This bugs me (question regarding Dental Anesthesiologists)

[TecmoBowl]

There's a dental anesthesiologist finishing up his training at my program who is flat out boasting about how he's setting up an ambulatory practice, having people (other anesthesiologists) work for him, and of course, taking some off the top. That's fine since that's how many businesses seem to run anyway...you've got the worker bees and the queen bee(s). My issue is this- WHY ARE OUR PROGRAMS TRAINING OTHER PROFESSIONS TO DO WHAT WE DO?? Are we not cheapening ourselves? Moreover, there are no practice restrictions once this sub-group finish their "dental anesthesia" training. Shouldn't we MDAs define our territory? Or better yet, stop training these so called "dental anesthesiologists", and keep our demand up. I'm not trying to start a riot here but it's obvious our / ASA's lack of practice definitions and parameters is making it to loose and continues to add to the threat of our field being viewed as "easy". Maybe I should write this to the ASAPAC but what do you guys/gals think?

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[urge]

What kind of training do dental anesthesiologists have?

 

[TecmoBowl]

Honestly, the training isn't bad. I mean at most institutions, it's clear what Residents are- cheap labor. For that matter, the Dental Anesthesia Resident is viewed the same. They do general cases, yes they intubate too! The mechanics are the same- background knowledge and overall case exposure less than MD Anesthesiologists pursuing it as their sole occupation. I mean they have it really good- bill for dental procedure and the anesthetic. Maybe I should go back to Dental school! My objection is why are we cheapening our field? Ultimately, it's not knowledge/passion/training that wins out- it seems like business savvy does- I mean it's really the wild, wild west sometimes. I have no objection to that- it's just geeze lets not keep making our field so easily accessible to EVERYONE.

 

[ucsfgaspain]

Wow that is f*cking scary. I didn't know that there were dental anesthetist. I ain't calling anyone an anesthesiologist unless they've been through a real anesthesia residency. Welcome to the world we live in.

Physicians always f*ck themselves for a couple of bucks. Dude we've had so many examples of this in anesthesia. Academic programs using CRNA's b/c they cost cheaper is just away to invite the enemy into your home. Don't come crying when they turn around and rob you blind **** if I were a CRNA I'd do the same thing.

Physicians should study simple business strategy and approach our industry in the same way. Erect barriers to entry to defend the trade from lower priced competitiors.

Sadly I don't think that this will happen. We've all ready sold out pain. I can't beleive how many anesthesia academic programs are taking PMR guys into their fellowships. THis really is a travesty. You will get replaced once they have critical mass. I don't blame them either cuz that's just the way all businesses work.

Have you seen that commercial where they state "Anesthesia ON" Well that's what the general public thinks of our skills. It's easy it's simple. Unless we act aggresively to defend our territory, my f*cking gardner will pretty soon be qualified to do anesthesia.

 

[Planktonmd]

This specialty has been on this self destructive pathway for more than 50 years.
We have historically allowed any one willing to do our job, and even helped them learn our business.
This is why the future isn't bright and this is why we get no respect.
I think that anesthesiologists had inherited low self esteem from the older generation that didn't care if they were treated like doctors as long as they made the big money.
Now, the big money is rapidly disappearing and we are left with this wonderful heritage.
Many of our leaders don't even dare to claim exclusivity to the practice of their own specialty, and this is why you will find the ASA only calling for a "physician" to supervise CRNA's they don't even have the guts to say that the one who supervises CRNA's has to be an ANESTHESIOLOGIST.
I have major doubts that this specialty is even salvageable.
I hate to say this to the new enthusiastic generation but that is the reality and it's not going to get better.
If you don't like it, now is the the time to get out.

 

[toughlife]

There's a dental anesthesiologist finishing up his training at my program who is flat out boasting about how he's setting up an ambulatory practice, having people (other anesthesiologists) work for him, and of course, taking some off the top. That's fine since that's how many businesses seem to run anyway...you've got the worker bees and the queen bee(s). My issue is this- WHY ARE OUR PROGRAMS TRAINING OTHER PROFESSIONS TO DO WHAT WE DO?? Are we not cheapening ourselves? Moreover, there are no practice restrictions once this sub-group finish their "dental anesthesia" training. Shouldn't we MDAs define our territory? Or better yet, stop training these so called "dental anesthesiologists", and keep our demand up. I'm not trying to start a riot here but it's obvious our / ASA's lack of practice definitions and parameters is making it to loose and continues to add to the threat of our field being viewed as "easy". Maybe I should write this to the ASAPAC but what do you guys/gals think?

Let's be clear here. The folks who determine who gets training in a certain area is not the ASAPAC. It is the academic institutions/universities who make arrangements to provide training to students in a certain academic curriculum. These are deals made between say an oral & maxillofacial program and an academic anesthesiology program who then gets a fee and cheap labor from the tuition/revenue paid/generated by the student.

As you know more academic anesthesiology programs are faltering financially as a result of the unfair teaching anesthesiology rule. As a result, they have to resorts to other methods to continue to obtain the much needed funding to keep the program opens. The AANA is neck deep in lobbying to maintain such discrepancy and choke anesthesiology programs so the CRNA training programs can flourish.

That is the root of the problem. We need to restore financial viabilty to our anesthesiology residency programs in order to avoid relying in training non-physicians for revenue.

Yes, I am sure there are program chairmen who are greedy and want more money regardless of its source. There's also financial pressure from hospital leaderships to generate more revenue at any cost and this is also contributing to the problem.

How do you put the brakes on this? Your dept needs to have strong representation at the hospital board and it needs to make a conscious effort in avoiding training others. It must also find other ways to obtain the revenue generated by the omfs/dentistry students.

 

[deleted126335]

.

 

[militarymd]

It's about the money.....I've said it many times before.

It's always been about the money. It will always be about the money.

For the academics....for the dentists...for you residents....for you attendings.......

