The future of anesthesiology

BLADEMDA

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    Agreed.

    At least in the U.S. we've never taken such old, and sick patients to the OR for any number of interventions. Sure, the intervention may be "benign" but when it's an 88 yo with AS, CAD, COPD, CKD etc etc. , well that's a game changer.

    Many have suggested that anesthesiologist will be taking care of the sicker patients, leaving the less sick (ASA 1/2's) to CRNA's. Well, if this happens, do you really think there will be any significant reduction in demand? Look at our demographics and reflect on the overall health of this demographic and the future, frankly, looks bright for those providing high acuity health care.

    4 months into my anesthesiology training and I've taken some seriously ill people under my (and my attending ofcourse...) care. The numbers of these types of patients is growing by the day as the baby boomers enter the picture.

    Your Assumption is that Medicare cares more about the elderly than saving money. Until Grandmas start dying in significant numbers expect the cost cutting to continue with limitations on consumption of expensive surgical services.

    http://obamacare-healthcarereformbi...eform/impact-of-obamacare-on-senior-citizens/
     
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    Osteoimperfecta

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      If you know the future of healthcare or can predict the future with such accuracy start picking stocks and investing in businesses. It's way more profitable than medicine if you are good at it.

      If you want to go into another field b/c you think it has a brighter future or for whatever reason just apply to it and go into it. I promise, no one here would be offended. We are not here to hold your hand or tell you the future of anesthesia is all rosy and that everything's going to be OK b/c truthfully, we don't know anything more than you do. We're just guessing like you are. You can make the same arguments for just about any field in medicine or any other job in the country. Go into anesthesia because you enjoy practicing anesthesia and let the rest of the BS sort itself out.

      Will we make less money? Probably but who knows? Will we be forced out of the ORs? Don't think so but what do I know? Just remember, know one knows the future and the only thing you can count on is change. If you like what you do you will be OK, if not you'll be miserable. It really is as simple as that. Work hard, keep fighting for the profession, and things will be OK.

      Great post. In the last 4 months I have met an FP who thinks he should have been a pathologist, a surgeon who should have been an anesthesiologist, anesthesiologists who should have been FPs, Pathologist who should have been an internist, and an internist who should have been an anesthesiologist. None btw, brave enough to actually switch. Go figure.
       
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      BLADEMDA

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        marnie123

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          Where is the evidence for any of this?



          Here is the sequence of Change:

          1. GI Centers- Some already have gone CRNA Only

          2. ASCs- A few have gone to the CRNA only model. More are likely to go MD /CRNA with the Doctor doing his/her own case right next door to the CRNA.

          3. Rural Hospitals- Many are CRNA only and more may consider it. Even if there is ONE Anesthesiologist the CRNA does his/her own case unsupervised.

          4. Community Hospital- They will feel the pressure to save money and reduce stipends. This means fewer Anesthesiologists and more CRNAs. 6:1 ratios are just around the corner.

          5. Larger Private Hospitals- Probably a few years behind Community hospitals.

          6. ACADEMIA- The Ivory tower will likely be years away from major changes. CRNAs won't be doing cases Solo.
           

          BLADEMDA

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            That is a great question, marnie. Blade, respectfully, please give specific locations and group names.

            No. Please join the Private Forum if you want specifics. Denial isn't just a river in Egypt.

            I am simply posting what I know to be factually true:


            1. GI Centers- Some already have gone CRNA Only

            2. ASCs- A few have gone to the CRNA only model. More are likely to go MD /CRNA with the Doctor doing his/her own case right next door to the CRNA.

            3. Rural Hospitals- Many are CRNA only and more may consider it. Even if there is ONE Anesthesiologist the CRNA does his/her own case unsupervised.

            4. Community Hospital- They will feel the pressure to save money and reduce stipends. This means fewer Anesthesiologists and more CRNAs. 6:1 ratios are just around the corner.

            5. Larger Private Hospitals- Probably a few years behind Community hospitals.

            6. ACADEMIA- The Ivory tower will likely be years away from major changes. CRNAs won't be doing cases Solo.
             

            BLADEMDA

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              This is very evident with MDA groups who have an active supervision model. Interestingly, this trend is also reflecting in MDA groups who have historically not utilized CRNA supervision models, but have begun exploring these models as a manor of providing more cost effective care (or a better bottom line for the practice). The latter of these two groups is by its nature identifying the price/compensation elasticity of the current market for CRNAs in traditional MDA practice models and at some level concurrently in hospital employment models.
              The developing CRNA employment market, however is also realizing opportunity in aligning with ASCs and Endoscopy practices. The ongoing development of these market segments will continue to offer CRNAs independent earning opportunities, especially as management companies and non-MDA practices drive market segment growth.

