The most recent advances in ansthesia?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

cleansocks

Junior Member
15+ Year Member
Joined
Apr 16, 2005
Messages
255
Reaction score
44
Hi,

I would like to become familiar with the most recent advances in anesthesia. These include new technologies, drugs, systems, methods of practice, etc.

Are there any articles you all would recommend that could provide this kind of information? How can I become familiar with the cutting edge in this field?

Thanks.
 
i believe the "sigh" function has been the biggest advance in anesthesia since Morton first gave ether. That, and bagels being brought to morning conferences. 😉 j/k
 
Last edited:
:laugh:

OP: here are my wild guesses at things that are new/"cutting edge." Kind of an odd question.
Dexmedetomidine, BIS, Glidescope/McGrath video laryngoscopes, new LMAs, new modes on the vent (?)


Thx - useful response. Not only recent advances, but things in development would be useful too if anyone knows.

Purpose is for interviews at residency programs. I am an MBA interested in involving myself in the both the buy side and sell side of medical tech/pharma related to my future specialty - anesthesia. Thus when they ask what I think about the market, where it's going, what new technologies I'm interested in, etc, I will have an educated response. I'm sure once I'm in anesthesia I will become very aware of developments quite easily, but at this point I am unfamiliar with them.
 
Thx - useful response. Not only recent advances, but things in development would be useful too if anyone knows.

Purpose is for interviews at residency programs. I am an MBA interested in involving myself in the both the buy side and sell side of medical tech/pharma related to my future specialty - anesthesia. Thus when they ask what I think about the market, where it's going, what new technologies I'm interested in, etc, I will have an educated response. I'm sure once I'm in anesthesia I will become very aware of developments quite easily, but at this point I am unfamiliar with them.

I'm confused. Are you going to be doing medical equipment sales? Why are you interviewing at residency programs? Are you an MS4 who has an MBA but forgot to mention he was an MS4? just curious.
 
I'm confused. Are you going to be doing medical equipment sales? Why are you interviewing at residency programs? Are you an MS4 who has an MBA but forgot to mention he was an MS4? just curious.

I'm an MD/MBA. I thought mentioning my question was for residency interviews would be enough to establish the MD part. Sorry for the confusion.

Sorry also for the nebulous business terms. To people in business, buy side = investors' side (ie venture capital, stocks, etc), sell side = company's side (ie development, marketing, etc.).
 
I'm an MD/MBA. I thought mentioning my question was for residency interviews would be enough to establish the MD part. Sorry for the confusion.

Sorry also for the nebulous business terms. To people in business, buy side = investors' side (ie venture capital, stocks, etc), sell side = company's side (ie development, marketing, etc.).

People aren't going to be interviewing you for a business position. They need you be a MD for 4 years. Stick with "interested in anesthesia business later" and pretend like hell you're interested in the patient care alone now. GL w/that.
 
People aren't going to be interviewing you for a business position. They need you be a MD for 4 years. Stick with "interested in anesthesia business later" and pretend like hell you're interested in the patient care alone now. GL w/that.

yep. although business and medicine are two of the highest paying fields in this country, nothing is similar about the two other than intellectual rigor. Your business sense is of no value in residency. They want people who will work hard and sensibly.
 
Thx - useful response. Not only recent advances, but things in development would be useful too if anyone knows.

Purpose is for interviews at residency programs. I am an MBA interested in involving myself in the both the buy side and sell side of medical tech/pharma related to my future specialty - anesthesia. Thus when they ask what I think about the market, where it's going, what new technologies I'm interested in, etc, I will have an educated response. I'm sure once I'm in anesthesia I will become very aware of developments quite easily, but at this point I am unfamiliar with them.

"purpose is for interviews at residency programs". Trust me, your business side of things is best kept under wraps. If anything it makes it look like you might bail on anesthesia. Tell them you can think of nothing else than giving good anesthesia care to patients. I suppose you can mention your MBA if you want, but first and foremost has to be your commitment to clinical care. They have no interest in training someone so they can not take care of patients and go make money in the business world after anesthesia.
 
Thank you for your replies.

I am aware of how narrow minded some people are when it comes to the subject of business in medicine. However, I have no choice but to address the matter since I did get a dual degree and did a bunch of work related to clinical business rather than research. So they will WITHOUT FAIL ask me why I got a dual degree. My answers will be truthfully that 1. I want to manage an anesthesia group and 2. i plan to invest the capital I generate into anesthesia as a venture capitalist, angel (early stage VC basically), and/or securities investor given my unique insights into the field. For part 2, I really would like to have some knowledge about the field and where it's probably going technologically, pharmacologically, and operationally.
 
