VA replacing anesthesiologists with nurses

[Steve_Zissou]

Physician Anesthesiologists Urge VA to Reverse Directive Jeopardizing Veterans’ Lives

The American Society of Anesthesiologists (ASA) urges Americans to protect our nation’s Veterans by asking the U.S. Department of Veterans Affairs (VA) to rev

www.newswise.com

Looks like this has happened before and been reversed before? I’m not quite sure the history. Thoughts?

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[deleted171991]

Physician Anesthesiologists Urge VA to Reverse Directive Jeopardizing Veterans’ Lives

The American Society of Anesthesiologists (ASA) urges Americans to protect our nation’s Veterans by asking the U.S. Department of Veterans Affairs (VA) to rev

www.newswise.com

Looks like this has happened before and been reversed before? I’m not quite sure the history. Thoughts?

It has never happened before, though the CRNAs have tried.

 

[Steve_Zissou]

Lots of complaining on sdn when things are pseudo-concerning. This is extremely concerning and my anesthesiology buddies are all privately voicing their, very real concerns. This really could trigger widespread crna independence.

Are there any concerted efforts, other than what seemed like a very weak ASA response, to fight it?

 

[2Fast2Des]

Are there any concerted efforts, other than what seemed like a very weak ASA response, to fight it?

The ASA will be the reason why anesthesia will be taken behind the barn and shot. It's become the AMA for us. Self serving and useless

 

[BLADEMDA]

Lots of complaining on sdn when things are pseudo-concerning. This is extremely concerning and my anesthesiology buddies are all privately voicing their, very real concerns. This really could trigger widespread crna independence.

Really? What do you think happens over the next 5-8 years? This gradual creep by the AANA/CRNAs towards independence practice has been going on for 20+ years. The dam is getting ready to break. First, the VA will FALL then the community hospitals. The specialty is in deep trouble IMHO. Prior efforts have worked to hold the barbarians off at the gates. But, they are relentless in their efforts to see Rome fall.

 

[Nivens]

Really? What do you think happens over the next 5-8 years? This gradual creep by the AANA/CRNAs towards independence practice has been going on for 20+ years. The dam is getting ready to break. First, the VA will FALL then the community hospitals. The specialty is in deep trouble IMHO. Prior efforts have worked to hold the barbarians off at the gates. But, they are relentless in their efforts to see Rome fall.

This is all I could think about reading your post:

 

[zero0]

Really? What do you think happens over the next 5-8 years? This gradual creep by the AANA/CRNAs towards independence practice has been going on for 20+ years. The dam is getting ready to break. First, the VA will FALL then the community hospitals. The specialty is in deep trouble IMHO. Prior efforts have worked to hold the barbarians off at the gates. But, they are relentless in their efforts to see Rome fall.

The irony is they're screwing themselves over too. They're just too stupid to see it.

 

[deleted126335]

This is all I could think about reading your post:

In their minds MDs are the army behind the black gate.

More appropriate:




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[jeterfan]

The academic anesthesia programs training srna students need to stop. That is the most effective way to make a statement. Waxing poetically written articles about the issue and talking to representatives is useless. Residents and attendings in these programs need to stop and think about their own future And the profession. Start training anesthesia assistants to address the manpower issue. There is no profession in the world that trains someone with less education to replace them. Are the bribes paid by the srna schools worth it?

 

[deleted126335]

The academic anesthesia programs training srna students need to stop. That is the most effective way to make a statement. Waxing poetically written articles about the issue and talking to representatives is useless. Residents and attendings in these programs need to stop and think about their own future And the profession. Start training anesthesia assistants to address the manpower issue. There is no profession in the world that trains someone with less education to replace them. Are the bribes paid by the srna schools worth it?

The chairperson who does that will likely be quickly replaced and their decision subsequently reversed. You don’t get to sit in the big chair unless you are willing to compromise principles along the way.


Sent from my iPhone using SDN mobile

 

[Steve_Zissou]

The irony is they're screwing themselves over too. They're just too stupid to see it.

How so?

 

[dannyboy1]

The chairperson who does that will likely be quickly replaced and their decision subsequently reversed. You don’t get to sit in the big chair unless you are willing to compromise principles along the way.