              The CRNA market is also very interesting in the sense that there are a significant number of independent CRNAs who run their own contract business platforms either as an individual or as a group.


              Dennis Gundersen
               

              BLADEMDA

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                Jeremy Cushing, CRNA, MSNA
                As an anesthetist for the past 12 years, I have been a part of several CRNA employment arrangements including CRNA owned groups. With over 15 years of experience with leadership training and facilitation management I have been able to use those skills in the Anesthesia practice arena as Anesthesia providers can be very adverse to change. I am a firm believer that locally owned and operated Anesthesia practices working in a collaborative fashion provides the most stable and rewarding environment for our communities and our patients.

                Collaborative= No Supervision
                 

                BLADEMDA

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                  Study Shows CRNA-Only Anesthesia Delivery Most Cost Effective
                  Data Show No Difference in Quality or Safety by Anesthesia Provider or Delivery Model
                  Park Ridge, Ill.—A Certified Registered Nurse Anesthetist (CRNA) acting as the sole anesthesia provider is the most cost effective model of anesthesia delivery, according to a new study conducted by Virginia-based The Lewin Group and published in the May/June 2010 issue of the Journal of Nursing Economics.
                  The study, titled “Cost Effectiveness Analysis of Anesthesia Providers,” considered the different anesthesia delivery models in use in the United States today, including CRNAs acting solo, physician anesthesiologists acting solo, and various models in which a single anesthesiologist directs or supervises one to six CRNAs. The results show that CRNAs acting as the sole anesthesia provider cost 25 percent less than the second lowest cost model. On the other end of the cost scale, the model in which one anesthesiologist supervises one CRNA is the least cost efficient model.
                  The study’s authors also completed a thorough review of the literature that compares the quality of anesthesia service by provider type or delivery model. This review of published studies shows that there are no measurable differences in quality of care between CRNAs and anesthesiologists or by delivery model.
                  “The data confirm that CRNAs deliver anesthesia safely and cost-effectively,” said AANA President James Walker, CRNA, DNP. “With growing demands on the healthcare system nationwide, we must do all we can to make sure the nation’s healthcare professionals are used as effectively and efficiently as possible. CRNAs, who administer approximately 32 million anesthetics to patients in the United States each year, stand ready to do our part.”
                  The results of the Lewin study were particularly compelling for people living in rural and other areas of the United States where anesthesiologists often choose not to practice for economic reasons. The safe, cost-effective anesthesia care provided by nurse anesthetists has been a mainstay in these areas for more than 100 years, ensuring millions of patients access to surgical, obstetrical, trauma stabilization, and diagnostic procedures.
                   

                  BLADEMDA

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                    That is a great question, marnie. Blade, respectfully, please give specific locations and group names.

                    Slim, if CRNAs don't practice SOLO anywhere then where does the "evidence" come from for all these AANA backed studies?

                    Second, I have seen many more Solo CRNAS over the past ten years. It is becoming more common and not less.

                    Third, the ASC, GI center, Hospital, etc, benefits financially from this Solo CRNA arrangement. The CRNA rarely gets much of the money earned/saved; instead, the owners of the ASC/Gi center keep the profits.
                     
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                    BLADEMDA

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                      "If there was any evidence that patients would suffer in ANYWAY by having independent CRNA practice it would have ceased to exist long long ago. You can be sure that the ASA would have been all over it and hospitals would not allow it for any reason if there was a greater risk of lawsuit because of patient risk. However, there is not. The evidence (all of it) has shown this to be true.

                      You do not have to like it, however, that is the reality."