Thank you for your replies.

I am aware of how narrow minded some people are when it comes to the subject of business in medicine. However, I have no choice but to address the matter since I did get a dual degree and did a bunch of work related to clinical business rather than research. So they will WITHOUT FAIL ask me why I got a dual degree. My answers will be truthfully that 1. I want to manage an anesthesia group and 2. i plan to invest the capital I generate into anesthesia as a venture capitalist, angel (early stage VC basically), and/or securities investor given my unique insights into the field. For part 2, I really would like to have some knowledge about the field and where it's probably going technologically, pharmacologically, and operationally.

and you are right, it is narrow minded, and you will have to address the question. I'd downplay it though, i'm just telling you man to man, or man to woman. It doesn't matter what your business plans are to them, they just want somebody who'd gonna bust their hump for 3 or 4 years. Long term, you may be right, but short term, they're looking out for their best interests....which means a hard working, committed resident for 3-4 years. Not a businessman...regardless of how you might add to the prestige of the program years down the road. (which you could do). Think of the long view...but play the short view as needed hoss.
 
Thank you for your replies.

I am aware of how narrow minded some people are when it comes to the subject of business in medicine. However, I have no choice but to address the matter since I did get a dual degree and did a bunch of work related to clinical business rather than research. So they will WITHOUT FAIL ask me why I got a dual degree. My answers will be truthfully that 1. I want to manage an anesthesia group and 2. i plan to invest the capital I generate into anesthesia as a venture capitalist, angel (early stage VC basically), and/or securities investor given my unique insights into the field. For part 2, I really would like to have some knowledge about the field and where it's probably going technologically, pharmacologically, and operationally.

I'll echo what Nuts said above...good luck with that. Most residency PDs don't want to hear they are training the next AMG director, even if your laudable goal is to use the capital to reinvest in the specialty rather than your 2nd vacation house.

For the sake of your residency interviews, I might recommend playing down your goals of capital investment, and instead describe your interest in understanding the business side of medicine to have a more secure practice, assist your colleagues in your group practice, and represent anesthesiologists for the hospital, etc. blah blah blah. If you have an interest in capital investment, state it as a side interest. As you describe it above, you almost sound as though you want to make a few bucks off passing gas before you move on to your greatest love, which is investment. That's not likely to be welcomed with open arms. That may have landed the coveted MD/MBA slot, but PDs could give a damn about your future business interests, they only want a warm body and open mind to show up for cases at 0600 and stick around for pre-ops until 1800.

Having said that, here's the deal with anesthesia- if you haven't heard the rumors, fewer and fewer bright young minds are entering academic practice, and even fewer are contributing to applicable clinical research. Discussion of this situation has reached alarmist terms, sometimes suggesting the demise of our specialty. Thus you won't necessarily find the hot new trends like you might find in cardiovascular devices and medication trials. Unfortunately, the money isn't there, nor is the research interest.

It's hard to prove long-term mortality benefits when we only see the patient for a few hours. There are exceptions (like Trasylol). Also notice that the actual drug arsenal of anesthesiologists is quite small, and hasn't changed significantly in recent memory. I'm not even sure if there are any commonly used drugs that are still in the proprietary phase. I think all are now generics, which tells you nothing new has come down the pipes in seven years.

Having exhausted you with all that, here's what I see:
BIS is not a new technology, and has reached and passed it's peak usage. However, the field of anesthesia awareness is just getting started, so I would expect more research and technology in the future.

Probably the only new drug of relevance is Sugammadex, which has not yet been released. I wouldn't expect much from drug development.

There have been several technologies trying to estimate what the PA Cath does in a non-invasive manner, but none have been widely adopted. There is room for improvement in this field, since fewer and fewer PACs are being placed.

There has been a recent influx of new intubation techniques, but this too may be reaching it's peak. Nonetheless, there will always be new developments in this area as managing the airway is probably our most critical and visible task.

Ultrasound technology for nerve blocks is expanding rapidly, and is becoming more commonplace even in private practice. I might expect better/augmented U/S technology to help better identify nerves.

If I were in your position, I might specialize in CV anesthesia, as there will always be money in cardiac disease.
 
trust me on this one, medicine may be one of the least creative jobs in the world. residency is not the time to be creative.
 
