USAP-answer to cheaper labor

[Howard888]

From Richard Dutton himself on dealing with staffing issues. At least admitting they’re looking for cheap labor. Again, these models crack with no surprises act and increasing labor cost (for both private equity and the pyramid MDs)


How is USAP addressing the continually growing anesthesiologist shortages in the U.S.?

RD: We are continuously investing in recruiting and retention efforts. I'm most proud of our work establishing anesthesia residencies in four of our cities and are exploring expedited pathways to bring non-U.S. anesthesiologists into practice here.

Why this U.S. Anesthesia Partners exec is excited about AI in the operating room

"Discover the top concerns facing the U.S. anesthesia industry in 2024, from declining reimbursements to staffing shortages and the impact of weight loss medica

www.beckersasc.com

---

Members don't see this ad.

 

[aneftp]

Residents are cheaper for night coverage since most place need just 2 (on ob and one or body)

But I don’t see how they are “cheaper” daytime when you are limited to covering 1:2 with residency’s

Medicare pays each institutions around 130-150k per resident and in return institutions pay residents 60-80k? In most places?

I know in some specialties that would help hospitals turns a profit. But in anesthesia world. I don’t see much profit from using residents unless it’s an all MD model or they are needed for night float

 

[Maverikk]

Which four cities?

 

[Beeftenderloin]

Residents are cheaper for night coverage since most place need just 2 (on ob and one or body)

But I don’t see how they are “cheaper” daytime when you are limited to covering 1:2 with residency’s

Medicare pays each institutions around 130-150k per resident and in return institutions pay residents 60-80k? In most places?

I know in some specialties that would help hospitals turns a profit. But in anesthesia world. I don’t see much profit from using residents unless it’s an all MD model or they are needed for night float

4 CRNA + 1 doc (4 rooms) = 1.65MM
4 residents + 2 docs (4 rooms) = 700k

Based on 300k nurse, 450k docs (academics), residents (150k/pop from CMS with easily 50k/pop of that being abused by the hospital/program for things only loosely associated with the residency).

That’s basically 250k per year savings PER RESIDENT. Some HCA program with 8 slots per year is saving 6MM/year on the backs of those residents. That’s way more than enough to incentivize this sort of practice.

Edit: Give or take 50k on the salaries, it doesn’t matter, the economics don’t change. There is a marked cost savings for a department that uses residents as a significant portion of its work force.

 

[Shimmy8]

Does the sponsoring hospital not get the money for the residents?

In places with lots of layers of call I also see this increasing the call burden of the attendings vs crnas.

 

[aneftp]

4 CRNA + 1 doc (4 rooms) = 1.65MM
4 residents + 2 docs (4 rooms) = 600k

Based on 300k nurse, 450k docs (academics), residents (150k/pop from CMS with easily 50k/pop of that being abused by the hospital/program for things only loosely associated with the residency).

That’s basically 250k per year savings PER RESIDENT. Some HCA program with 8 slots per year is saving 6MM/year on the backs of those residents. That’s way more than enough to incentivize this sort of practice.

Edit: Give or take 50k on the salaries, it doesn’t matter, the economics don’t change. There is a marked cost savings for a department that uses residents as a significant portion of its work force.

I get the math
4 crnas x 300k (assuming they work similar hours to residents with overtime) equals 1.2 million plus 450k attending

4 residents x 70k (some places like Boston is 90k resident salary) equals 280k (Medicare pays say 130k per resident x 4). 520k from Medicare -280k equals 240k.

So 2 attendings is 900k. 4 residents free labor

Now it gets to efficiency of labor. That’s the big question. Can’t put a resident in busy Gi suites with with 1 crna flipping rooms by themselves . Still have to use crnas. Maybe ca-3 can be used but they will bitch and complain about no educational purpose of doing 20 Gi scopes by themselves by 5pm. Certainly can’t use a ca-1 for those cases.

But I get the math. Residents are labor cost saving in general.

 

[abolt18]

I get the math
4 crnas x 300k (assuming they work similar hours to residents with overtime) equals 1.2 million plus 450k attending

4 residents x 70k (some places like Boston is 90k resident salary) equals 280k (Medicare pays say 130k per resident x 4). 520k from Medicare -280k equals 240k.