                      CRNA
                       

                      BLADEMDA

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                        Increasingly, surgery centers and practices related to surgery centers attempt to profit from the providing of anesthesia services. In the last couple of years, the American Society for Anesthesia has attacked various models as improper kickback relationships and has argued to the Office of Inspector General that the real intent of these relationships is to provide profits to surgeons who refer business to the ambulatory surgery center through the ability to profit from anesthesia services. More recently, the Maryland Association of Nurse Anesthetists has filed for a declaratory judgment with the Maryland of Department of Health and Mental Hygiene which regulates physicians. Here, the anesthetists argued that a model whereby a physician practice or Ambulatory Surgery Center (ASC) pays the Certified Registered Nurse Anesthetists (CRNAs) a flat fee per day and CRNAs assign all theirs fees to the practice or ASC was illegal.

                        Recently however, at least four non-anesthesia physician group practices utilizing ASCs have required anesthesia providers, including CRNAS, to enter into contractual relationships with the physician group practices. Under the Agreement the CRNA is required to relinquish all rights to independently bill and are required to assign all billing rights and rights to compensation to the non-anesthesia physician group practice.

                        Under this new business model, the non-anesthesia group practice is able to dramatically increase profit margins by collecting the fee for service normally collected by the anesthesia provider and in turn, compensating the anesthesia provider, including CRNAs, a flat daily fee. These non-anesthesia physician groups have also increased the rates for the anesthesia procedures care to further maximize their profit.2 Until this recent development, the non-anesthesia group practices did not bill for the anesthesia services.

                        The non-anesthesia physician group practices in question presented contracts to the CRNAs and informed the CRNAs that they would accept the contract or the non-anesthesia group physician practice would find other anesthesia providers. The CRNAs had no bargaining power and were essentially forced into a contract of adhesion.
                         

                        BLADEMDA

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                          Anesthesiologists and certified
                          registered nurse anesthetists
                          provide high-quality, efficacious
                          anesthesia care to the U.S. population.
                          This research and analyses
                          indicate that CRNAs are less costly
                          to train than anesthesiologists
                          and have the potential for providing
                          anesthesia care efficiently.
                          Anesthesiologists and CRNAs are
                          interchangeable.
                          They can perform
                          the same set of anesthesia
                          services, including relatively rare
                          and difficult procedures such as
                          open heart surgeries and organ
                          transplantations, pediatric procedures,
                          and others. CRNAs are generally
                          salaried. Their compensation
                          lags behind that of anesthesiologists,
                          and they generally
                          receive no overtime pay. As the
                          demand for health care continues
                          to grow, increasing the number of
                          CRNAs, and permitting them to
                          practice in the most efficient
                          delivery models, will be a key to
                          containing costs while maintaining
                          quality care. $

                          NURSING ECONOMIC$/May-June 2010/Vol. 28/No. 3
                           

                          Lysinee

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                            If 1 MD supervises 6 CRNA's, what effect would it have on the MD's salary?

                            I would assume that the market would become competitive for MD's, and thus a lower salary. Is it reasonable to conclude that a MD can still make 200-250K working in the suburb or city area?

                            Thanks.
                             

                            BLADEMDA

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                              If 1 MD supervises 6 CRNA's, what effect would it have on the MD's salary?

                              I would assume that the market would become competitive for MD's, and thus a lower salary. Is it reasonable to conclude that a MD can still make 200-250K working in the suburb or city area?

                              Thanks.

                              Here is my 2 cents of advice:

                              1. Obamacare- Will the Supreme Court uphold it this Spring?

                              2. AANA Studies- Any evidence by the ASA/ABA/SDN (published) that MD (A)s add value over CRNA with Senior, experienced CRNA as a "floater"?
                              So far the answer is "NO."

                              3. Gi Centers/ASCs- MD(A)s continue to lose ground in these centers because CRNAs can be employed by the surgeons/center and greatly increase profit margins for the owners of the center.

                              4. Fellowship- Highly advisable for those looking for a 20 year career in the field who have not started a Residency yet.

                              5. Legal- What exactly can an MD(A) do that a CRNA can not as it pertains to the practice of anesthesia?

                              6. Midlevels- Why would CMS/Medicare pay you a physician's wage for a nurses job?

                              7. Ratios- Will Hospital CEOs cut or reduce stipends to anesthesia groups in the upcoming years? What will this do to supervision ratios?

                              8. National Opt-Out- If Obamacare gets upheld in 2012 then National CRNA opt-out is right around the corner.

                              9. Skill set- Why exactly should a hospital pay you TWICE the CRNA wage for doing a CRNA type job? What unique skills do you bring to the table?