I'll echo what Nuts said above...good luck with that. Most residency PDs don't want to hear they are training the next AMG director, even if your laudable goal is to use the capital to reinvest in the specialty rather than your 2nd vacation house.

For the sake of your residency interviews, I might recommend playing down your goals of capital investment, and instead describe your interest in understanding the business side of medicine to have a more secure practice, assist your colleagues in your group practice, and represent anesthesiologists for the hospital, etc. blah blah blah. If you have an interest in capital investment, state it as a side interest. As you describe it above, you almost sound as though you want to make a few bucks off passing gas before you move on to your greatest love, which is investment. That's not likely to be welcomed with open arms. That may have landed the coveted MD/MBA slot, but PDs could give a damn about your future business interests, they only want a warm body and open mind to show up for cases at 0600 and stick around for pre-ops until 1800.

Having said that, here's the deal with anesthesia- if you haven't heard the rumors, fewer and fewer bright young minds are entering academic practice, and even fewer are contributing to applicable clinical research. Discussion of this situation has reached alarmist terms, sometimes suggesting the demise of our specialty. Thus you won't necessarily find the hot new trends like you might find in cardiovascular devices and medication trials. Unfortunately, the money isn't there, nor is the research interest.

It's hard to prove long-term mortality benefits when we only see the patient for a few hours. There are exceptions (like Trasylol). Also notice that the actual drug arsenal of anesthesiologists is quite small, and hasn't changed significantly in recent memory. I'm not even sure if there are any commonly used drugs that are still in the proprietary phase. I think all are now generics, which tells you nothing new has come down the pipes in seven years.

Having exhausted you with all that, here's what I see:
BIS is not a new technology, and has reached and passed it's peak usage. However, the field of anesthesia awareness is just getting started, so I would expect more research and technology in the future.

Probably the only new drug of relevance is Sugammadex, which has not yet been released. I wouldn't expect much from drug development.

There have been several technologies trying to estimate what the PA Cath does in a non-invasive manner, but none have been widely adopted. There is room for improvement in this field, since fewer and fewer PACs are being placed.

There has been a recent influx of new intubation techniques, but this too may be reaching it's peak. Nonetheless, there will always be new developments in this area as managing the airway is probably our most critical and visible task.

Ultrasound technology for nerve blocks is expanding rapidly, and is becoming more commonplace even in private practice. I might expect better/augmented U/S technology to help better identify nerves.

If I were in your position, I might specialize in CV anesthesia, as there will always be money in cardiac disease.

Thanks for all the info!

One thing that strikes me as an area that needs improvement is all the sitting in the OR. I think we have the technology now to create machines that autonomously manage things like BP, O2, even paralysis. I'm surprised there's nothing in development to remove anesthesiologists from the OR table-side role all together (aside from expensive CRNA's).

I will think about how to represent myself as an anesthesiologist first, businessman second. Perhaps saying something like that in my personal statement would help reassure them of my committment to the field. That and downplaying the investment side of things. However, with respect to wanting to manage a group, I honestly don't see why wanting to play an active role in the operation of an anesthesia group should be a negative; maintaining an active role as an anesthesiologist is almost a prerequisite for such a position.
 
Thanks for all the info!

One thing that strikes me as an area that needs improvement is all the sitting in the OR. I think we have the technology now to create machines that autonomously manage things like BP, O2, even paralysis. I'm surprised there's nothing in development to remove anesthesiologists from the OR table-side role all together (aside from expensive CRNA's).

I will think about how to represent myself as an anesthesiologist first, businessman second. Perhaps saying something like that in my personal statement would help reassure them of my committment to the field. That and downplaying the investment side of things. However, with respect to wanting to manage a group, I honestly don't see why wanting to play an active role in the operation of an anesthesia group should be a negative; maintaining an active role as an anesthesiologist is almost a prerequisite for such a position.

People generally dislike the idea of someone making money off people who are purportedly their colleagues.

They have this device, McSleepy.

Have you, say, actually done an anesthesia rotation yet? You know you're signing up for a solid 3 years of table-side "sitting", right? It's so boring. You'll probably get really bored, what managing O2 and all. :laugh:
 
One thing that strikes me as an area that needs improvement is all the sitting in the OR. I think we have the technology now to create machines that autonomously manage things like BP, O2, even paralysis. I'm surprised there's nothing in development to remove anesthesiologists from the OR table-side role all together (aside from expensive CRNA's).

You never know when it's going to hit the fan. The machine won't be able to manage that.