So 2 attendings is 900k. 4 residents free labor

Now it gets to efficiency of labor. That’s the big question. Can’t put a resident in busy Gi suites with with 1 crna flipping rooms by themselves . Still have to use crnas. Maybe ca-3 can be used but they will bitch and complain about no educational purpose of doing 20 Gi scopes by themselves by 5pm. Certainly can’t use a ca-1 for those cases.

But I get the math. Residents are labor cost saving in general.

What's hilarious to me, in a sick way, is that I hear people say things like "a CA-1 shouldn't be doing that case or have that much autonomy" but then in the same breath they'll have a brand new, first day on the job and out of school crna go do any and every case with limited oversight, including those 20 Endo cases. Or even an srna will start off their rotations in the Endo suite with minimal supervision by their crna or the physician. It blows my mind and pisses me off.

Can't count how many times I saw crap like that where I trained, or heard from the crnas all about their "anesthesia school" and how much autonomy they had and how many Endo cases they did from the get-go.

 

[GasPerspectives]

The ASA advertises exactly how much new residencies save hospitals.

"In the study, the researchers compared the cost of anesthesiology residents vs. nurse anesthetists, factoring in actual work hours and supervision ratios. They determined expanding the program to include more residents is financially beneficial as the cost per hour of clinical coverage for residents was $29.14, whereas paying nurse anesthetists to work overtime was $181.12 per hour of clinical coverage and paying nurse anesthetists to take on extra shifts was $255.31 per hour of clinical coverage. The researchers concluded that over three years, the addition of three residency positions resulted in a cost savings of between $440,000 and $730,000 for the first year, $840,000 and $1.4 million for the second year, and $1.2 million and $1.9 million for the third year. The analysis factored in the cost of those three additional residents, who weren’t supported by federal funding."

Source

The long game for these entities is to increase the number anesthesiologists in the workforce in order to lower salaries. In the meantime they massively save on labor costs with residents staffing ORs.

 

[GassYous]

I get the math
4 crnas x 300k (assuming they work similar hours to residents with overtime) equals 1.2 million plus 450k attending

4 residents x 70k (some places like Boston is 90k resident salary) equals 280k (Medicare pays say 130k per resident x 4). 520k from Medicare -280k equals 240k.

So 2 attendings is 900k. 4 residents free labor

Now it gets to efficiency of labor. That’s the big question. Can’t put a resident in busy Gi suites with with 1 crna flipping rooms by themselves . Still have to use crnas. Maybe ca-3 can be used but they will bitch and complain about no educational purpose of doing 20 Gi scopes by themselves by 5pm. Certainly can’t use a ca-1 for those cases.

But I get the math. Residents are labor cost saving in general.

Doing gi scopes fast is a very valuable lesson for private practice. I've relieved people 30 minutes into a case, they have nothing charted and just sitting around. How are you going to get a 20 case day finished if that's how you operate?

 

[DazedWanderer]

Residents are cheaper for night coverage since most place need just 2 (on ob and one or body)

But I don’t see how they are “cheaper” daytime when you are limited to covering 1:2 with residency’s

Medicare pays each institutions around 130-150k per resident and in return institutions pay residents 60-80k? In most places?

I know in some specialties that would help hospitals turns a profit. But in anesthesia world. I don’t see much profit from using residents unless it’s an all MD model or they are needed for night float

Maybe I'm missing something... Residents are basically free labor for the hospital as the government indirectly pays the residents' salary. Even if supervising 1:2 the hospital/practice is only on the hook for 1 attending salary to cover 2 ORs or 2 attending salaries to staff 4 ORs. Private practice they can supervise CRNA 1:4, with an average CRNA salary we will say 50% of an attending salary (that's being generous, realistically in the current market it is usually higher than 50%). So private practice best case scenario they are paying the equivalent total of 3 attending salaries to staff 4 ORs vs 2 attending salaries to staff 4 ORs when using residents. That's at least a 33% cost savings to use residents instead of CRNAs which is huge.