                              10. Collaboration- The interim goal of the AANA is a Collaborative practice with occasional medical supervision of CRNAs. The easy cases go to the CRNAs while the MD(A)s do the hard cases. Nobody is actually out supervising anyone consistently. Again, this is the interim goal until the ultimate goal of CRNA=MDA can be reached.
                               
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                              BLADEMDA

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                                "Low-end consumers of anesthesia services regard the ability to safely produce a deeply sedated or anesthetized patient who is happy at the end of the procedure as a commodity, where the key differentiators—compensation and fit with the procedure area workflow—boil down to cost. "

                                Time for you all to re-read Mark Lema on the future of this specialty.

                                Note he predicts 10:1 ratios as possible and MORE Solo CRNA practice.
                                 

                                BLADEMDA

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                                  Nurses are an equal, if not superior choice, to administer anesthesia



                                  anesthesia-3-300x258.jpg




                                  BY DAVID L. KNOWLTON

                                  Unlike so many others in the health care policy arena who find themselves concerned with bottom lines, gored oxen and political consequences, my job as President and CEO of the New Jersey Health Care Quality Institute is a relatively easy one. I have a clear focus: health care quality and patient safety.
                                  So when the Institute was asked to weigh in on the issue of whether New Jersey Advanced Practice Nurse Anesthetists should remain the only Advanced Practice Nurses required to have the presence or direct supervision of a physician certified in their specialty (Anesthesiologists), we did not hesitate. The clear answer from a patient safety point of view is unequivocally “No.” The cause of health care quality is not advanced by requiring supervision and may, in fact, be harmed. In my view patient safety is the only issue that should matter in this increasingly heated issue exchange.
                                  It is important to understand the history of anesthesiology in America to fully comprehend this issue and why nurses are an equal, if not superior choice, medically for this procedure. As I testified before the Department of Health and Senior Services Health Care Administration Board which correctly advanced regulations eliminating the supervision requirement, the very first professional that provided dedicated coverage to a patient under anesthesia was a nurse. That was more than 125 years ago. Physicians did not follow until some three decades later. Since that time, nurse anesthetists have grown to providing more than 25 million anesthesia applications annually with a safety record of which nearly every medical professional would be proud.
                                  In fact, this is not even a close call when it comes to patient safety. Every peer-reviewed study that has ever been conducted on the issue — and there have been many — has reached the same conclusion. Nurse Anesthetists have performed at the same level of Anesthesiologists or better than Anesthesiologists. It’s a safe record and in the field of health care quality, where there are so many failures in this nation for which we should be ashamed, this is one to be admired.
                                  I will cite just one of the studies not only because it is the most recent, but because it is also the most comprehensive and the most compelling. The study was published in the August 2010 issue of Health Affairs and it says everything one needs to know just by its title, “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians.” The study examined nearly 500,000 individual cases and confirms what previous studies have clearly demonstrated: Advanced Practice Nurse Anesthetists provide safe, high-quality care. The study also shows the quality of care administered is optimal, regardless of whether physician supervision is conducted or not.
                                  This most recent study followed up on a Federal government decision in 2001 that permitted states to “opt out” of the Medicare physician supervision requirement for Nurse Anesthetists. Since this option was offered, 16 states — most recently Colorado this past September — have opted out. The study concluded that the Medicare physician supervision rule is obsolete and unnecessary. In fact, one of the study’s authors, Jerry Cromwell, PhD, said “We find no evidence that opting out of the oversight requirement harms patients in any way.”
                                  And there is an objective approach to assess this risk. As imperfect as the medical malpractice insurance system is, it is still a good gauge of risk and dangers. It is interesting to note that the average New Jersey physician Anesthesiologist’s malpractice rate ranges from $14,124 to $31,843 annually. Compare that to the $120,198 to $197,425 range for OB/GYN’s. This difference in rates demonstrates that an OB/GYN has at least six and up to 16 times the risk of an Anesthesiologist.
                                  Interestingly enough, Certified Nurse Midwives, who have similar degree and licensure requirements as Nurse Anesthetists, may practice and treat patients independently. These Midwives work unsupervised in both hospital Labor & Delivery units as well as free-standing birthing centers. It seems counterintuitive to require a physician to be present to directly supervise a Nurse Anesthetist’s care while no such oversight is deemed necessary for Nurse Midwives given that both nursing specialties have an excellent safety record and Nurse Anesthetists have between six and 16 times less risk involved in the care they provide. Additionally, while Nurse Midwives often practice on their own with no physician present or even nearby, Nurse Anesthetists never practice without a physician present and part of their team. Further, the current Advanced Practice Nursing rules require collaboration by a physician with all of their protocols and medications before they can be administered. Requiring the unnecessary, duplicative and costly presence of an Anesthesiologist to supervise an Advanced Practice Nurse Anesthetists makes no sense whatsoever.
                                  New Jersey should do the right thing and take the course that leads to better health care quality outcomes. The Commissioner of Health & Senior Services should ignore the distracting, economically-motivated arguments on this issue and focus only on quality, safety and the health of the patient. That path is clear; Advanced Practice Nurse Anesthetists should be treated as all other Advanced Practice Nurses and should not be required to have an Anesthesiologist present for the safe delivery of their care.
                                  David L. Knowlton, President and CEO of the New Jersey Health Care Quality Institute headquartered in West Trenton, is a former Deputy Commissioner of Health during the administration of Governor Tom Kean.
                                   