Until the end of time...it'll be about the money for everyone.....

so why get all upset about it.....just accept it.

If you're not happy with the system....move to Russia, or Kenya or France...or some other sh it bag country.....they'll WELCOME you with OPEN arms.

 

[Gaseous Clay]

We have a dental anesthesia resident who is also just about to finish his training. He seems to be doing well and I have not heard any complaints about him from other residents nor attendings. During a regular work day, he does the dental OR room or the oral surgery room. Once a week, they go to the dental clinic and provide "General" IV sedation there. He takes just as much call as the residents and works the late list, so at 3 pm, he can be put in just about any room.

In terms of the original poster, let the guy dream of what is he about to do. If an anesthesiologist is willing to work for this guy, so be it. But this dental anesthesiologist may go broke trying to set up this practice. Also, I don't believe there are all that many of them.

 

[frank51]

I was very surprised to find out about this specialty, even though the first 2 years of medical and dental school are similar, 3rd and 4th year definitely aren't similar at all, furthermore, they don't take Step 1, 2, 3. I thought they were limited to doing Anesthesia for dental procedures only, I had no idea that the scope of their practice was unlimited.

 

[usnavdoc]

It doesn't matter. The first anesthetic was administered by a dentist (Morton). Today's dentists are his inheritors. If you want more heart burn check out:

http://www.asdahq.org/

Not that it really matters but you need to reread your anesthesia history.

 

[pd4emergence]

Let's be clear here. The folks who determine who gets training in a certain area is not the ASAPAC. It is the academic institutions/universities who make arrangements to provide training to students in a certain academic curriculum. These are deals made between say an oral & maxillofacial program and an academic anesthesiology program who then gets a fee and cheap labor from the tuition/revenue paid/generated by the student.

As you know more academic anesthesiology programs are faltering financially as a result of the unfair teaching anesthesiology rule. As a result, they have to resorts to other methods to continue to obtain the much needed funding to keep the program opens. The AANA is neck deep in lobbying to maintain such discrepancy and choke anesthesiology programs so the CRNA training programs can flourish.

That is the root of the problem. We need to restore financial viabilty to our anesthesiology residency programs in order to avoid relying in training non-physicians for revenue.

Yes, I am sure there are program chairmen who are greedy and want more money regardless of its source. There's also financial pressure from hospital leaderships to generate more revenue at any cost and this is also contributing to the problem.

How do you put the brakes on this? Your dept needs to have strong representation at the hospital board and it needs to make a conscious effort in avoiding training others. It must also find other ways to obtain the revenue generated by the omfs/dentistry students.

Tough,
I try to avoid these turf war discussions b/c they always denigrate into the MD vs whatever argument. I don't have a problem training SRNA's. But I think they should be trained to work within an ACT model. In my opinion CRNA's should never be doing CVL's or peripheral nerve blocks. I believe it is the job of the anesthesiologist to do those things. Why do we continue to train these procedures to nurses with no anatomical training other than an undergraduate level course. I don't teach these to our SRNA's, and our CRNA's never do lines or blocks. There is no question in my practice that is just the way it is. These are not their responsibility. Also, I think if the AANA continues to lobby against the teaching rule we should not allow SRNA's in our rooms to do anything, not even touch a vaporizer until they quit their underhanded tactics and leave this legislation alone. I think eventually the ASA will have to do a PR campaign highlighting what is we do and who we are otherwise the aana will try to do that for us. I think the only way for us to save our specialty is for the average person on the street to come in for an operation and be educated enough to know the difference between an anesthesiologist and a CRNA.

 

[maceo]

There's a dental anesthesiologist finishing up his training at my program who is flat out boasting about how he's setting up an ambulatory practice, having people (other anesthesiologists) work for him, and of course, taking some off the top. That's fine since that's how many businesses seem to run anyway...you've got the worker bees and the queen bee(s). My issue is this- WHY ARE OUR PROGRAMS TRAINING OTHER PROFESSIONS TO DO WHAT WE DO?? Are we not cheapening ourselves? Moreover, there are no practice restrictions once this sub-group finish their "dental anesthesia" training. Shouldn't we MDAs define our territory? Or better yet, stop training these so called "dental anesthesiologists", and keep our demand up. I'm not trying to start a riot here but it's obvious our / ASA's lack of practice definitions and parameters is making it to loose and continues to add to the threat of our field being viewed as "easy". Maybe I should write this to the ASAPAC but what do you guys/gals think?

its not an issue really until someone young and healthy turns up brain dead or outright dead from a routine procedure. then people start asking questions. just like what happened in pa with that 18 year old girl who died in a plastic surgeons office

 

[toughlife]

Tough,
I try to avoid these turf war discussions b/c they always denigrate into the MD vs whatever argument. I don't have a problem training SRNA's. But I think they should be trained to work within an ACT model. In my opinion CRNA's should never be doing CVL's or peripheral nerve blocks. I believe it is the job of the anesthesiologist to do those things. Why do we continue to train these procedures to nurses with no anatomical training other than an undergraduate level course. I don't teach these to our SRNA's, and our CRNA's never do lines or blocks. There is no question in my practice that is just the way it is. These are not their responsibility. Also, I think if the AANA continues to lobby against the teaching rule we should not allow SRNA's in our rooms to do anything, not even touch a vaporizer until they quit their underhanded tactics and leave this legislation alone. I think eventually the ASA will have to do a PR campaign highlighting what is we do and who we are otherwise the aana will try to do that for us. I think the only way for us to save our specialty is for the average person on the street to come in for an operation and be educated enough to know the difference between an anesthesiologist and a CRNA.

I agree with you 100% but the problem is that despite this common sense approach many attendings continue to teach the SRNAs how to do everything.

I have seen attendings just stand by while they allow the SRNA to drop in a central or arterial line or even hold their hand to teach them how. I have found that enraging and something NOT to emulate.