However, with respect to wanting to manage a group, I honestly don't see why wanting to play an active role in the operation of an anesthesia group should be a negative; maintaining an active role as an anesthesiologist is almost a prerequisite for such a position.


It sounds better if you say you want to have a leadership position in your practice group. To say you want to direct an AMG implies you want to skim the pockets of everyone working under you.
 
I'm surprised there's nothing in development to remove anesthesiologists from the OR table-side role all together (aside from expensive CRNA's).

Wow dude, you have no idea what anesthesiology is about. Do you even care about taking care of patients? Your evil plan will never work. Internship will chew you up and spit you out. My advice is to join the pencil pushing ranks of a$$ kissing robot suit businessmen now and save yourself and your patients 4 years of hell.

Have a nice day!

Oh and to answer your question....sugammadex.
 
Wow dude, you have no idea what anesthesiology is about. Do you even care about taking care of patients? Your evil plan will never work. Internship will chew you up and spit you out. My advice is to join the pencil pushing ranks of a$$ kissing robot suit businessmen now and save yourself and your patients 4 years of hell.

Have a nice day!

Oh and to answer your question....sugammadex.

Perhaps the narrow mindedness mentioned in earlier posts is an understatement in this case. I will have a nice day, thanks.

You never know when it's going to hit the fan. The machine won't be able to manage that.

It sounds better if you say you want to have a leadership position in your practice group. To say you want to direct an AMG implies you want to skim the pockets of everyone working under you.

Ah, so they are creating it - that McSleepy machine. Of course if **** hits the fan you want to be there. All you need to do is have a central location from which a couple/few anesthesiologists on duty can remotely monitor all the OR's and have quick access to them if necessary. Of course many surgical suites are not currently designed for such a system. However, my bets are this is where we eventually wind up, especially for longer cases. This would not only render the CRNA much less useful but provide us with a special, central niche in the operating center.

Until then, I have no problem sitting; hell I prefer it. I don't expect it to be boring. I tend to be very thorough and I'm sure there'll be plenty to be thorough about throughout a case. but if it does turn out to be boring I will bring reading material and learn how to build cars or something =). A win win situation no matter how the dice fall.

I see - so when one says "manage a group" many interpret that to mean "direct a doctor." Honestly I find this very strange, perhaps because I have developed a much different definition of "management and leadership" than most.

I imagine a situation where I join a group, work to become partner, and as a result of my unique knowledge base in business end up performing the tasks that are normally outsourced to professionals: financial analysis, helping the group negotiate with insurance/hospital, HR management (ie secretaries, etc), finding good professionals (lawers, accountants), calling and/or facilitating corporate discussions with partners, etc. This on top of being an anesthesiologist. Of course for the extra work I expect to be compensated, but it's work that I enjoy and the partners can decide if they would prefer to pay me to do it or get someone else. Do people still view this negatively?

I will try to find wording to express my interest in the above rather than using "managing a group" to encompass these thoughts. Thanks for the insights.
 
Wow dude, you have no idea what anesthesiology is about. Do you even care about taking care of patients? Your evil plan will never work. Internship will chew you up and spit you out. My advice is to join the pencil pushing ranks of ***** kissing robot suit businessmen now and save yourself and your patients 4 years of hell.

Wow, what an a$shole. What "evil plan?" The OP was just speculating about inefficiencies. I'm suprised the OP responded so calmly to this ridiculous ****. Probably'll make a good anesthesiologist considering he/she can deal with people like you so maturely.
 
Last edited:
you have no idea what you're talking about. you are not going to run the business side of the group usually outsourced to professionals and do anesthesia. as far as monitoring from a different location - $hit happens SO quickly that this idea will NEVER work. nothing will ever beat a well trained physician monitoring, diagnosing and responding to a clinical environment.

come back and offer opinions after actually finishing a residency.


Perhaps the narrow mindedness mentioned in earlier posts is an understatement in this case. I will have a nice day, thanks.



Ah, so they are creating it - that McSleepy machine. Of course if **** hits the fan you want to be there. All you need to do is have a central location from which a couple/few anesthesiologists on duty can remotely monitor all the OR's and have quick access to them if necessary. Of course many surgical suites are not currently designed for such a system. However, my bets are this is where we eventually wind up, especially for longer cases. This would not only render the CRNA much less useful but provide us with a special, central niche in the operating center.

Until then, I have no problem sitting; hell I prefer it. I don't expect it to be boring. I tend to be very thorough and I'm sure there'll be plenty to be thorough about throughout a case. but if it does turn out to be boring I will bring reading material and learn how to build cars or something =). A win win situation no matter how the dice fall.