Sent from my iPhone using SDN mobile

I guess I compromised my principles for nothing. I’m just a grunt.

 

[deleted126335]

I guess I compromised my principles for nothing. I’m just a grunt.

You likely got to keep your job or make your life a little easier. That’s something.


Sent from my iPhone using SDN mobile

 

[zero0]

How so?

There's a lot of ways this can go. My personal opinion is that CRNAs will win and ultimately get their way. I'm talking almost universal independent practice much sooner than I expected, courtesy of COVID-19. They really jumped on this thing and milked it for all it's worth. From there it's not hard to predict what happens. The anesthesia job market become oversaturated almost overnight. Anesthesiologist salaries drop but so do theirs. They also lose those cushy 40-hour work weeks, start staying later, taking more call and more real responsibilities for the first time in their career. They become overworked and underpaid and realize being a noctor isn't all it's cracked up to be, but by then the ship has sailed. After all is said and done, the only ones who come up ahead are the suits, probably the same ones manipulating those tools at AANA to begin with.

 

[Man o War]

You guys are making a lot of assumptions. As I’ve mentioned before, I’ve worked in opt out states. Hospitals could go out tomorrow and hire all CRNAs, yet they don’t. Anesthesiologists do more than fine in those states. Plenty of MD only practices in said states, in fact.
CRNAs are actually more restricted by hospital credentialing than they are by state laws.
If you’ve worked with enough of them, you know how limited their abilities are as a rule.

 

[Southpaw]

The academic anesthesia programs training srna students need to stop. That is the most effective way to make a statement. Waxing poetically written articles about the issue and talking to representatives is useless. Residents and attendings in these programs need to stop and think about their own future And the profession. Start training anesthesia assistants to address the manpower issue. There is no profession in the world that trains someone with less education to replace them. Are the bribes paid by the srna schools worth it?

in typical fashion physicians will watch the entire thing completely explode and then turn around and wonder ‘what just happened here....’.

 

[aneftp]

Think about this. Who will lose their jobs? It’s hard to get rid of anyone in the VA system. No one will lose their jobs. And crnas get paid worst in VA system than private. So cRna will have little overtime in VA system. What cRna making 200-240k in ACT model will go to VA making 150-160k?

It’s not like the ARNP (Primary care etc) who get to practice independently in Va system the past 2-3 years have magically gotten a pay raise.

 

[Urzuz]

That is the most effective way to make a statement. Waxing poetically written articles about the issue and talking to representatives is useless.

Don’t hold your breath. The ASA’s response to the continuous erosion of anesthesiologists’ practice realm is akin to politicians’ responses to gun violence following a mass shooting.

“This is deeply concerning.” “Thoughts and prayers to the (anesthesiologists) who have lost their live(lihood)s.” “Keep sending us checks.”

 

[Tony C anesthesia]

The ASA has been the worst representative of all times. They suck our money for membership fees, CME fees, expensive conferences and meetings, and does nothing to protect our profession. We must be total idiots to pay ASA for all that garbage. The ASA has hurt our community more than anyone else. Do not blame CRNAs for this crap.

 

[deleted171991]

You guys are making a lot of assumptions. As I’ve mentioned before, I’ve worked in opt out states. Hospitals could go out tomorrow and hire all CRNAs, yet they don’t. Anesthesiologists do more than fine in those states. Plenty of MD only practices in said states, in fact.
CRNAs are actually more restricted by hospital credentialing than they are by state laws.
If you’ve worked with enough of them, you know how limited their abilities are as a rule.

The VA is as sensitive to budget as other places. They will not hire an MD unless they can't get away with a CRNA. At least that's what my friends tell me.

If CRNAs get independent practice in the VA, they will use it to say: "We practice independently on sick veterans every day, why are we not allowed to take care of healthier civilians?" I bet that we will have independent CRNA practice in ALL states within 5-10 years of the VA.

Even now, hospitals hire MDs not to medically DIRECT, as they are legally supposed to. They hire them as firefighters, to reduce LIABILITY. How do I know that? In most places, if a CRNA refuses to follow medical orders (which they consider just "suggestions"), not much will happen to him/her. If anything, the doc will suffer.