The AANA continues to lobby hard against the teaching rule to the point of distorting the truth and providing misinformation to legislators. How do I know? Well, I sat in the offices of congressmen/women in Washington and heard it there. They often confuse the politicians to the point that they need clarifications of who we are and what we do constantly.

The nurses have such a bold, deceiptful conniving campaign going on the politicians are confused. I won't say it is all their fault because many anesthesiologists are guilty of the widespread CRNA proliferation via supporting their teaching institutions for the right price.

I was in Washington two weeks ago and I was encouraged to see how many residents and attendings were present and committed to maintaining our viability. The effort to do so is inmense and it is driven by selfless, caring individuals who want nothing but the best for anesthesiology.

It was also an eye opening experience to hear stories from different state societies as to the battles they have to fight against the midlevels and how they are doing it. I found out how the AA licensing battle was won in Oklahoma, met the AAAA president and had a discussion about AAs.

I learned it took almost 17 years and a group of dedicated individuals to get the 32% medicare reimbursement increase last year. Interestinly, it was a member of one of the ROAD specialties who was key in helping us get that raise.

It is clear that the AANA wants us out and they spend massive resources to lobby at the federal and state level and they want to be Anesthesiology. They do not believe we should lead the ACT and are 1000% committed to getting their way.

I will provide more confidential information about my visit to Washington in the private forum.

 

[swpm]

It doesn't matter. The first anesthetic was administered by a dentist (Morton). Today's dentists are his inheritors. If you want more heart burn check out:

http://www.asdahq.org/

Early surgeons were barbers. When you need your appy, are you going to cruise on over to Supercuts?

Does that not matter either?

 

[jwk]

.

I agree with you 100% but the problem is that despite this common sense approach many attendings continue to teach the SRNAs how to do everything. Many attendings are stupid enough to teach the SRNAs everything from blocks, to awake fiberoptic intubations.

I have seen attendings just stand by while they allow the SRNA to drop in a central or arterial line or even hold their hand to teach them how. I have found that enraging and something NOT to emulate.

The AANA continues to lobby hard against the teaching rule to the point of distorting the truth and providing misinformation to legislators. How do I know? Well, I sat in the offices of congressmen/women in Washington and heard it there. They often confuse the politicians to the point that they need clarifications of who we are and what we do constantly.

The nurses have such a bold, deceiptful conniving campaign going on the politicians are confused. I won't say it is all their fault because many anesthesiologists are guilty of the widespread CRNA proliferation via supporting their teaching institutions for the right price.

I was in Washington two weeks ago and I was encouraged to see how many residents and attendings were present and committed to maintaining our viability. The effort to do so is inmense and it is driven by selfless, caring individuals who want nothing but the best for anesthesiology.

It was also an eye opening experience to hear stories from different state societies as to the battles they have to fight against the midlevels and how they are doing it. I found out how the AA licensing battle was won in Oklahoma, met the AAAA president and had a discussion about AAs.

I learned it took almost 17 years and a group of dedicated individuals to get the 32% medicare reimbursement increase last year. Interestinly, it was a member of one of the ROAD specialties who was key in helping us get that raise.

It is clear that the AANA wants us out and they spend massive resources to lobby at the federal and state level and they want to be Anesthesiology. They do not believe we should lead the ACT and are 1000% committed to getting their way.

I will provide more confidential information about my visit to Washington in the private forum.

 

[2win]

This specialty has been on this self destructive pathway for more than 50 years.
We have historically allowed any one willing to do our job, and even helped them learn our business.
This is why the future isn't bright and this is why we get no respect.
I think that anesthesiologists had inherited low self esteem from the older generation that didn't care if they were treated like doctors as long as they made the big money.
Now, the big money is rapidly disappearing and we are left with this wonderful heritage.
Many of our leaders don't even dare to claim exclusivity to the practice of their own specialty, and this is why you will find the ASA only calling for a "physician" to supervise CRNA's they don't even have the guts to say that the one who supervises CRNA's has to be an ANESTHESIOLOGIST.
I have major doubts that this specialty is even salvageable.
I hate to say this to the new enthusiastic generation but that is the reality and it's not going to get better.
If you don't like it, now is the the time to get out.

EXCELLENT POST!!!! PLANKTON YOU ARE RIGHT AND THIS IS THE FUTURE - not bright at all. This speciality is lost.

 

[toughlife]

2WIN and plankton need some cojones. Stop being ladies and have the courage to go the distance even when things don't seem rosy.

Nothing is easy in life and if you throw your hands up and give up you will lose for sure.

Remember the saying " You will always miss 100% of the shots you don't take"? Well, same thing here. If you don't like the way things are going, then do something.

I was just selected to be part of an ASA committee and I will sure stand up and make my voice heard and let those in control know we young grasshoppas want change. There are plenty of committed people to effect change and we can make it happen. Giving up is easy. Working hard and fighting is not.

 

[Taurus]

I was just selected to be part of an ASA committee and I will sure stand up and make my voice heard and let those in control know we young grasshoppas want change. There are plenty of committed people to effect change and we can make it happen. Giving up is easy. Working hard and fighting is not.

Awesome!

 

[drusso]

I'm not an anesthesiologist, but did do my pain fellowship in an anesthesia department. I was surprised to discover that there dental anesthesiologists there (there was also a dental school). I didn't know that this was a career option for dental students. What's always struck me as interesting about anesthesiology is that historically its seems to have straddled the practice of nursing and medicine. I think there is lesson here with regards to scope of practice. Once you give an inch, you'll never get it back!

 

[sevoflurane]

I hate to say it... but I'm intimately aware of an anesthesia program that had a dental trained anesthesia provider doing acute pain and general anesthesia... and doing it well to boot. Now he has left and is making >350k in private practice. This same guy had definite global knowledge deficits, but would do a great job with technical anesthesia. For example... he never heard of words like... mucositis- he thought i made up the word.