I see - so when one says "manage a group" many interpret that to mean "direct a doctor." Honestly I find this very strange, perhaps because I have developed a much different definition of "management and leadership" than most.

I imagine a situation where I join a group, work to become partner, and as a result of my unique knowledge base in business end up performing the tasks that are normally outsourced to professionals: financial analysis, helping the group negotiate with insurance/hospital, HR management (ie secretaries, etc), finding good professionals (lawers, accountants), calling and/or facilitating corporate discussions with partners, etc. This on top of being an anesthesiologist. Of course for the extra work I expect to be compensated, but it's work that I enjoy and the partners can decide if they would prefer to pay me to do it or get someone else. Do people still view this negatively?

I will try to find wording to express my interest in the above rather than using "managing a group" to encompass these thoughts. Thanks for the insights.
 
I see - so when one says "manage a group" many interpret that to mean "direct a doctor." Honestly I find this very strange, perhaps because I have developed a much different definition of "management and leadership" than most.

I imagine a situation where I join a group, work to become partner, and as a result of my unique knowledge base in business end up performing the tasks that are normally outsourced to professionals: financial analysis, helping the group negotiate with insurance/hospital, HR management (ie secretaries, etc), finding good professionals (lawers, accountants), calling and/or facilitating corporate discussions with partners, etc. This on top of being an anesthesiologist. Of course for the extra work I expect to be compensated, but it's work that I enjoy and the partners can decide if they would prefer to pay me to do it or get someone else. Do people still view this negatively?

Dude you got an MBA. Congratulations. MBA's aren't worth crap nowadays, didn't anybody tell you? You sound fairly pompous and arrogant. My impression from your comments is that you feel your business classes made you smarter than the rest of the docs might work with some day, and as such deserve more money. So basically it's about the $$. This will not go over well with residency programs.
 
you have no idea what you're talking about. you are not going to run the business side of the group usually outsourced to professionals and do anesthesia. as far as monitoring from a different location - $hit happens SO quickly that this idea will NEVER work. nothing will ever beat a well trained physician monitoring, diagnosing and responding to a clinical environment.

come back and offer opinions after actually finishing a residency.


While I respect your opinion as a resident, I resent your disrespect and hostility. I wonder if you people are so brash in person or if you can only speak so brazenly while hiding behind your keyboards.

I find it ironic that a resident with no formal management or business training tells me "I have no idea what I am talking about" and then proceeds to tell me that an attending with an MBA cannot practice anesthesia and help manage a group. While I certainly am not going to say "you have no idea" since you have had ample exposure to the field that I lack, I will say that your assumption that it is impossible to help manage an organization while practicing is incorrect, as I do have first hand evidence to the contrary.

Secondly, I find it amusing that in lambasting my conjecture about automating routine OR management and telling me to "come back once I've completed residency," you were also telling that to the RESIDENTS who SUPPORT the idea in a thread I found on SDN.
http://forums.studentdoctor.net/showthread.php?p=6670404

Why don't you post in that thread about how these residents who believe that automation with close monitoring is possible have "no idea what they're talking about?" Or tell them to "come back when they've finished training." I would love to see their response.
 
Dude you got an MBA. Congratulations. MBA's aren't worth crap nowadays, didn't anybody tell you? You sound fairly pompous and arrogant. My impression from your comments is that you feel your business classes made you smarter than the rest of the docs might work with some day, and as such deserve more money. So basically it's about the $$. This will not go over well with residency programs.

No, it is not about the money. As I mentioned earlier, I thoroughly enjoy the business side of things. And yes, I expect to be paid if I do extra professional work. Does that mean it is about the $$? Why don't you allocate some of your professional work as "free work?" If you don't, does that suggest you do it only "for the money?"

No, I don't believe I'm smarter than other docs with my additional training and experience. I do believe I will be qualified to fulfill these managerial roles and I do believe I am more qualified than individuals who have never been formally trained in the task and who have not had the same experience managing finances, negotiating, etc. Is that saying "I'm smarter?" If another partner who is a pain specialist believes they deserve to be paid more than the general anesthesiologists in the group, does that mean he thinks his extra training has made him smarter than everybody else? Is he in it for the money too?

With respect to the MBA: In the corporate world, an MBA from anywhere except top schools is regarded as being of little value. People who have to work their way up a company food chain generally don't get very far with such a degree. I don't believe that holds true for a professional with business training. It's definitely useful as a personal tool for these individuals.
 