This is turning into a nursing specialty, except for the few complicated cases, because the difference in outcomes is hard to measure (and it's a monkey see monkey do specialty - it's all about the numbers under the belt). Just because we know how to place some lines and they don't, or some regional blocks and they don't, I wouldn't feel safe. The laymen who matter (surgeons, patients, families) don't see the difference in thinking and judgment, just the difference in social skills and macro outcomes.

Contrast it with critical care, let's say, where correct diagnosis and judgment have a much higher impact for most patients. No app or book can replace a good intensivist, and families can see that, because it can be the difference between turning a patient around or not. One either understands the individual pathophysiology, or one doesn't. In anesthesia, seconds and doctors do matter, but too rarely for laymen to appreciate. A lot of surgeons appreciate having a physician at the head of the bed only after a (near) miss due to some ridiculous CRNA mistake. Even then, many hospital bean counters won't care.

 

[Man o War]

The VA is as sensitive to budget as other places. They will not hire an MD unless they can't get away with a CRNA. At least that's what my friends tell me.

If CRNAs get independent practice in the VA, they will use it to say: "We practice independently on sick veterans every day, why are we not allowed to take care of healthier civilians?" I bet that we will have independent CRNA practice in ALL states within 5-10 years of the VA.

Even now, hospitals hire MDs not to medically DIRECT, as they are legally supposed to. They hire them as firefighters, to reduce LIABILITY. How do I know that? In most places, if a CRNA refuses to follow medical orders (which they consider just "suggestions"), not much will happen to him/her. If anything, the doc will suffer.

This is turning into a nursing specialty, except for the few complicated cases, because the difference in outcomes is hard to measure (and it's a monkey see monkey do specialty - it's all about the numbers under the belt). Just because we know how to place some lines and they don't, or some regional blocks and they don't, I wouldn't feel safe. The laymen who matter (surgeons, patients, families) don't see the difference in thinking and judgment, just the difference in social skills and macro outcomes.

I keep reading this on here. If this was all a fact, then why don’t the hospitals in opt out states just can all their anesthesiologists and hire all CRNAs? Almost half the states already allow them independence....and in the rest, the CRNAs are just allowed to maim and kill patients with a surgeon signing the chart.
Some of my highest locums rates come from hospitals in opt out states. Why would they pay me a premium if the nurses are just as capable?

 

[aneftp]

The VA is as sensitive to budget as other places. They will not hire an MD unless they can't get away with a CRNA. At least that's what my friends tell me.

If CRNAs get independent practice in the VA, they will use it to say: "We practice independently on sick veterans every day, why are we not allowed to take care of healthier civilians?" I bet that we will have independent CRNA practice in ALL states within 5-10 years of the VA.

Even now, hospitals hire MDs not to medically DIRECT, as they are legally supposed to. They hire them as firefighters, to reduce LIABILITY. How do I know that? In most places, if a CRNA refuses to follow medical orders (which they consider just "suggestions"), not much will happen to him/her. If anything, the doc will suffer.

This is turning into a nursing specialty, except for the few complicated cases, because the difference in outcomes is hard to measure (and it's a monkey see monkey do specialty - it's all about the numbers under the belt). Just because we know how to place some lines and they don't, or some regional blocks and they don't, I wouldn't feel safe. The laymen who matter (surgeons, patients, families) don't see the difference in thinking and judgment, just the difference in social skills and macro outcomes.

What va independent practice for primary docs? Those primary care docs still working. In fact there are openings for N and primary care docs.

NPs are staffing VA ERs “independent “

They need bodies. Working bodies.

it’s just not anesthesia

 

[deleted171991]

I keep reading this on here. If this was all a fact, then why don’t the hospitals in opt out states just can all their anesthesiologists and hire all CRNAs? Almost half the states already allow them independence....and in the rest, the CRNAs are just allowed to maim and kill patients with a surgeon signing the chart.
Some of my highest locums rates come from hospitals in opt out states. Why would they pay me a premium if the nurses are just as capable?