 

[Planktonmd]

2WIN and plankton need some cojones. Stop being ladies and have the courage to go the distance even when things don't seem rosy.

Nothing is easy in life and if you throw your hands up and give up you will lose for sure.

Remember the saying " You will always miss 100% of the shots you don't take"? Well, same thing here. If you don't like the way things are going, then do something.

I was just selected to be part of an ASA committee and I will sure stand up and make my voice heard and let those in control know we young grasshoppas want change. There are plenty of committed people to effect change and we can make it happen. Giving up is easy. Working hard and fighting is not.

I am not giving up, I am just telling you what the true state of affairs is.
If I was giving up I would have changed careers, I chose to learn how to navigate the system and still enjoy doing my job.
The future of this specialty is very questionable and all the ASA is doing is trying to delay the rapid collapse, they are not trying to regain what we have already lost.
You wont find any one in the ASA saying that we are the primary pain specialists or that we should be running the ICU's because we already lost pain and intensive care and we don't have the "COJONES" you mentioned to cliam them back.
You wont find anyone in the ASA who has the "COJONES" to say that CRNA's have to be supervised by Anesthesiologists not any physician would do.
So, while you are there at the ASA maybe you want to tell them to grow some cojones.

 

[ucsfgaspain]

Tough,

I love your fire. That's what we need to advocate for us in Washington. As you know...I will shamefully admit that I dropped my ASA membership a while ago b/c of the whole pain issue. I am proud to say, "I'm Back" definitely in part cuz I need to maintain the hope. If I don't hold out hope for our future who will? It's refreshing to see that the younger generation is trying to do right.

I truly wish that I had as much optimism as you Tough. I tend to agree with Plank. But I just dutifully sent in my contribution to the ASAPAC. I did it to maintain hope that we can turn this stinking ship around but the cold, logical side of me is not as optimistic.

Go raise some hell

 

[2win]

It's about the money.....I've said it many times before.

It's always been about the money. It will always be about the money.

For the academics....for the dentists...for you residents....for you attendings.......

Until the end of time...it'll be about the money for everyone.....

so why get all upset about it.....just accept it.

If you're not happy with the system....move to Russia, or Kenya or France...or some other sh it bag country.....they'll WELCOME you with OPEN arms.

we cannot move to Russia, France,,,maybe Kenya - the ABA diploma and residency is not recognized. There the "anesthesia" still has the ICU, they didn't sell it for nothing.

 

[2win]

2WIN and plankton need some cojones. Stop being ladies and have the courage to go the distance even when things don't seem rosy.

Nothing is easy in life and if you throw your hands up and give up you will lose for sure.

Remember the saying " You will always miss 100% of the shots you don't take"? Well, same thing here. If you don't like the way things are going, then do something.

I was just selected to be part of an ASA committee and I will sure stand up and make my voice heard and let those in control know we young grasshoppas want change. There are plenty of committed people to effect change and we can make it happen. Giving up is easy. Working hard and fighting is not.

The new generation could be better than the old one. So far when I see that a chairman from a big anesthesia department *Miami* - is stating that his main goal is the "economics" of the OR and BS like that, when textbooks in anesthesia have CRNA-s contributors, when the only goal in the residency programs is to have a body in the OR - aloow me to get dissapointed about the "bright" future of anesthesia. Why not an alternative to the ASA? With clear goals, young people - to change the shape of our future? We need a radical change in the residency programs. 40% OR, much more ICU and pain, electives in pulmonary and cardiology. I still see anesthesia docs asking for a consult to read a banal X ray,,,So that's my 2 cents and "cojones". GLTY

 

[toughlife]

Plankton, I know anesthesiology is not in a good situation but this can be attributed to weak people entering the field, those who only have financial interests and don't care about the specialty.

I have said it before and will say it again, the old generation of slackers has to go. They are the ones who sold out the field and it is what is causing a lot of trouble know. Many left pain and CCM go because OR anesthesia pays more. Again, greed is at the root of all trouble.

In order to regain those fields we need people who WANT to do it. That's why we need to encourage the new generation of residents to look into those fields and get them interested.

Also, to be successful we have to change our strategy and be more politically active, after visiting the politicians in their turf, I learned that the future of anesthesia and medicine in general is being decided there and at state legislatures. That's what the competition is doing.

So let's change our tactic and think big. Believe me we can change things..

Finally, I think the ASA has always reiterated the leadership of the anesthesiologists as the head of the ACT

http://www.asahq.org/publicationsAndServices/standards/16.pdf

Here's some inspiration if you need it...

Legislative update: House passes SGR fix, Teaching Rule reform!



By an overwhelming vote of 355-59, the U.S. House of Representatives on Tuesday passed H.R. 6331, a bill that would stop the massive 10.6% Medicare payment cut scheduled for implementation on July 1.

H.R. 6331, the "Medicare Improvements for Patients and Providers Act" would avert Medicare payment cuts AND reform the Medicare anesthesiology teaching rule!
ASA commends Ways and Means Committee chair Charles Rangel (D-NY) and Health Subcommittee chair Pete Stark (D-CA), as well as Energy and Commerce Committee chair John Dingell (D-MI), and Health Subcommittee chair Frank Pallone (D-NJ) for authoring H.R. 6331. The bill includes many critical Medicare provisions, several of which are vital to anesthesiology. Of particular importance, the legislation:

Blocks Medicare payment cuts for 18 months through December 31, 2009 and provides a 1.1% positive Medicare payment update for 2009. The bill's 18-month fix provides time for Congress to develop an alternative update mechanism to address the additional Medicare payment cuts still projected for 2010 and beyond.
Includes the language of H.R. 2053, authored by Rep. Xavier Becerra (D-CA) and Rep. Pete Sessions (R-TX) and cosponsored by 124 additional Representatives, that restores full Medicare payment to anesthesiology teaching programs.
Extends the 1.0 floor on the work GPCI through December 31, 2009.
Increases the PQRI bonus to 2.0% for 2009 and 2010.
U.S. Senate consideration of H.R. 6331 or similar legislation is possible for later this week.