                                  ccmonopolies

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                                    If 1 MD supervises 6 CRNA's, what effect would it have on the MD's salary?

                                    I would assume that the market would become competitive for MD's, and thus a lower salary. Is it reasonable to conclude that a MD can still make 200-250K working in the suburb or city area?

                                    Thanks.

                                    If what Blademda says plays out, then non-fellowship trained anesthesiologists will likely end up with salaries that are similar to CRNAs, which would be mid 100s to low 200s.

                                    Like I said, I think fellowship trained anesthesiologists will still be able to provide services that CRNAs can't, and thus will be compensated in a different way. Whether this number is higher or lower will depend on how they are paid and more importantly, the volume of services that they do.

                                    It's really simple, if you can provide a service that others can't, you can generate revenue that other providers can't.

                                    On a side note, the views count on this thread has gone up by at least 100,000 over the last few days, I wonder how this is happening. Someone must be linking to this thread somewhere.
                                     
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                                    BLADEMDA

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                                      If what Blademda says plays out, then non-fellowship trained anesthesiologists will likely end up with salaries that are similar to CRNAs, which would be mid 100s to low 200s.

                                      Like I said, I think fellowship trained anesthesiologists will still be able to provide services that CRNAs can't, and thus will be compensated in a different way. Whether this number is higher or lower will depend on how they are paid and more importantly, the volume of services that they do.

                                      It's really simple, if you can provide a service that others can't, you can generate revenue that other providers can't.

                                      On a side note, the views count on this thread has gone up by at least 100,000 over the last few days, I wonder how this is happening. Someone must be linking to this thread somewhere.

                                      If you are willing to do a fellowship I can recommend Anesthesiology to an MS3 or MS4. If you aren't willing to do a Fellowship then I have caveats on my recommendation:

                                      1. Limited debt from school- Owe less than $100K
                                      2. No problem living on $200K or less
                                      3. No Ego- So what if anesthesia is Nursing level duty
                                      4. CRNAs are your colleagues in the true meaning of the word
                                      5. You don't care where or how you work as long as you earn a living
                                      6. You don't really care if CRNA=MD(A)
                                       

                                      BLADEMDA

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                                        survivordangerfieldjpg-1227fd727d29d53e.jpg



                                        With my wife I don't get no respect. I made a toast on her birthday to 'the best woman a man ever had.' The waiter joined me.


                                        I'm not a sexy guy. I went to a hooker. I dropped my pants. She dropped her price.


                                        I tell you, I'm not a sexy guy. I was the centerfold for Playgirl magazine. The staples covered everything!


                                        What a childhood I had, why, when I took my first step, my old man tripped me!


                                        Last week I told my psychiatrist, "I keep thinking about suicide." He told me from now on I have to pay in advance.


                                        I tell ya when I was a kid, all I knew was rejection. My yo-yo, it never came back!


                                        Oh, when I was a kid in show business I was poor. I used to go to orgies to eat the grapes.


                                        When I was a kid I got no respect. The time I was kidnapped, and the kidnappers sent my parents a note they said, "We want five thousand dollars or you'll see your kid again."


                                        I tell ya, my wife was never nice. On our first date, I asked her if I could give her a goodnight kiss on the cheek - she bent over!