 

[Howard888]

Residents one piece…You guys are also missing the bringing in foreign grads piece. Foreign salaries much lower typically so they’re hoping to get much cheaper MD attendings as well.

Hey again at least being open.

 

[ambiturner]

Well on the plus side, at least the solution wasn’t to open CRNA schools and lobby for independent practice

 

[Beeftenderloin]

I get the math
4 crnas x 300k (assuming they work similar hours to residents with overtime) equals 1.2 million plus 450k attending

4 residents x 70k (some places like Boston is 90k resident salary) equals 280k (Medicare pays say 130k per resident x 4). 520k from Medicare -280k equals 240k.

So 2 attendings is 900k. 4 residents free labor

Now it gets to efficiency of labor. That’s the big question. Can’t put a resident in busy Gi suites with with 1 crna flipping rooms by themselves . Still have to use crnas. Maybe ca-3 can be used but they will bitch and complain about no educational purpose of doing 20 Gi scopes by themselves by 5pm. Certainly can’t use a ca-1 for those cases.

But I get the math. Residents are labor cost saving in general.

And that’s with residents working comparable hours to the CRNA they’re replacing, which they arent. Realistically they’re working at least 1.5x, if not 2x hours. Plus a lot of those hours are after 5 and on weekends/holidays with no increased cost associated with coverage. Realistically it’s probably something more like 350-500k savings per resident per year.

Residents in programs where they ARE the labor force often don’t realize how much power they collectively have. They all decide to not show up one day and the money making machine for the hospital grinds to a halt. And no other specialty in medicine has residents anywhere near this costly to replace with an “alternative provider”.

 

[aneftp]

And that’s with residents working comparable hours to the CRNA they’re replacing, which they arent. Realistically they’re working at least 1.5x, if not 2x hours. Plus a lot of those hours are after 5 and on weekends/holidays with no increased cost associated with coverage. Realistically it’s probably something more like 350-500k savings per resident per year.

Residents in programs where they ARE the labor force often don’t realize how much power they collectively have. They all decide to not show up one day and the money making machine for the hospital grinds to a halt. And no other specialty in medicine has residents anywhere near this costly to replace with an “alternative provider”.

My residency (true academic center) didn’t have crna. Said crnas too expensive. Just docs and residents. But that was more than a couple of decades ago. Attendings did solo cases also probably 20% of the time.

I guess that rare in todays true academic world.

Maybe it’s them to get back to MD only residency with residents. Maybe cheaper long term.

 

[nimbus]

And that’s with residents working comparable hours to the CRNA they’re replacing, which they arent. Realistically they’re working at least 1.5x, if not 2x hours. Plus a lot of those hours are after 5 and on weekends/holidays with no increased cost associated with coverage. Realistically it’s probably something more like 350-500k savings per resident per year.

Residents in programs where they ARE the labor force often don’t realize how much power they collectively have. They all decide to not show up one day and the money making machine for the hospital grinds to a halt. And no other specialty in medicine has residents anywhere near this costly to replace with an “alternative provider”.

https://www.reuters.com/world/asia-pacific/why-are-south-korean-trainee-doctors-strike-over-medical-school-quotas-2024-02-21/

 

[Fpg1245]

https://www.reuters.com/world/asia-pacific/why-are-south-korean-trainee-doctors-strike-over-medical-school-quotas-2024-02-21/

Happening more and more these days.

NHS strikes are another example.

I don’t think these stories are getting the attention they should be especially among trainees and attendings

You’re a cog in the govt wheel and when you stop working you’re considered a criminal.

Take note.

 

[nimbus]

Happening more and more these days.

NHS strikes are another example.

I don’t think these stories are getting the attention they should be especially among trainees and attendings

You’re a cog in the govt wheel and when you stop working you’re considered a criminal.

Take note.

Same for flight attendants. They need permission to strike.

 

[DirtDocMD]

So, open up residencies for cheap labor, bring in FMG’s for said residency slots, ALSO bring in FMG’s who’ve done FOREIGN residencies as “teaching staff”/“visiting professors” to work on the residency program’s “institutional permit”, hope resident FMG’s stick around and work cheap????