ASA is also grateful for the leadership of Sens. Max Baucus (D-MT) and Charles Grassley (R-IA), who continue their efforts to advance a Medicare bill that ASA trusts will retain the language of S. 2056, authored by Sens. Jay Rockefeller (D-WV) and Jon Kyl (R-AZ), and cosponsored by 29 additional Senators. S. 2056 is the Senate companion to H.R. 2053.

 

[toughlife]

The new generation could be better than the old one. So far when I see that a chairman from a big anesthesia department *Miami* - is stating that his main goal is the "economics" of the OR and BS like that, when textbooks in anesthesia have CRNA-s contributors, when the only goal in the residency programs is to have a body in the OR - aloow me to get dissapointed about the "bright" future of anesthesia. Why not an alternative to the ASA? With clear goals, young people - to change the shape of our future? We need a radical change in the residency programs. 40% OR, much more ICU and pain, electives in pulmonary and cardiology. I still see anesthesia docs asking for a consult to read a banal X ray,,,So that's my 2 cents and "cojones". GLTY

Excellent idea and that is why I support the new generation of residents getting involved because we have a different perspective into what is best for anesthesiology vs. old geezers who are only concerned about getting fat paychecks without doing any work.

Half ICU/PAIN and half OR would be great. We need more medicine-based specialty training rather than warming an OR stool and feeling like champions by the simple act of intubating someone or putting a line. It is amazing how little medicine many anesthesiologists actually know. Many run to anesthesia because of its little similarity to the traditional medicine-based specialties and this hurts us. We need people who really want to add to the specialty not detract from it.

I think MMD did have a point. We need to clean up our house and train real physicians not stool warmers.

 

[toughlife]

Tough,

I love your fire. That's what we need to advocate for us in Washington. As you know...I will shamefully admit that I dropped my ASA membership a while ago b/c of the whole pain issue. I am proud to say, "I'm Back" definitely in part cuz I need to maintain the hope. If I don't hold out hope for our future who will? It's refreshing to see that the younger generation is trying to do right.

I truly wish that I had as much optimism as you Tough. I tend to agree with Plank. But I just dutifully sent in my contribution to the ASAPAC. I did it to maintain hope that we can turn this stinking ship around but the cold, logical side of me is not as optimistic.

Go raise some hell

thanks for supporting the ASAPAC. Those guys work very hard on our behalf and are key in our fight against those who want to see us out of the picture.

I know it is easy to get discouraged and I always tell those who find it difficult to write letters or call their representatives to at least support the PAC financially.

We need believers to turn this ship around and I keep the hope because I know that those who want to see us fail are banking on our losing hope.
I love challenges and the bigger it is the more I like it so I won't be giving up anytime soon.

 

[Planktonmd]

Plankton, I know anesthesiology is not in a good situation but this can be attributed to weak people entering the field, those who only have financial interests and don't care about the specialty.

I have said it before and will say it again, the old generation of slackers has to go. They are the ones who sold out the field and it is what is causing a lot of trouble know. Many left pain and CCM go because OR anesthesia pays more. Again, greed is at the root of all trouble.

In order to regain those fields we need people who WANT to do it. That's why we need to encourage the new generation of residents to look into those fields and get them interested.

Also, to be successful we have to change our strategy and be more politically active, after visiting the politicians in their turf, I learned that the future of anesthesia and medicine in general is being decided there and at state legislatures. That's what the competition is doing.

So let's change our tactic and think big. Believe me we can change things..

Finally, I think the ASA has always reiterated the leadership of the anesthesiologists as the head of the ACT

http://www.asahq.org/publicationsAndServices/standards/16.pdf

Here's some inspiration if you need it...

Legislative update: House passes SGR fix, Teaching Rule reform!



By an overwhelming vote of 355-59, the U.S. House of Representatives on Tuesday passed H.R. 6331, a bill that would stop the massive 10.6% Medicare payment cut scheduled for implementation on July 1.

H.R. 6331, the "Medicare Improvements for Patients and Providers Act" would avert Medicare payment cuts AND reform the Medicare anesthesiology teaching rule!
ASA commends Ways and Means Committee chair Charles Rangel (D-NY) and Health Subcommittee chair Pete Stark (D-CA), as well as Energy and Commerce Committee chair John Dingell (D-MI), and Health Subcommittee chair Frank Pallone (D-NJ) for authoring H.R. 6331. The bill includes many critical Medicare provisions, several of which are vital to anesthesiology. Of particular importance, the legislation:

Blocks Medicare payment cuts for 18 months through December 31, 2009 and provides a 1.1% positive Medicare payment update for 2009. The bill's 18-month fix provides time for Congress to develop an alternative update mechanism to address the additional Medicare payment cuts still projected for 2010 and beyond.
Includes the language of H.R. 2053, authored by Rep. Xavier Becerra (D-CA) and Rep. Pete Sessions (R-TX) and cosponsored by 124 additional Representatives, that restores full Medicare payment to anesthesiology teaching programs.
Extends the 1.0 floor on the work GPCI through December 31, 2009.
Increases the PQRI bonus to 2.0% for 2009 and 2010.
U.S. Senate consideration of H.R. 6331 or similar legislation is possible for later this week.

ASA is also grateful for the leadership of Sens. Max Baucus (D-MT) and Charles Grassley (R-IA), who continue their efforts to advance a Medicare bill that ASA trusts will retain the language of S. 2056, authored by Sens. Jay Rockefeller (D-WV) and Jon Kyl (R-AZ), and cosponsored by 29 additional Senators. S. 2056 is the Senate companion to H.R. 2053.