Because it's a slow process, it won't happen overnight. It's the IBM rule. Let me explain.

There used to be a saying in IT: nobody will fault you for buying IBM (or whoever the leader is in a certain line of business) even if things go south. That's exactly how bureaucrats think. They are risk averse, unless they are incentivized (e.g. we give you 25% of the money you save as an year-end bonus).

So they will replace MDs with CRNAs, just not suddenly. SLOWLY, so they can see what happens and cover their behinds. They will slowly increase coverage ratios, they will slowly stop raising physician salaries to keep up with inflation, they will slowly let them go and hire CRNAs instead. Most people won't notice it, unless they compare now with a decade ago, and then again with a decade from now.

It's ABSOLUTELY happening. You may not see it, in your neck of woods, but it's there. How do I know it? The CRNA schools wouldn't be mushrooming otherwise. There is a huge demand for them in the market, and it's not like suddenly we need many more anesthesia providers than 10-20 years ago. The only explanation is exactly what I said: the doctors are being replaced. SLOWLY, but STEADILY. They chip away at us like water carving its way through stone (just much faster).

 

[deleted171991]

What va independent practice for primary docs? Those primary care docs still working. In fact there are openings for N and primary care docs.

NPs are staffing VA ERs “independent “

They need bodies. Working bodies.

it’s just not anesthesia

Repeat after me: THERE IS NO PHYSICIAN SHORTAGE. There is just brainwash for the public. Don't forget that this country has been training foreign docs for ages, to compensate for the difference between supply and demand (let's not mention the new American medical schools that opened recently, 30% more AMGs during the last decade).

When one continuously reduces physician salaries, of course one will have a "shortage", especially in BFE.

 

[Man o War]

Because it's a slow process, it won't happen overnight. It's the IBM rule. Let me explain.

There used to be a saying in IT: nobody will fault you for buying IBM (or whoever the leader is in a certain line of business) even if things go south. That's exactly how bureaucrats think. They are risk averse, unless they are incentivized (e.g. we give you 25% of the money you save as an year-end bonus).

So they will replace MDs with CRNAs, just not suddenly. SLOWLY, so they can see what happens and cover their behinds. They will slowly increase coverage ratios, they will slowly stop raising physician salaries to keep up with inflation, they will slowly let them go and hire CRNAs instead. Most people won't notice it, unless they compare now with a decade ago, and then again with a decade from now.

It's ABSOLUTELY happening. You may not see it, in your neck of woods, but it's there. How do I know it? The CRNA schools wouldn't be mushrooming otherwise. There is a huge demand for them in the market, and it's not like suddenly we need many more anesthesia providers than 10-20 years ago. The only explanation is exactly what I said: the doctors are being replaced. SLOWLY, but STEADILY. They chip away at us like water carving its way through stone (just much faster).

I travel across the country for locums and I don’t see it anywhere. I am constantly getting locums offers.
CRNA schools are saturating the market because they’re greedy. They’re producing an inferior product, which isn’t going to be a good situation when they go try to work on their own. Not too long ago, I witnessed an SRNA standing in a thoracic room watching the case. When I inquired I was told the surgeons wouldn’t let them touch their patients, and that they are allowed to count this toward their already meager case counts required to graduate.
What I see occurring is they’re going to go the way of NPs sooner rather than later, and will either be forced to work in places the doctors don’t want to or take a massive pay cut. PPs using ACT will love it because they’re going to get a steep discount on labor and can be very selective as to who they hire.

 

[deleted171991]

I travel across the country for locums and I don’t see it anywhere. I am constantly getting locums offers.
CRNA schools are saturating the market because they’re greedy. They’re producing an inferior product, which isn’t going to be a good situation when they go try to work on their own. Not too long ago, I witnessed an SRNA standing in a thoracic room watching the case. When I inquired I was told the surgeons wouldn’t let them touch their patients, and that they are allowed to count this toward their already meager case counts required to graduate.
What I see occurring is they’re going to go the way of NPs sooner rather than later, and will either be forced to work in places the doctors don’t want to or take a massive pay cut.