                                        I tell you, with my doctor, I don't get no respect. I told him, "I've swallowed a bottle of sleeping pills." He told me to have a few drinks and get some rest.


                                        Some dog I got too. We call him Egypt because he leaves a pyramid in every room.

                                        With my dog I don't get no respect. He keeps barking at the front door. He don't want to go out. He wants me to leave.
                                         
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                                        D P356

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                                          I'm a medical student with an interest in anesthesia. Denial? Not really. I don't intend to be disrespectful on the forum at all. Truth is, Blade, you don't know what is going to happen, you don't even know what is going to happen tomorrow. You just don't. If anesthesia becomes a free market, who do you think will have the advantage on cost AND liability. If things go poorly for your "enemy" (who you say is more cost effective) then you will have more bargaining power b/c your added value will finally become realized. What is your exit strategy from anesthesia since it is going to be so bad? What field are you going to go into next as this current field may not be worth your effort? Wall Street, Consulting? I would guess that you will stay put b/c you probably have it pretty good and will for a while. From the attendings I've spoken to, they don't feel threatened. You are on the extreme side of the spectrum, and I appreciate what you've written b/c I have asked many attendings about the issue and their thoughts on crnas. It has allowed me to explore the field more. As I'm only a student, my medical knowledge is not anything close to an attending's, but from my research/investigating and conversations with Docs, I would have to say that I disagree with you.
                                          In a couple states, optometrists can define their scope of practice and will likely begin to perform lasix. Who is going to teach them? And if they botch enough of those procedures, word will get out about the difference between them and a ophthalmologist.
                                           

                                          anynoise

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                                            From the attendings I've spoken to, they don't feel threatened.

                                            lol....what have they said? just out of cur iosity.... the attendings you talked to are probably professors at academic institution, they dont truly understand the magnitude of the issue on the front line(private community hospitals, surgical centers, in private practice.) of course, they dont feel threatened if they are in their 50s been in anesthesia for 20 years and have a big fat office and lecture on muscle relaxants once every couple of months
                                             
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                                            BLADEMDA

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                                              lol....what have they said? just out of cur iosity.... the attendings you talked to are probably professors at academic institution, they dont truly understand the magnitude of the issue on the front line(private community hospitals, surgical centers, in private practice.) of course, they dont feel threatened if they are in their 50s been in anesthesia for 20 years and have a big fat office and lecture on muscle relaxants once every couple of months

                                              And that my friends is the truth.:thumbup:
                                               

                                              D P356

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                                                Blade,
                                                Sure, there were some academic attendings, and mutliple private practice attendings as well (some in their early 30s and some in their 50s). What did they say? Enough for me to think anesthesiology will be a great field to enter, and that is all that matters. When you see a man skilled at his work, he takes a back seat to no one. Thanks.
                                                 

                                                anynoise

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                                                  Blade,
                                                  Sure, there were some academic attendings, and mutliple private practice attendings as well (some in their early 30s and some in their 50s). What did they say? Enough for me to think anesthesiology will be a great field to enter, and that is all that matters. When you see a man skilled at his work, he takes a back seat to no one. Thanks.
                                                  there you have it.. ok. so after all you wanna go into anesthesia. Thats awesome. really is. Just dont say you were not well informed if you are somehow not satisfied with your lot or practice situation. I want people to go into anesthesia, but after they are fully aware of the challenges that we face on a daily basis. And these problems are IN YOUR FACE daily..
                                                   

                                                  BLADEMDA

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                                                    there you have it.. ok. so after all you wanna go into anesthesia. Thats awesome. really is. Just dont say you were not well informed if you are somehow not satisfied with your lot or practice situation. I want people to go into anesthesia, but after they are fully aware of the challenges that we face on a daily basis. And these problems are IN YOUR FACE daily..

                                                    Another great post. :thumbup:
                                                     

                                                    cfdavid

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                                                      there you have it.. ok. so after all you wanna go into anesthesia. Thats awesome. really is. Just dont say you were not well informed if you are somehow not satisfied with your lot or practice situation. I want people to go into anesthesia, but after they are fully aware of the challenges that we face on a daily basis. And these problems are IN YOUR FACE daily..

                                                      This applies to me. I've been tuned in to these issues for going on 6 years now.... (f.ck....)