If the ASA wants to really to represent us they have to clearly advocate that CRNA's have to be supervised by ANESTHESIOLOGISTS no one else!
This should be clearly stated and advocated because if we accept anything less we are simply committing professional suicide.
A transitory medicare payment increase is not an achievement when we are talking about the future of this specialty.
Let's face reality and cut the B.S.

 

[toughlife]

If the ASA wants to really to represent us they have to clearly advocate that CRNA's have to be supervised by ANESTHESIOLOGISTS no one else!
This should be clearly stated and advocated because if we accept anything less we are simply committing professional suicide.
A transitory medicare payment increase is not an achievement when we are talking about the future of this specialty.
Let's face reality and cut the B.S.

I am confused. How can fixing the teaching reimbursement rule be transitory?

I understand aobut the medicare payment but that is a problem that all of medicine faces not just anesthesia. That's one the AMA and the entire house of medicine need to do something about not just us.

I agree with anesthesiologists supervising CRNAs and that should be one of the ASA mandates. We need to push them to include that as one of the main tenets just like patient safety is.

 

[amyl]

i don't know guys.... maybe the sky is falling...but maybe the wake up call is being received. my residency class seems very informed of the threat to anesthesia...they have all pledged to donate to the ASA, the state organization, the PAC and the state PAC (at the suggestion of our PD). i will continue to be cautiously optomistic.
p.s. -- tl, would love to hear about your trip to d.c. in the private forum when you get the chance....

 

[fakin' the funk]

It is amazing how little medicine many anesthesiologists actually know. Many run to anesthesia because of its little similarity to the traditional medicine-based specialties and this hurts us. We need people who really want to add to the specialty not detract from it

That IS the specialty. ??? Those people are the specialty, that's why the specialty is great and that's why it attracts the people it does. Maybe it's doomed, maybe it's not, but that's what people like about it. If they wanted to be internists, they'd do that instead wouldn't they?

Do you really have to have an internist's level of knowledge when a common induction plan on this board is "Pent, sux, tube" for every patient?

 

[2win]

That IS the specialty. ??? Those people are the specialty, that's why the specialty is great and that's why it attracts the people it does. Maybe it's doomed, maybe it's not, but that's what people like about it. If they wanted to be internists, they'd do that instead wouldn't they?

Do you really have to have an internist's level of knowledge when a common induction plan on this board is "Pent, sux, tube" for every patient?

YES - you do need to have at least the level of knowledge that an internist has regarding the CV, pulmonary and critical care. Seems that your opinion about anesthesia is the wrong one. Regarding attracting the people in anesthesia - you buddy get out and check WHAT IS THE OPINION OF OTHER PROFESSIONALS ABOUT US! Do you think that anesthesia is about intubating? So the CRNA are the one qualified and they are the one capable to do it! I see my daughter (if she'll have surgery) in the hands of a guy WHO KNOWS MEDICINE, how to READ an X ray, read an ABG, have balls to stand to a surgeon who maybe is wrong, manage a blood transfusion and so on. I see that you're a student or maybe a resident - don't get deceived by others dude... Toughlife at leat is fighting and he has a dream. I admire him and I believe in the new generation.

 

[Surfer]

Sorry but most anesthesiologists (myself included) have no intention of EVER working in an ICU. If I wanted to work in an ICU i'd be an internist. Don't cede the O.R. to the nurses. It's really that simple.

 

[FutureDMD1234]

i understand your opinion about dental anesthesiologists. Yes, they went into it for the money. Some of you are not willing to go to a dental office to put patient to sleep because you make money in the hospital than there. Yes, we have crnas to do the job but most of them don't want to do that.

 

[Planktonmd]

Sorry but most anesthesiologists (myself included) have no intention of EVER working in an ICU. If I wanted to work in an ICU i'd be an internist. Don't cede the O.R. to the nurses. It's really that simple.

Don't worry, you are not expected to work in the ICU and even if you wanted to you will have to compete with the other specialists that control intensive care.
The same goes for pain management, we only have a small share of this field and it is rapidly shrinking, so don't worry about that either.
Regarding the nurses taking over the OR, how do you suggest we should stop it?
The ASA is saying forget it, let's just become perioperative consultants and let the nurses enjoy the OR.
This is exactly how we gave up pain and intensive care previously: we said forget it we'll do something else more lucrative.
It's not pretty, trust me.

 

[2win]

Don't worry, you are not expected to work in the ICU and even if you wanted to you will have to compete with the other specialists that control intensive care.
The same goes for pain management, we only have a small share of this field and it is rapidly shrinking, so don't worry about that either.
Regarding the nurses taking over the OR, how do you suggest we should stop it?
The ASA is saying forget it, let's just become perioperative consultants and let the nurses enjoy the OR.
This is exactly how we gave up pain and intensive care previously: we said forget it we'll do something else more lucrative.
It's not pretty, trust me.

Ditto. Battle is lost - ASA is a joke....How can we change it? from inside or just build another organization?

 

[fakin' the funk]

Regarding attracting the people in anesthesia - you buddy get out and check WHAT IS THE OPINION OF OTHER PROFESSIONALS ABOUT US! ....I admire him and I believe in the new generation.

The opinion of other professionals about anesthesiologists is what it is because many of the current attendings come across as lazy, unintellectual, etc. Is this a legacy of the anesthesiology market in the 90's? Most attendings come in to check in on the resident or CRNA and usually end of chatting about pop culture, their hobby, etc. Instead of talking about the mechanism of disease X and the newest literature on Y. This is why research in anesthesia sucks because for many years so few future academics went into the field.

I too believe in a new generation - a new generation of intrinsically brighter anesthesiologists (probably drawn by the type of work, the lifestyle, and the pay) with a strong background in medicine and critical care that complements their OR work but does not (necessarily) replace it. If, over the last 20 years, anesthesiology had drawn the caliber of residents that it currently is, the field wouldn't be in the situation it is.

