commercials.....just DON'T do it.

although I'd still go into anesthesia even if I got paid as a primary care physician

 

[deleted126335]

.

 

[Bertelman]

- don't do it.....based on statistics...you are likely one of the lower 4/5 of performers...so I don't want someone like you as a colleague.

That's funny.

Based on statistics, you are also "likely one of the lower 4/5 of performers."

 

[deleted50478]

We'll see if you feel the same way when you are 62🙄

If I see myself working at 62 I'll be pissed off. 😛

 

[militarymd]

That's funny.

Based on statistics, you are also "likely one of the lower 4/5 of performers."

yep, and i'm the first the admit that possibility....so why would I want another one in the mix.

I want to be in the BOTTOM of the top 1/5....and that is an honest statement.

I want EVERYONE around me to be better than me, that ways I will always strive to be better, and have role models to emulate.

That is my attitude in real life.

 

[Noyac]

I have only interviewed at what I consider to be top notch jobs at this point. Every one of them has told me that they will not be hiring until after the health care reform issue is settled and they know what the ramifications will be. They have also told me that "with your qualifications someone else will have hired you before we start hiring." Someone just hire me already.

I suspect that the flood gates are going to open in the next 6-8 months and practices will start hiring again. The practices I am familiar with have essentially had a hiring freeze on since Nov/ Dec of last year and are getting tired of running lean. It doesn't look like there will be significant change from the D.C. front, and the economy has stabilized somewhat even if it isn't growing yet.

just my random thoughts

- pod

Periop,
I read your comment and I think only one thing. If you are interviewing at "top notch" places and they are not offering you anything then you are not interviewing well enough. You are more than likely a good candidate but you are not impressing them enough. The excuses they are giving you, wait till the health care reform issue is solved, is not an honest answer. If they need bodies then they need bodies no matter what the healthcare does. They can always get rid of you if they need to later which isn't a good option but still an option. And the comment like "with your qualifications someone else will have hired you before we start hiring" is also not an honest one in my opinion. To me it means, don't check back with us.

I may be off base with these comments, I hope so. But I think in this environment you need to hone your interview skills. You can't just walk in and say I did so-and-so fellowship, give me a job. Think about the interactions you are having with the members of the group. Are they engaging you? Are they rushing to get back to cases or work? Or are they sticking around to continue talking with you. Are they showing up for dinner? It's important.

Good Luck

 

[periopdoc]

I hear what you are saying, although it would be the first time I have ever had someone tell me that I interview poorly, but these are not the comments that they give me after the interview. These are the first statements they make after we shake hands and introduce ourselves. Maybe it is just a ploy to see how I react and if I still interview well despite them telling me there is no job. Maybe I am just that funny looking...

For a while I thought they were just put off by something in my application so I had a couple of highly respected PP guys look over my paperwork and they didn't see any red flags.

The practices have kept in contact with me since the interviews, and I know that they haven't hired anyone yet so maybe I am just being too impatient.

You can't just walk in and say I did so-and-so fellowship, give me a job. Think about the interactions you are having with the members of the group.

I certainly am not relying on my credentials to get the jobs. I have always been of the philosophy that the CV gets you the interview and the interview get you the job. Believe me I have been reflecting on my interviews multiple times every day. Probably obsessing too much.

- pod

 

[Narcotized]

It ain't getting better. The idea that increased borrowing and consumption will help the economy is a joke. It is getting a lot worse; worse than last year, worse than 1930. We are more broke than we were last year and in 1930, we weren't buried by this much interest and entitlements in 1930, and the prospects of just growing out of it all are less now than 80 years ago.

The floodgates of jobs won't open in 6-8 months. Doctors will find they still aren't rich, their portfolios in a mess, relative pay most likely dropping, and be prepared to be pissed off at the increased number of 62 year olds that are still working. It is mathematically guaranteed that whatever money you do put away will significantly drop in real value as inflation grinds it to dust. Doctors will threaten to walk out en mass on Healthcare Reform, but guess what, they won't have much choice but to keep working.

We are in a debt death spiral with no leadership. No one has explained to the public that your standard of living HAS TO go down before we can get any of it under control. The public still demands a propped up standard of living maintained by more debt, and the politicians deliver it. The borrowing/debt ponzi will crash just like the real estate ponzi, the dotcom ponzi, Madoffs ponzi, the tulip ponzi, and any other ponzi ever created. It ain't pretty.

 

[Noyac]

I hear what you are saying, although it would be the first time I have ever had someone tell me that I interview poorly, but these are not the comments that they give me after the interview. These are the first statements they make after we shake hands and introduce ourselves. Maybe it is just a ploy to see how I react and if I still interview well despite them telling me there is no job. Maybe I am just that funny looking...

For a while I thought they were just put off by something in my application so I had a couple of highly respected PP guys look over my paperwork and they didn't see any red flags.