1. when you're an anesthesiologist NO ONE wants you to come in and MANAGE the money in a group. they want you to turn cases. in most metropolitan areas it would be YEARS before anyone even lets you see the books. obviously, there are people that practice and DO the books, but they are at the upper levels of the profession, not the lowest.

2. when you say to others you wanna manage the business side of anesthesia - that translates to "i wanna make money from the work of others." that's all good, but will not fly at an academic residency interview...

3. 2 residents agreed that someday there may be a machine that can replace us in the OR. lots of things are possible, someday. i believe we will not see the APPLICATION of such technology for decades (you don't see any planes flying with passengers without a pilot - even though we have the technology). yes, believe it or not i disagree with other residents. there is not much consensus on ANYTHING in anesthesiology.

just what the field needs. another fu@king businessman...


While I respect your opinion as a resident, I resent your disrespect and hostility. I wonder if you people are so brash in person or if you can only speak so brazenly while hiding behind your keyboards.

I find it ironic that a resident with no formal management or business training tells me "I have no idea what I am talking about" and then proceeds to tell me that an attending with an MBA cannot practice anesthesia and help manage a group. While I certainly am not going to say "you have no idea" since you have had ample exposure to the field that I lack, I will say that your assumption that it is impossible to help manage an organization while practicing is incorrect, as I do have first hand evidence to the contrary.

Secondly, I find it amusing that in lambasting my conjecture about automating routine OR management and telling me to "come back once I've completed residency," you were also telling that to the RESIDENTS who SUPPORT the idea in a thread I found on SDN.
http://forums.studentdoctor.net/showthread.php?p=6670404

Why don't you post in that thread about how these residents who believe that automation with close monitoring is possible have "no idea what they're talking about?" Or tell them to "come back when they've finished training." I would love to see their response.
 
2 residents agreed that someday there may be a machine that can replace us in the OR. lots of things are possible, someday. i believe we will not see the APPLICATION of such technology for decades (you don't see any planes flying with passengers without a pilot - even though we have the technology). yes, believe it or not i disagree with other residents. there is not much consensus on ANYTHING in anesthesiology.

I agree the tech is years away, but if a surgeon can use a robot to remove cancer, I'm not sure automating anesthesia is so hard.
 
1. when you're an anesthesiologist NO ONE wants you to come in and MANAGE the money in a group. they want you to turn cases. in most metropolitan areas it would be YEARS before anyone even lets you see the books. obviously, there are people that practice and DO the books, but they are at the upper levels of the profession, not the lowest.

As a resident it is your job to turn cases. As an attending you have more lattitude. You are right that managing the books, AKA accounting, is something that I would not be able to do without more training. Financially I am interested in analysis and liquid asset allocation, which I have actually already been paid to do for a group of docs (not anesthesiologists, tho).

2. when you say to others you wanna manage the business side of anesthesia - that translates to "i wanna make money from the work of others." that's all good, but will not fly at an academic residency interview...

I am glad I posted this thread to learn that is how that phrase is interpreted by many smart people. I explain in a post above why it is not about making money off of others. I'll definitely reword it.

3. 2 residents agreed that someday there may be a machine that can replace us in the OR. lots of things are possible, someday. i believe we will not see the APPLICATION of such technology for decades (you don't see any planes flying with passengers without a pilot - even though we have the technology). yes, believe it or not i disagree with other residents. there is not much consensus on ANYTHING in anesthesiology.

just what the field needs. another fu@king businessman...


This field along with the rest of medicine definitely needs businessmen that can reduce costs while improving patient care from a systems standpoint while hard working residents like you improve the field by turning cases and being good doctors. I'm actually not a money hungry bad guy.
 
Last edited:
I guess I just don't understand why you feel you need to do residency? Nobody can debate that there is a lack of financial smarts in the world of medicine- at least on the side of the docs. If you're trying to learn about the future of anesthesia, you can do that easily without being a resident. Why not just make it a "mdMBA" and run with it? Screw residency when what you clearly like to do doesn't really involve patient care.
 