“I'm most proud of our work establishing anesthesia residencies in four of our cities and are exploring expedited pathways to bring non-U.S. anesthesiologists into practice here.”

 

[NumTacos]

From Richard Dutton himself on dealing with staffing issues. At least admitting they’re looking for cheap labor. Again, these models crack with no surprises act and increasing labor cost (for both private equity and the pyramid MDs)


How is USAP addressing the continually growing anesthesiologist shortages in the U.S.?

RD: We are continuously investing in recruiting and retention efforts. I'm most proud of our work establishing anesthesia residencies in four of our cities and are exploring expedited pathways to bring non-U.S. anesthesiologists into practice here.

Why this U.S. Anesthesia Partners exec is excited about AI in the operating room

"Discover the top concerns facing the U.S. anesthesia industry in 2024, from declining reimbursements to staffing shortages and the impact of weight loss medica

www.beckersasc.com

Would be curious to ask him “do you think anesthesiologists are overpaid?”. If his answer was yes, it suggests to me that he is single-handedly trying to change the strategic landscape for our profession as part of a commercial entity. Curious if he actually sees it that way, because that’s the way he is acting.

 

[Status Sciaticus]

Residents one piece…You guys are also missing the bringing in foreign grads piece. Foreign salaries much lower typically so they’re hoping to get much cheaper MD attendings as well.

Hey again at least being open.

Well, if they were really business savvy, they would start a residency program, staff it with underpaid foreign attendings to oversee the residents.

 

[aneftp]

Well, if they were really business savvy, they would start a residency program, staff it with underpaid foreign attendings to oversee the residents.

That’s what one of the big wigs in Florida tired to do. Anesthesiologist well known made 200 million plus selling to private not once but twice ! In the same meta practice

He took over a friends hospital private contract. Than hired fmg docs on j-1 visa for 170k in the 2010-2020 era. Full time.

Hospital admin found out. Looks bad on hospital admin cause they aren't exactly indigent hospital in major metro area in Florida. He just used a glitch in the way hospitals are configure. Some major metro area hospitals can be j-1 visa compatible.

So they gave it back to his private group. But there are guys who know how to use cheap labor

The cheapest labor aren’t residents. It’s srna puppies mills. So that’s the next step. Just expand more crna schools if you want to get cheaper.

 

[lane]

Would be curious to ask him “do you think anesthesiologists are overpaid?”. If his answer was yes, it suggests to me that he is single-handedly trying to change the strategic landscape for our profession as part of a commercial entity. Curious if he actually sees it that way, because that’s the way he is acting.

What an unserious comment. Dutton was the chief of quality for the ASA before joining USAP. He still practices clinically in addition to his work as the CQO. Given the exponentially growing demand for anesthesia services, increasing shortage of anesthesiologists, lack of growth in reimbursement rates, legislative hurdles, and myriad headwinds from CMS and commercial payors why would he (or anyone) believe anesthesiologists are overpaid?

 

[secretasianman]

Well when you pay residents 50-60k a year for 50-80 hour weeks, of course it’s a great deal and great to financially exploit. Just like slave labor.

 

[DesiredMemberName?]

Doing gi scopes fast is a very valuable lesson for private practice. I've relieved people 30 minutes into a case, they have nothing charted and just sitting around. How are you going to get a 20 case day finished if that's how you operate?

Sounds like they knew relief was on the way.

 

[NumTacos]

What an unserious comment. Dutton was the chief of quality for the ASA before joining USAP. He still practices clinically in addition to his work as the CQO. Given the exponentially growing demand for anesthesia services, increasing shortage of anesthesiologists, lack of growth in reimbursement rates, legislative hurdles, and myriad headwinds from CMS and commercial payors why would he (or anyone) believe anesthesiologists are overpaid?

It was serious. Are you Dr Dutton? If so, I apologize for coming across callous, it’s not my intent. It is curious for the very reason that he is promoting extra residencies and facilitating foreign labor to deal with the anesthesia shortage. He works for a for-profit company, so it looks maybe a little weird from that perspective. If you are Dr Dutton or know him well enough, I’d actually love to hear his opinion.