 

[toughlife]

That IS the specialty. ??? Those people are the specialty, that's why the specialty is great and that's why it attracts the people it does. Maybe it's doomed, maybe it's not, but that's what people like about it. If they wanted to be internists, they'd do that instead wouldn't they?

Do you really have to have an internist's level of knowledge when a common induction plan on this board is "Pent, sux, tube" for every patient?

That is exactly the problem with anesthesia. The "pent, sux, tube mentality" that is common place everywhere.

Everyone else sees us as tube jockeys with no other skills besides pushing meds that a nurse can be trained to do.

Believe me when I say many have it out for gas and can't wait to have our head on the chopping block and give it to the nurses. We need physicians not monkeys.

 

[militarymd]

.............
I too believe in a new generation - a new generation of intrinsically brighter anesthesiologists (probably drawn by the type of work, the lifestyle, and the pay) with a strong background in medicine and critical care that complements their OR work but does not (necessarily) replace it. If, over the last 20 years, anesthesiology had drawn the caliber of residents that it currently is, the field wouldn't be in the situation it is.

that is the problem...and you're saying that it's going to fix it????

As long as people are drawn because of money and lifestyle......you will continue to have people who sell out....

I'll sell any of you out for a nickel......I'm not ashamed of it....it's business.

 

[toughlife]

Sorry but most anesthesiologists (myself included) have no intention of EVER working in an ICU. If I wanted to work in an ICU i'd be an internist. Don't cede the O.R. to the nurses. It's really that simple.

And may I ask what you are doing to ensure the ORs are not ceded to the nurses?

If you want to continue to sit in the OR, then you more than anyone else, should become the most aggressive, politically active guy out there. That privilege will be harder and harder to come by as time progresses. Why? because the system will continue to push the limits to make it economically unfeasible to do it and the competition will keep on spanking you in the legislative arena to make sure you are not afforded that privilege.

Don't like that future, well then do your part and donate to your state organization and the ASAPAC. In other words, put your money where your mouth is.

 

[toughlife]

Don't worry, you are not expected to work in the ICU and even if you wanted to you will have to compete with the other specialists that control intensive care.
The same goes for pain management, we only have a small share of this field and it is rapidly shrinking, so don't worry about that either.
Regarding the nurses taking over the OR, how do you suggest we should stop it?
The ASA is saying forget it, let's just become perioperative consultants and let the nurses enjoy the OR.
This is exactly how we gave up pain and intensive care previously: we said forget it we'll do something else more lucrative.
It's not pretty, trust me.

Planktom I have a lot of respect for you, but you criticize harshly without offering any solutions or contributing to finding one.

Since you have been an attending for a while, what have you done to change things?

Those who control the money supply will force change whether we like it or not. Physicians are at the mercy of the govt and the insurance companies because we are too lazy to stand up to them and be our advocates.
We in anesthesiology will be forced to offer more than just OR babysitting to maintain our position and value.

Is this the ASA's fault? If you are talking about abandoning areas like ICU and pain, did you do fellowships in those areas and try to remain active in those fields? I know some anesthesiologists who did and they still practice CCM to this day. So before pointing fingers, take a hard look in the mirror and ask yourself what you have done to help out.

 

[Planktonmd]

Planktom I have a lot of respect for you, but you criticize harshly without offering any solutions or contributing to finding one.

Since you have been an attending for a while, what have you done to change things?

Those who control the money supply will force change whether we like it or not. Physicians are at the mercy of the govt and the insurance companies because we are too lazy to stand up to them and be our advocates.
We in anesthesiology will be forced to offer more than just OR babysitting to maintain our position and value.

Is this the ASA's fault? If you are talking about abandoning areas like ICU and pain, did you do fellowships in those areas and try to remain active in those fields? I know some anesthesiologists who did and they still practice CCM to this day. So before pointing fingers, take a hard look in the mirror and ask yourself what you have done to help out.

I have no idea what you are trying to say!
My point is very clear:
CCM and pain are lost, it's a done deal, they were lost because we didn't fight for them.
The only thing we have left is surgical anesthesia.
Your ASA wants us to give up surgical anesthesia and become some sort of anesthesia consultants who compete with all the other specialists that practice perioperative medicine.
Your ASA does not feel that anesthesia administration requires the supervision of an Anesthesiologist and repeatedly declared that a "physician" is all that is required to supervise CRNA's.
Your ASA wants to change our identity instead of fighting to keep it.
Did you ever ask yourself: Why should our role be different than the role of Anesthesiologists in other countries?
Why do we have to abandon our OR's while everywhere else Anesthesiologists continue to practice hands on anesthesia?
And if that is what the economics of medicine in this country are forcing us to do, shouldn't we at least try to fight?
You asked what I did to contribute?
I gave money to your ASA every year, religiously, I contacted local politicians and spoke to people about our specialty.
I got up early every day and gave my patients the best care possible.
What did you do for the specialty? You attended a few meetings?

 

[2win]

I have no idea what you are trying to say!
My point is very clear:
CCM and pain are lost, it's a done deal, they were lost because we didn't fight for them.
The only thing we have left is surgical anesthesia.
Your ASA wants us to give up surgical anesthesia and become some sort of anesthesia consultants who compete with all the other specialists that practice perioperative medicine.
Your ASA does not feel that anesthesia administration requires the supervision of an Anesthesiologist and repeatedly declared that a "physician" is all that is required to supervise CRNA's.
Your ASA wants to change our identity instead of fighting to keep it.
Did you ever ask yourself: Why should our role be different than the role of Anesthesiologists in other countries?
Why do we have to abandon our OR's while everywhere else Anesthesiologists continue to practice hands on anesthesia?
And if that is what the economics of medicine in this country are forcing us to do, shouldn't we at least try to fight?
You asked what I did to contribute?
I gave money to your ASA every year, religiously, I contacted local politicians and spoke to people about our specialty.
I got up early every day and gave my patients the best care possible.
What did you do for the specialty? You attended a few meetings?