I agree the tech is years away, but if a surgeon can use a robot to remove cancer, I'm not sure automating anesthesia is so hard.

removing a cancer with a robot is not automation. it still requires a surgeon and in effect only adds a layer of complexity to the procedure, rather than simplifying it. the surgeon is still sitting there in the room bitching about what a hard case it is, and how lucky the patient was to have found him and his gifted hands. 🙄
 
removing a cancer with a robot is not automation. it still requires a surgeon and in effect only adds a layer of complexity to the procedure, rather than simplifying it. the surgeon is still sitting there in the room bitching about what a hard case it is, and how lucky the patient was to have found him and his gifted hands. 🙄

My point was not to compare robot surgery with robot anesthesia. My point was that inventions seem far-fetched and unrealistic until they become feasible.

The technical finesse required to translate a surgeon's hand motions to a contraption's movements are much more difficult than what would be required to titrate gases and IV meds. Aside from actually intubating and extubating the patient, basically everything the anesthesiologist does on basic cases could be easily translated to remote control. The only hurdle is logistics of being at the right place at the right time. I don't think it is far-fetched to say CRNAs could be replaced by standard OR nurses, with just enough anesthesiologists to cover a few rooms each.

Look at Vanderbilt- although the technology may not be utilized to its full potential, they have a pretty sweet computer system that allows attendings or anyone else to pull up (I think) 4 rooms on a monitor, with the same monitor setup as in the room, as well as a tracking camera showing what's going on basically anywhere in the room. They even have a visor that allows this to be viewed while mobile.

Incidentally, I don't think our profession is helping the cause by perpetrating the cliche that anesthesia is 95% boredom punctuated by 5% terror.
 
I guess I just don't understand why you feel you need to do residency? Nobody can debate that there is a lack of financial smarts in the world of medicine- at least on the side of the docs. If you're trying to learn about the future of anesthesia, you can do that easily without being a resident. Why not just make it a "mdMBA" and run with it? Screw residency when what you clearly like to do doesn't really involve patient care.

I can see why you'd think that since this thread has been entirely about my business aspirations ( <-- I actually had to look this word up to make sure it can be used in this context since I've been using it in a different way for so long now!).

But I do really like anesthesia - the intellectual challenge of mastering and applying complex physiology, the elegant short procedures that nonetheless require years to master, the personal reward of reassuring and protecting a patient through their most terrifying/vulnerable moments, the fact that everything that we do - even a comprehensive review of systems - is important (rather than useless routine as in many other specialties). PLUS the added benefits (that I won't mention to PD's of course) of no rounding (!) or excessive notes (!), or lifelong relationships with patients (a positive for me at least). It's freakin' awesome. In fact, I can't imagine a more perfect fit for me. The one thing I will miss is the diagnostic challenge that comes with other forms of medicine. But even there I have to make sure they don't have any surprise undocumented diagnoses so I'll probably be satisfied there as well.

So in summary I really like and want to do both.
 
Sorry to piss some of you off, but its time for a, as so eloquently said in Stripes by Bill Murray,

"THATS THE FACT, JACK!" rebuttal.

Yeah, we take care of patients out here in private practice.

But in the end,

MEDICINE IS A BUSINESS.

FIRE AT WILL MY WAY, BUT MY C NOTES ARE IMPORTANT.

You can take that or leave it.

But at least I'm being honest with you.

I didnt enter this profession with Sister Theresa aspirations.

I entered it knowing I could pay off my (very large) student loan debt and live a lifestyle I deserved after sacrificing my twenties.

Yes, I like my job very much.

Yes, I take very good care of patients.

But I expect to get paid.

So this dude with business accumen shows up in our forum and he wants to make the most bang for his buck?

More power to ya, Dude.

Lets not forget how much the CEO of HCA made last year.

Or any other hospital owner/insurance CEO who is riddled with profit year after year, while physicians struggle to gain reimbursement for cases already done.

Bring your business expertise to the field, Dude.

Welcome to SDN ANESTHESIA.

I'm all ears.

We can all potentially learn from you.
 
what you may not realize (or may very well realize) is that people that make lots of money in medicine make it at the expense of patients and other hard working physicians. if that's ok with you you - nice. i have spent my twenties roughing it too, but i do not feel entitled to f3ck my collegues for a buck.
 
what you may not realize (or may very well realize) is that people that make lots of money in medicine make it at the expense of patients and other hard working physicians. if that's ok with you you - nice. i have spent my twenties roughing it too, but i do not feel entitled to f3ck my collegues for a buck.

I'm not inferring you haffta f uk anyone.

What I am inferring is we are entitled to a piece-of-the-pie, since we are the individuals that actually make this whole medicine industry happen.

What would the medicine industry be without doctors?

Repeat the above sentence in your head while you reread your post, all the while thinking how much jack hospitals/drug companies/ortho hardware companies/CEOs of said companies are making.