 

[makemoney2024]

That’s what one of the big wigs in Florida tired to do. Anesthesiologist well known made 200 million plus selling to private not once but twice ! In the same meta practice

He took over a friends hospital private contract. Than hired fmg docs on j-1 visa for 170k in the 2010-2020 era. Full time.

Hospital admin found out. Looks bad on hospital admin cause they aren't exactly indigent hospital in major metro area in Florida. He just used a glitch in the way hospitals are configure. Some major metro area hospitals can be j-1 visa compatible.

So they gave it back to his private group. But there are guys who know how to use cheap labor

The cheapest labor aren’t residents. It’s srna puppies mills. So that’s the next step. Just expand more crna schools if you want to get cheaper.

Jesus. People are greedy.

 

[Coffee PRN]

Will Dr. Dutton please stand up

 

[lane]

It was serious. Are you Dr Dutton? If so, I apologize for coming across callous, it’s not my intent. It is curious for the very reason that he is promoting extra residencies and facilitating foreign labor to deal with the anesthesia shortage. He works for a for-profit company, so it looks maybe a little weird from that perspective. If you are Dr Dutton or know him well enough, I’d actually love to hear his opinion.

Every practice that isn’t directly taxpayer funded (ie academic or VA) is a for-profit company.
Of course I’m not Rick, but I am familiar enough with him and USAP to know it’s a simple concept: the demand for anesthesia growth far outpaces the current and anticipated supply. Commercial payers driving down reimbursement rates and vertically integrating along with CMS paying roughly half of what it did 20 years ago (when adjusted for inflation) with an aging population are real and present threats to every practice (except… academics and VA). Maintaining competitive rates helps every anesthesiologist, and that should be a universal goal. Expanding residency positions and FMGs has no bearing on those whatsoever.

 

[okayplayer]

Every practice that isn’t directly taxpayer funded (ie academic or VA) is a for-profit company.
Of course I’m not Rick, but I am familiar enough with him and USAP to know it’s a simple concept: the demand for anesthesia growth far outpaces the current and anticipated supply. Commercial payers driving down reimbursement rates and vertically integrating along with CMS paying roughly half of what it did 20 years ago (when adjusted for inflation) with an aging population are real and present threats to every practice (except… academics and VA). Maintaining competitive rates helps every anesthesiologist, and that should be a universal goal. Expanding residency positions and FMGs has no bearing on those whatsoever.

Of course flooding the market with cheap labor (at a large enough volume) will depress salaries. Not debatable.

 

[lane]

Of course flooding the market with cheap labor (at a large enough volume) will depress salaries. Not debatable.

If you think that’s large enough volume to put a dent in salaries you’re fooling yourself. There’s a national shortfall of tens of thousands of positions in the coming years.
United, Cigna, et al vertically integrating and creating salaried practices while also cutting rates by 30% depresses income. And it’s happening. That’s not debatable.

 

[okayplayer]

Both are true, my friend.

 

[CubsDynasty]

If you think that’s large enough volume to put a dent in salaries you’re fooling yourself. There’s a national shortfall of tens of thousands of positions in the coming years.
United, Cigna, et al vertically integrating and creating salaried practices while also cutting rates by 30% depresses income. And it’s happening. That’s not debatable.

If the FMG gets approval you'd have tens of thousands of applicants from around the world overnight. There's a half million anesthesiologists around the world and 99.9% of them make a fraction of what they would make in the US. People would be fighting over one another to take a 200k salary and salaries would drop instantly. Lets just hope that never comes to fruition.

 

[kidthor]

Will Dr. Dutton please stand up

He's a smart guy and a very good anesthesiologist.

But he's now also clearly a USAP executive with all the associated baggage. Synergy with graphs and charts and the need to wear a suit (and probably a fat golden parachute)...

 

[aneftp]

He's a smart guy and a very good anesthesiologist.

But he's now also clearly a USAP executive with all the associated baggage. Synergy with graphs and charts and the need to wear a suit (and probably a fat golden parachute)...

You become very rusty quickly if u don’t do clinical anesthesia solo urself occasionally

And extremely rusty when u “supervise” one 8 hour day and do admin work the rest of the time.