                                                      Sure, there are challenges, but that just means we need to step up to the plate. Not to minimize our problems, because BLADE had brought a lot of specifics (on the political and legislative level) into the forefront. But, a lot of these problems/challenges are up to us to solve. It's a matter of will, perhaps on many levels, but it's doable. And I don't consider myself to be naive to reality.....
                                                       

                                                      dizzy21

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                                                        This applies to me. I've been tuned in to these issues for going on 6 years now.... (f.ck....)

                                                        Sure, there are challenges, but that just means we need to step up to the plate. Not to minimize our problems, because BLADE had brought a lot of specifics (on the political and legislative level) into the forefront. But, a lot of these problems/challenges are up to us to solve. It's a matter of will, perhaps on many levels, but it's doable. And I don't consider myself to be naive to reality.....

                                                        I agree with you cfdavid.

                                                        Blade's post may seem a little loony at times but he is using the biggest bullhorn at our disposal to get anesthesiologist to wake up and realize that grinning passive aggressive crna nurse who asks you how your weekend was is actively attempting to push all of us out of the field we created.

                                                        Wake up people. Contribute to the ASA-PAC. Blade brings up so many good issues. I just hope someone out there is listening.

                                                        Believe it or not there are active and extremely well funded people pushing back against all the murses and their propaganda machine. The noctors that could barely make it through community college will not be taking over our field and threatening the lives of our patients.
                                                         

                                                        countingdays

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                                                          I agree with you cfdavid.

                                                          Blade's post may seem a little loony at times but he is using the biggest bullhorn at our disposal to get anesthesiologist to wake up and realize that grinning passive aggressive crna nurse who asks you how your weekend was is actively attempting to push all of us out of the field we created.

                                                          Wake up people. Contribute to the ASA-PAC. Blade brings up so many good issues. I just hope someone out there is listening.

                                                          Believe it or not there are active and extremely well funded people pushing back against all the murses and their propaganda machine. The noctors that could barely make it through community college will not be taking over our field and threatening the lives of our patients.

                                                          and/or contribute to whoever runs against Obama.
                                                           

                                                          BLADEMDA

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                                                            I agree with you cfdavid.

                                                            Blade's post may seem a little loony at times but he is using the biggest bullhorn at our disposal to get anesthesiologist to wake up and realize that grinning passive aggressive crna nurse who asks you how your weekend was is actively attempting to push all of us out of the field we created.

                                                            Wake up people. Contribute to the ASA-PAC. Blade brings up so many good issues. I just hope someone out there is listening.

                                                            Believe it or not there are active and extremely well funded people pushing back against all the murses and their propaganda machine. The noctors that could barely make it through community college will not be taking over our field and threatening the lives of our patients.

                                                            Loony? I post the FACTS. I back-up my opinions with hard evidence. CRNAS moving into ASCs, GI centers and starting their own practices. Currently, they have about 5% market penetration but this is GROWING as surgeons/Gi docs see the $$$$ made by employing a CRNA and cutting out the anesthesiologist.

                                                            I know several Gi practices that are CRNA solo. The Gi docs are making $200K or more each just from the anesthesia portion. ASCs? Ditto. Money is what motivates many people to walk the line in terms of patient care and Federal anti-trust laws (stark).
                                                             

                                                            BLADEMDA

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                                                              If you are willing to do a fellowship I can recommend Anesthesiology to an MS3 or MS4. If you aren't willing to do a Fellowship then I have caveats on my recommendation:

                                                              1. Limited debt from school- Owe less than $100K
                                                              2. No problem living on $200K or less
                                                              3. No Ego- So what if anesthesia is Nursing level duty
                                                              4. CRNAs are your colleagues in the true meaning of the word
                                                              5. You don't care where or how you work as long as you earn a living
                                                              6. You don't really care if CRNA=MD(A)

                                                              My post above is pretty clear. What exactly have I stated above that is crazy?
                                                              It may be my opinion but it is backed up by the market and likely trends in anesthesia.
                                                               

                                                              BLADEMDA

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                                                                The truth is the future of anesthesiology is what we make of it. If the younger attendings and current trainees are willing to step up to the plate and fight for the specialty's survival and relevance we can win the war.

                                                                But, if things go badly I have outlined the consequences of losing to the AANA
                                                                Propaganda machine. Up to this point it has been one AANA paid study after the other. When will we respond? Or more importantly, will we respond at all?
                                                                 
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