I have no desire to f uk my colleagues.

I have every desire to get paid for what I do.

And I have no ethical repercussions about said views, since said ortho rep supervisor just flew in to see WHATS UP with his ortho-rep employees in his BE-200 King Air.

That he owns.

Just upgraded from a Beech Baron.
 
Sorry to piss some of you off, but its time for a, as so eloquently said in Stripes by Bill Murray,

"THATS THE FACT, JACK!" rebuttal.

Yeah, we take care of patients out here in private practice.

But in the end,

MEDICINE IS A BUSINESS.

FIRE AT WILL MY WAY, BUT MY C NOTES ARE IMPORTANT.

You can take that or leave it.

But at least I'm being honest with you.

I didnt enter this profession with Sister Theresa aspirations.

I entered it knowing I could pay off my (very large) student loan debt and live a lifestyle I deserved after sacrificing my twenties.

Yes, I like my job very much.

Yes, I take very good care of patients.

But I expect to get paid.

So this dude with business accumen shows up in our forum and he wants to make the most bang for his buck?

More power to ya, Dude.

Lets not forget how much the CEO of HCA made last year.

Or any other hospital owner/insurance CEO who is riddled with profit year after year, while physicians struggle to gain reimbursement for cases already done.

Bring your business expertise to the field, Dude.

Welcome to SDN ANESTHESIA.

I'm all ears.

We can all potentially learn from you.

Thanks, Jet.
 
this is one of the problems with medicine today. physicians are increasingly looking upwards in terms of salary to people with much less training and commitment.

it makes us feel bad that some CEO is making 10 mill a year.
it makes us feel bad that some wall street 24 year old is making 500k/yr
that some 19 year old internet dude just made his first billion
the list goes on.

so, we try to make more money.

unfortunately, we don't make any products or shift funds or write software.
we use our knowledge to take care of real people.

the "i've got to get mine" mentality is causing a huge amount of overtreatment for those patients who have money. and a huge amount of undertreatment for those who don't.

people doing procedures on 102 year olds to bill medicare. ORs filled with this stuff.

however we rationalize it, the fact is that the majority of our collegues do not participate in the business of medicine with rock solid ethics. seeing a supervisor of a company that makes metal joints as a role model may be a problem.

i agree, i want to get a piece of the pie too. i agree we are being exploited and that the real workers of medicine are not getting paid. but, i also see that under the current system a businessman mentality in medicine is more likely to compromise good, ethical patient care and a respectful supportive practice environment for physicians. perhaps a nice suburban pp is different.


I'm not inferring you haffta f uk anyone.

What I am inferring is we are entitled to a piece-of-the-pie, since we are the individuals that actually make this whole medicine industry happen.

What would the medicine industry be without doctors?

Repeat the above sentence in your head while you reread your post, all the while thinking how much jack hospitals/drug companies/ortho hardware companies/CEOs of said companies are making.

I have no desire to f uk my colleagues.

I have every desire to get paid for what I do.

And I have no ethical repercussions about said views, since said ortho rep supervisor just flew in to see WHATS UP with his ortho-rep employees in his BE-200 King Air.

That he owns.

Just upgraded from a Beech Baron.
 
this is one of the problems with medicine today. physicians are increasingly looking upwards in terms of salary to people with much less training and commitment.

it makes us feel bad that some CEO is making 10 mill a year.
it makes us feel bad that some wall street 24 year old is making 500k/yr
that some 19 year old internet dude just made his first billion
the list goes on.

so, we try to make more money.

unfortunately, we don't make any products or shift funds or write software.
we use our knowledge to take care of real people.

the "i've got to get mine" mentality is causing a huge amount of overtreatment for those patients who have money. and a huge amount of undertreatment for those who don't.

people doing procedures on 102 year olds to bill medicare. ORs filled with this stuff.

however we rationalize it, the fact is that the majority of our collegues do not participate in the business of medicine with rock solid ethics. seeing a supervisor of a company that makes metal joints as a role model may be a problem.

i agree, i want to get a piece of the pie too. i agree we are being exploited and that the real workers of medicine are not getting paid. but, i also see that under the current system a businessman mentality in medicine is more likely to compromise good, ethical patient care and a respectful supportive practice environment for physicians. perhaps a nice suburban pp is different.

when you end up with 200,000 in student loan debt just for medical school, it doesn't even have to be "I've got to get mine". just "I've got to pay back my loans" is enough.
 
Top