Plankton should be the one one of the ASA consultants. They should be happy that they have somebody like him.... I do believe also that ASA are a bunch of loosers so far. This is the moment to step out and to replace them. Hpw we can change the way that our profession is seen? I believe that we have to change the residency. Forget about letting the inteligent, full of hopes resident in OR 99% of the time! Let them to breath some pulmonary and cardiac, ICU and echo! Why do I have to call in OR a cardiac guy to red a cardicac TEE? Just because we are not trained to do it...So let's change this bs. You know in my place they still call anesthesia on speakers to place an IV!???? This is the opinion of others about us. And never heard "surgery room X for an IV placement". ASA didn't fight at all for us, so I have no respect for them. Toughlife - it is the time to replace them.

 

[jetproppilot]

I've been in this biz a long time and I've never heard of a Dental Anesthesiologist.

Is that a recognized accreditation?

 

[toughlife]

I have no idea what you are trying to say!
My point is very clear:
CCM and pain are lost, it's a done deal, they were lost because we didn't fight for them.
The only thing we have left is surgical anesthesia.
Your ASA wants us to give up surgical anesthesia and become some sort of anesthesia consultants who compete with all the other specialists that practice perioperative medicine.
Your ASA does not feel that anesthesia administration requires the supervision of an Anesthesiologist and repeatedly declared that a "physician" is all that is required to supervise CRNA's.
Your ASA wants to change our identity instead of fighting to keep it.
Did you ever ask yourself: Why should our role be different than the role of Anesthesiologists in other countries?
Why do we have to abandon our OR's while everywhere else Anesthesiologists continue to practice hands on anesthesia?
And if that is what the economics of medicine in this country are forcing us to do, shouldn't we at least try to fight?
You asked what I did to contribute?
I gave money to your ASA every year, religiously, I contacted local politicians and spoke to people about our specialty.
I got up early every day and gave my patients the best care possible.
What did you do for the specialty? You attended a few meetings?

Look it is very simple. If the ASA wanted to give up OR anesthesia, why in the hell would they be fighting to rectify unfair laws like the teaching rule so teaching attendings can get paid fairly for teaching residents? Is it because they anticipate being absent from the OR in the near future?

If they had intention to give up the OR, why are they concerned about achieving parity in reimbursement in the rural areas?

Look man, the fault is ours because we don't do a damn thing about it. Why is it that there are 40K+ anesthesiologists in this country and only 11% care to be actively involved in protecting the specialty. Where's the rest?

I also take care of patients and so does everyone else who comes to this forum. Yes, I also donate money albeit not at an attending level but I do. Hell, many attendings don't give a penny. I also get up early in the morning just like you and everyone else does. So does that make me special? No, it's my job. I have also called politicians and talk to everyone I can about protecting anesthesiology. Your actions are not unique and special in any way and neither are mine. They are the minimum that should be expected from all of us.

I am not aware of the ASA giving up the OR. If that was the case, I would switch specialties. In other countries, anesthesiologists also practice CCM as is Europe's case. In the rest of the world they are the OR kings but then the rest of the world was not stupid enough to allow other providers to move into the OR. In other words, they did not allow greed to prevail over common sense.

In this country it is all about the $$ so we have to live with the consequences such inclinations have brought us.

What do you suggest we do to continue to dominate in the OR?

 

[FutureDMD1234]

He is a DENTAL anesthesiologist. It really means that he won't take your job. I'm sure he means that other Dental anesthesiologists or he doesn't know that law. Nobody complains about the oral surgeons administering iv sedation. Like I said before, not a lot of MDA's would go to a dentist's office to put the patients to sleep. This is ridiculous. CRNA's are more of a concern.

 

[Planktonmd]

What do you suggest we do to continue to dominate in the OR?

We need to stop saying that the administration of anesthesia can be supervised by any physician, and we need stick to our current identity and not try to create a new one that pleases the AANA and insurance companies.
The teaching reimbursement reversal thing is not progress, It is a desperate attempt to delay the disaster.
And if I wanted to be a politician I would have done that, I am a Physician and I thought I have a professional organization to which I contribute that is supposed to defend my interests, I obviously was wrong.
The solution is easy and it starts with our professional organization, they need to get their act together and start addressing the real issues.
You can't defend a specialty and at the same time attempt to destroy it.

 

[jwk]

They already are administering anesthesia in some states. That is local anesthetic. They are supervised. They just started the idea of oral health practioner in Minnesota to do tooth extraction and others. Dental anesthesiology is not even a recoginized specialty. They can't practice medicine anyway by law. They are limited to dentistry if you are worried. You must of didn't understand the guy or he is naive about the law. Oral Surgeons usually administer IV sedation anyway. They are just making a specialty out of it plus more training.

You clearly don't know what you don't know.

 

[toughlife]

We need to stop saying that the administration of anesthesia can be supervised by any physician, and we need stick to our current identity and not try to create a new one that pleases the AANA and insurance companies.
The teaching reimbursement reversal thing is not progress, It is a desperate attempt to delay the disaster.
And if I wanted to be a politician I would have done that, I am a Physician and I thought I have a professional organization to which I contribute that is supposed to defend my interests, I obviously was wrong.
The solution is easy and it starts with our professional organization, they need to get their act together and start addressing the real issues.
You can't defend a specialty and at the same time attempt to destroy it.

My dad used to say that if you want something done right, you need to do it yourself. I am a resident trying to help the current situation as best I can.

You have obviously given up on everything and I it seems you are a firm believer that everything is lost. So then keep on doing what you think it's best for you and I will do the same. I don't know what else I can offer you besides making sure your concerns makes it to the right people.

I think putting your thoughts on an email and shooting it to the ASA would be a good idea.

Good luck