A “good anesthesiologist” has different connotations once u move into an executive role. When they are not familiar with day to day activities.

That’s really the downfall of many big AMCs leadership as they move away from day to day activities. And try to rely on the groups on the ground to handle themselves and lose track what exactly is going on

 

[DazedWanderer]

Residents one piece…You guys are also missing the bringing in foreign grads piece. Foreign salaries much lower typically so they’re hoping to get much cheaper MD attendings as well.

Hey again at least being open.

The worst thing for anesthesia salaries (and physician salaries in general) in the US would be legislation opening the flood gates to foreign-trained doctors. There is almost an unlimited quantity of doctors who would immigrate to America in a heartbeat if given the chance to practice here. Many would gladly work for a small fraction of the salary that an anesthesiologist in America would typically command and this would have far more profound effects on salary depression than increasing US residency training spots. If the anesthesia provider shortage becomes too severe simply removing these artificial barriers to practice from foreign-trained anesthesiologists would solve the shortage much quicker and much cheaper than increasing our own training spots. It would also give the appearance of inclusivity. Short term solution, cost savings, and easy virtue signaling all in one, sounds like ripe low hanging fruit for legislators to try to enact something like this in the future if the shortage gets dire enough to the point politicians are pressured to actively intervene.

 

[lane]

You become very rusty quickly if u don’t do clinical anesthesia solo urself occasionally

And extremely rusty when u “supervise” one 8 hour day and do admin work the rest of the time.

A “good anesthesiologist” has different connotations once u move into an executive role. When they are not familiar with day to day activities.

That’s really the downfall of many big AMCs leadership as they move away from day to day activities. And try to rely on the groups on the ground to handle themselves and lose track what exactly is going on

Considering he’s currently a clinical site chief I’d say any rust is gone

 

[lotsapain]

Is this why USAP lost a number of large contracts in Texas including those that are establishing residency programs

 

[lotsapain]

The worst thing for anesthesia salaries (and physician salaries in general) in the US would be legislation opening the flood gates to foreign-trained doctors. There is almost an unlimited quantity of doctors who would immigrate to America in a heartbeat if given the chance to practice here. Many would gladly work for a small fraction of the salary that an anesthesiologist in America would typically command and this would have far more profound effects on salary depression than increasing US residency training spots. If the anesthesia provider shortage becomes too severe simply removing these artificial barriers to practice from foreign-trained anesthesiologists would solve the shortage much quicker and much cheaper than increasing our own training spots. It would also give the appearance of inclusivity. Short term solution, cost savings, and easy virtue signaling all in one, sounds like ripe low hanging fruit for legislators to try to enact something like this in the future if the shortage gets dire enough to the point politicians are pressured to actively intervene.

And not a single person here said anything about quality.... there is a SIGNIFICANT rift between quality in US and other countries in terms of delivery of care (due to many factors), we are not even talking about difference in some of the medications used elsewhere that are not approved in the US market (nor the naming conventions). Good luck receiving anesthesia by someone who has not been in residency in US/Canada ... maybe UK/Germany...

 

[DazedWanderer]

And not a single person here said anything about quality.... there is a SIGNIFICANT rift between quality in US and other countries in terms of delivery of care (due to many factors), we are not even talking about difference in some of the medications used elsewhere that are not approved in the US market (nor the naming conventions). Good luck receiving anesthesia by someone who has not been in residency in US/Canada ... maybe UK/Germany...

If the shortage is bad enough and constituents are mad enough, do you think quality will continue to be prioritized over quantity and the simple matter of getting people access to care? We already know quality of care is not a priority over quantity of care as we see CRNAs being granted independent practice across the country. I'd be more confident in the quality of anesthesia delivered by a British-trained anesthesiologist than a CRNA to be frank.

Also, there is really no rift between the quality of care in the US and other developed countries. Significant differences in the healthcare systems and logistics in how they operate? Yes of course, but that's distinct from quality of care. Even if they removed the arbitrary barriers from similarly wealthy developed English speaking countries only, thousands of the doctors in the NHS would be on their way over here happy to work for half the pay we are getting because even that is still double what they were being paid in the UK.

