The ASA and the younger generation anesthesiologists should lobby state and federal Congresses on postgraduate training schools and establish more AA schools and have all states be able to employ AAs. That way 1) more anesthesia providers 2) improved care team model 3) keeps more anesthesiologists as team leaders as opposed to just chart-signers or "collaborative" liability sponges 4) More AAs means that maybe less nurses go to CRNA school thus increasing the number of nurses who stay nurses instead of jumping to CRNA school. The CRNAs can be independent, but they cannot have the anesthesiologists take blame if there is a lawsuit under their independent care and the surgeons shouldn't have to take the blame either unless they agree to "staff" the CRNAs.
The anesthesiologists who choose jobs that are 8:1 supervision or collaborative or whatever you want to call it maybe have no options in that geographical area or they just don't care and want to have a cash grab while waiting for retirement. It's up to the younger generation of anesthesiologists to have political persuasion to change the direction of the current narrative in anesthesiology. Pride in the Profession
Its not that easy.
There is big money in status quo.
Hospitals do not care about safety and quality. They may say that, but they really do not. They only care about cost and profit. They view anesthesia as pain in the ass already due to subsidies and paying us for "on call" when there is no production or billable activity. They hate that anesthesia is rate limiting step for procedures.
They still have this archaic mindset where they feel that anesthesia should bill for itself and surgeon should bill for themselves and they will get the facility fee. At medicare rate of $20/unit and an aging population, convincing them on our lack of profitability and how market will not support a salary of $200K/year for an anesthesiologist with billing, is like talking to a big giant non responsive delusional wall.
I do not know what the right answer is. If you do, let me know. People much smarter and brighter than me are unable to solve these issues and current solution is cost difference paid for anesthesia services (i.e. subsidy).
My personal take is that instead of fighting this war for every young anesthesiologist, one should focus on dedicating their individual time working with a hospital/practice that is either MD only or strict medical direction with CRNAs that are already trained to know their place in team setting. Maybe academics is also a good option. And if those two options pay you acceptable market rate, take it. If not, then continue locums until you find a reaonable package. Locums long term is not for everyone. Its brutal if you have a family and children.
There are multiple layers of greed and corruption. Insurance companies that are wanting to nickel and dime everyone. Hospitals. Private equity. Surgeons. Surgeon partners that co-own facilities. Then anesthesia partners that have controlling interest in a practice and get to pick and choose schedule and operations. The same anesthesiologist partners are looking to work less and dump their work on the younger docs. My previous CMO was being paid for a full day's worth of work for "being last one on schedule". Typically he would do 1-2 endoscopy cases that started at 9/10, and then he'd leave. He was an employed CMO and made more than any of the regular anesthesiologists. Never worked past 1 pm in my 4 years there. No weekends, no call.
Unless there is parity in labor and pay, one cannot be satisfied.
And that's the best case private practice scenario.
Our only leverage is labor shortage and hospitals are trying to fill that gap with CRNAs. So right now the field is open. You don't like an environment - move. Walk with your feet. That's the best answer.
If you are employed, esp. with a CRNA led or owned company - you can kiss you autonomy and softer yet important aspects of being a physician completely good bye. Your role is transactional. That's ok for a little bit, but long term, you're not going anywhere professionally and not truly growing as a physician. These are the same places that allow CRNAs to do "peer reviews" on anesthesiologists and they think its ok.
So yes, the above thoughts sound idealistic and nice on paper and good to motivate and rile up younger anesthesiologists, but local politics and policies determine everything. I bet 95% of the anesthesiologists have never read bylaws, rules and regulations, and credentialing documents of a facility they work at. That would be start to see how you can locally make a difference. That's if you care to begin with. Most people feel its too much time and easier to hang the jacket once done, and spend time with their families or do something else. And thats ok too. How much can one fight? It takes a toll on you.