The practices have kept in contact with me since the interviews, and I know that they haven't hired anyone yet so maybe I am just being too impatient.



I certainly am not relying on my credentials to get the jobs. I have always been of the philosophy that the CV gets you the interview and the interview get you the job. Believe me I have been reflecting on my interviews multiple times every day. Probably obsessing too much.

- pod

Your right, the CV gets you the interview and the interview gets you the job. My only question is why are they interviewing if they are not hiring? Interviewing is a pain in the ass and it can be expensive of for both the group and the interviewee.

 

[periopdoc]

Your right, the CV gets you the interview and the interview gets you the job. My only question is why are they interviewing if they are not hiring? Interviewing is a pain in the ass and it can be expensive of for both the group and the interviewee.

Probably because about two weeks after they get my application, they get a call from me. "Hey I am gonna be in your area in a couple of weeks and wondered if I could drop by and meet a few of your partners."

Really I am just being impatient as these are pretty informal interviews and I know that they aren't hiring.

Oh and about the "top notch" comment, keep in mind that my definition of a top notch practice is more similar to what you would like than what most are looking for.

I would rather be in a practice where more of the partners own these

than these

- pod

 

[periopdoc]

I guess I should note the sad ending of N295BA, the gorgeous Helio Courier in that previous post.


- pod

 

[2ndyear]

I would imagine you're looking at around $200,000 for a nice used Courier on floats right? Real nice plane though.

 

[periopdoc]

I would imagine you're looking at around $200,000 for a nice used Courier on floats right? Real nice plane though.

That's probably a little rich, but not too far off for a good condition 295/395 w/ floats.

Incidentally my favorite plane vid (I know it's a PA-18 not a Helio, but great vid anyway)

[YOUTUBE]6XYFcw1c-Oo[/YOUTUBE]

If you get a chance, check out some more of his vids here Cubdriver749er's channel on YouTube



-pod

 

[Noyac]

It's still early, POD. I was offered the job I have in January. If it's anything at all, it's probably more that they can't hold out for 9 months waiting for you to finish. With your training, you will end up with something nice.

This is very true. We are dealing with this very issue right now.

 

[Consigliere]

Why don't you tell us how you really feel

One of the more annoying quotes I always hear....ranks right up there with "that guy" who always says "that's what SHE said" after any vaguely sexually suggestive statement 😡

 

[maceo]

We are in a debt death spiral with no leadership. No one has explained to the public that your standard of living HAS TO go down before we can get any of it under control. The public still demands a propped up standard of living maintained by more debt, and the politicians deliver it. The borrowing/debt ponzi will crash just like the real estate ponzi, the dotcom ponzi, Madoffs ponzi, the tulip ponzi, and any other ponzi ever created. It ain't pretty.

huh, debt is what this country is all about. if there were no debt there woud be a tiny tiny economy. so according to those in the know.. DEBT IS GOOD. If we could get 1 year olds in debt... thats what we would do.... The problem is.. people cant pay off this debt there lay the problem.

 

[maceo]

One of the more annoying quotes I always hear....ranks right up there with "that guy" who always says "that's what SHE said" after any vaguely sexually suggestive statement 😡

thats what she said.. seriously

 

[deleted50478]

huh, debt is what this country is all about. if there were no debt there woud be a tiny tiny economy. so according to those in the know.. DEBT IS GOOD. If we could get 1 year olds in debt... thats what we would do.... The problem is.. people cant pay off this debt there lay the problem.

No. Debt that allows a business to start or grow is good. The increased returns more than pay for the debt.
Debt for social programs doesn't lead to growth and can never pay for itself. Worse, it leads to even more reliance on social programs and more unproductive debt.

 

[Narcotized]

according to those in the know.. DEBT IS GOOD.... The problem is...

The problem is, "those is the know" don't know dick. As mentioned, debt is productive when it's return is greater than the cost of borrowing. Debt blown on consumption and entitlements returns NADA. And the idea that we can borrow and consume our way to prosperity is so ignorant that anyone educated, including the president, should be totally embarassed to float along this idea.

We use this phrase, "We are a consumer economy," as if that has some legitimacy. In other words, we produce nothing and blow a bunch of money consuming crap we can't afford. What would you think of an individual that doesn't work but just consumes off of credit cards? Basically a deadbeat that will eventually fail, right? That's your "consumer economy" in a nutshell. Payback is gonna be a bitch.

 

[Consigliere]

😎

thats what she said.. seriously

You're a jag-off...seriously.

 

[mille125]

huh, debt is what this country is all about. if there were no debt there woud be a tiny tiny economy. so according to those in the know.. DEBT IS GOOD. If we could get 1 year olds in debt... thats what we would do.... The problem is.. people cant pay off this debt there lay the problem.

i dont think that you really believe this...you are smarter than that

 

[maceo]

😎

You're a jag-off...seriously.

thats what she said... seriously