 

[aneftp]

Considering he’s currently a clinical site chief I’d say any rust is gone

My clinical site friend doesn’t do any work. One 8 hour elective shift a month.

 

[lotsapain]

If the shortage is bad enough and constituents are mad enough, do you think quality will continue to be prioritized over quantity and the simple matter of getting people access to care? We already know quality of care is not a priority over quantity of care as we see CRNAs being granted independent practice across the country.

Also, there is really no rift between the quality of care in the US and other developed countries. Significant differences in the healthcare systems and logistics in how they operate? Yes of course, but that's distinct from quality of care. Even if they removed the arbitrary barriers from developed English speaking countries only, thousands of the doctors in the NHS would be on their way over here happy to work for half the pay we are getting because even that is still double what they were being paid in the UK.

I have received care once in Croatia (a beautiful country) - the emergency doc there was still making his way through the EKG Book... his solution to my care involved the use of hot water in a large pan..... (wound up being the right solution incidentally). As I have mentioned UK/Germany/Canada/South Africa may not be an issue.... otherwise your milege may vary.

Access to bad care is worse then no care at all (some CRNAs pay more attention then a few locums docs I have met who are so jaded they won't even know how to open a Pyxis).

 

[aneftp]

I have received care once in Croatia (a beautiful country) - the emergency doc there was still making his way through the EKG Book... his solution to my care involved the use of hot water in a large pan..... (wound up being the right solution incidentally). As I have mentioned UK/Germany/Canada/South Africa may not be an issue.... otherwise your milege may vary.

Access to bad care is worse then no care at all (some CRNAs pay more attention then a few locums docs I have met who are so jaded they won't even know how to open a Pyxis).

My friend is Croatian. When his mother end of life. Or near near of life. Instead of peg. They put ng tube.

Govt healthcare said no peg for her. Since life expectancy not long (elderly but not dying) but not exactly in good shape

So he flew there paid cash for peg and she lived another 18 months

That’s how govt healthcare is in those countries.

 

[amyl]

I’ll chime in as someone who has worked in the OR next to Dutton in the past few years and as someone who has worked with fmgs.
Before Dutton took his current position in Maryland he spent his clinical time in dallas at my hospital. We are a level one trauma center and take care of the sickest patients. He previously worked at shock trauma in Baltimore. His cv is long and very quality focused. His comments (and Usap’s approach) are not attempting to pay anesthesiologists less… I think we are looking to maintain a steady supply of anesthesiologists. Retirements outpace graduates by 1000/year… this is info USAP has provided to our recruiting team (of which I am a part). We are looking to get ahead of that not lessen salaries.
My group has been discussing having a residency program… we certainly have the clinical volume and would turn out top notch residents who had seen everything (we are a major transplant center, high risk ob, etc.). We would have to send them elsewhere for peds. I think we have elected not to open a residency program at this time as the majority of the partners weren’t interested in it.

Now for the fmg part -
I trained at the Cleveland clinic who does have a program for fmg anesthesiologists to come do a second residency in the USA. I worked next to residents that were the chief of their hospital in China, established anesthesiologist in Egypt or other similar places. While my experience is admittedly anecdotal - the “chief” from China was horrid as a ca1… they started over. I’m sure she was great when they were done with her. Another (from India?) was also terrible and never completed the residency here and was pushed out - they’re out of medicine. There were some from Egypt, India, Italy? And some other places I can’t recall that were good residents and ended up capable doctors. My point is this - and I hope this is what Dutton means - those fmgs have to come here and be trained AGAIN- come be residents…. Not come “fresh off the boat” and be taking care of patients.
I’ve seen lots of bad anesthesiologists that trained in this country too…. Definitely need to up our games.

 

[circleK]

We are continuously investing in recruiting and retention efforts. I'm most proud of our work establishing anesthesia residencies in four of our cities and are exploring expedited pathways to bring non-U.S. anesthesiologists into practice here

These are two contradictory sentences.
Is he focused on recruitment and retention or creating a new cheaper source of labor? I’m surprised he didn’t talk about bringing in SRNAs as a “solution”

 

[makemoney2024]

The worst thing for anesthesia salaries (and physician salaries in general) in the US would be legislation opening the flood gates to foreign-trained doctors. There is almost an unlimited quantity of doctors who would immigrate to America in a heartbeat if given the chance to practice here. Many would gladly work for a small fraction of the salary that an anesthesiologist in America would typically command and this would have far more profound effects on salary depression than increasing US residency training spots. If the anesthesia provider shortage becomes too severe simply removing these artificial barriers to practice from foreign-trained anesthesiologists would solve the shortage much quicker and much cheaper than increasing our own training spots. It would also give the appearance of inclusivity. Short term solution, cost savings, and easy virtue signaling all in one, sounds like ripe low hanging fruit for legislators to try to enact something like this in the future if the shortage gets dire enough to the point politicians are pressured to actively intervene.

I am sure they would limit the number of people who would come in. Come on, it wouldn’t be a free for all.

 

[thinkorswim]

If the FMG gets approval you'd have tens of thousands of applicants from around the world overnight. There's a half million anesthesiologists around the world and 99.9% of them make a fraction of what they would make in the US. People would be fighting over one another to take a 200k salary and salaries would drop instantly. Lets just hope that never comes to fruition.

Let’s pare down the hyperbole here. The only FMGs that are reasonably able to come and work here that easily would have to be US citizens, and there aren’t that many floating around. All the other non-citizens would have to navigate an immigration process that isn’t favorable to physicians. Some work visas even go so far as to explicitly exclude clinical physicians.

The greatest threat comes from within our own healthcare system, both from insurance companies and mid levels.

 

[makemoney2024]

Let’s pare down the hyperbole here. The only FMGs that are reasonably able to come and work here that easily would have to be US citizens, and there aren’t that many floating around. All the other non-citizens would have to navigate an immigration process that isn’t favorable to physicians. Some work visas even go so far as to explicitly exclude clinical physicians.

The greatest threat comes from within our own healthcare system, both from insurance companies and mid levels.

Wait what? Immigration here as a physician would be difficult if they opened this pathway? Would this not make it easier as this would be a professional in critical need?
Also I thought immigrating here as a physician would be say easier than I don’t know, a laborer.

 

[Howard888]

As the original poster of this I do not question Duttons clinical abilities nor capabilities at large or individual traits.

However…let’s not sugar cost that he slipped up and shouldn’t have said this. USAP is facing a battle it can’t win with nsa without making different rules. They can’t increase rates and even he said the payers aren’t paying for silly quality metrics anymore. He’s corporate now…cheap labor does make the numbers work better. Again, I said well..he’s open and said it. The problem is the downstream effects of a flood of foreign grads as others mentioned and dumbing down residencies like HCA is also doing. HCA and USAP are doing the EXACT same thing right now.

It’s not a coincidence

 

[abolt18]

In my opinion, physicians from other 1st world countries should NOT be required to do an entire 4-year residency. I had a co-resident who had completed her training in Australia, then came and did an OB anesthesia fellowship in the USA, THEN did residency in anesthesia. Woof!

They could easily create an accelerated 1-2 year "training" where they rotate through every subspecialty to prove themselves capable, then take ABA boards, and BAM they're done. English proficiency would obviously be a must as well.

 

[thinkorswim]

Wait what? Immigration here as a physician would be difficult if they opened this pathway? Would this not make it easier as this would be a professional in critical need?
Also I thought immigrating here as a physician would be say easier than I don’t know, a laborer.

I’m not sure what expedited pathways USAP is exploring but a relatively small PE-backed company is unlikely to change immigration law or medical licensure requirements. There has been a critical need for physicians in this country for decades now and nothing has changed on those fronts.

Sure, it’s easier to immigrate here as a physician than an unskilled laborer. But once here, a physician still needs to satisfy training and licensure requirements before working. This is why the largest H-1B employers are all tech companies where an educated immigrant can come and work immediately. But even those for-profit companies are only able to secure visas for 1-2% of their workforce in any given year.

So yeah, in the end, I’m not worried about immigrants taking our jobs.