That's thoracic. Cardiac will probably be the same. Open vascular the same. And I am sure there are others, although not many I can think about. Although, in many places, all these are done with supervised CRNAs, even in a 3:1 model (one cardiac and two non-cardiac rooms per anesthesiologist).

Most cases are not like that. They are bread and butter, just ripe for takeover (and there are cases where outpatient surgeons/proceduralists hire their own experienced CRNA for anesthesia). They are also the biggest moneymakers: the simple elective (semi)outpatient procedures on ASA 1-3 patients.

I'd rather be "eat what you kill" in an endoscopy suite than in a thoracic or cardiac room. Even just an employee, because it's easier and because, sooner or later, some dumb bean counter will wonder why they are paying me more than a CRNA for a room that brings in less money.

Also, ask yourself: why do they rather pay YOU these rates, instead of hiring a permanent doc for the same money? Maybe because they don't want to pay anybody well enough, long-term, hence the reason for having a staffing problem in the first place. These places will always exist, in every country; there is usually a reason people don't want to work/live there. But I am talking about most jobs (which are where most people are, on the coasts and in metropolitan areas), not these outliers.

To those who disagree with me: let's just look again in a decade. Even the most optimistic of my friends agree that things are worse now than 10 years ago. Usually, when the sky is falling in a profession, people tend to not notice it until it's close, because that's when things speed up. See also my post above, about SLOWness in change. Leaders have been advised to do that at least since Machiavelli.

 

[yossarian22]

I encourage everyone to look into the group Physicians for Patient Protection (PPP). They have over 10k members, and a very active facebook group (physicians for patient protection - official). I have seen more bold action from them in the last two weeks than I have ever seen the ASA put out. See their news stories on VA anesthesia here:

Patient care or politics? The argument over who administers anesthesia inside the country’s VAs

ATLANTA, Ga. (CBS46) – The coronavirus crisis is reigniting a battle over who should be allowed to manage anesthesia care for veterans and their families inside the country’s largest integrated

www.cbs46.com

Atlanta News Videos | WSB-TV

Watch Atlanta news videos from WSB-TV. The latest local news videos from the Atlanta Metro area. Sports, crime, and the latest entertainment.

www.wsbtv.com

The CBS report enraged the AANA, and the trolls came out on twitter.
There are more news reports brewing across the nation from PPP. Meanwhile, the ASA came only has out with a "statement."

 

[Rocky222Balboa]

Pain, cardiac, peds, cc. Never a better time to do a fellowship

 

[deleted171991]

Pain, cardiac, peds, cc. Never a better time to do a fellowship

Sorry to be the negative guy again.

Pain reimbursements are way down. A lot of pain docs are practicing anesthesia. Plus interventional pain is one touch above homeopathy, for most (not all) patients, sorry. And the rest is mostly psych.

Peds is full; there are just so many children's hospitals in the country, and one can use generalists (or even CRNAs) for most bread and butter outpatient peds, no offense.

Critical care is a pain for combined jobs. Even for 100% critical care, it's not easy to get into community MICUs, which are like 90% of the ICU jobs. And it's paid worse than anesthesia, on a workload basis (no stool sitting there, for sure).

Most fellowships are just a royal waste of money. The future value of that 300K invested now is sky high. Better make hay while the sun still shines.

Be a GREAT generalist, and you will always have a job. Learn from Mr. Wonderful (Shark Tank): you don't want a small part of a small part of the market; there is usually too little demand for/profit from that.

 

[Rocky222Balboa]

Sorry to be the negative guy again.

Pain reimbursements are way down. A lot of pain docs are practicing anesthesia. Plus interventional pain is one touch above homeopathy, for most (not all) patients, sorry. And the rest is mostly psych.

Peds is full; there are just so many children's hospitals in the country, and one can use generalists (or even CRNAs) for most bread and butter outpatient peds, no offense.

Critical care is a pain for combined jobs. Even for 100% critical care, it's not easy to get into MICUs, which are like 90% of the ICU jobs. And it's paid worse than anesthesia, on a workload basis (no stool sitting there, for sure).

Most fellowships are just a royal waste of money. The future value of that wasted 300K is sky high.

Be a GREAT generalist, and you will always have a job.

Pain: As I understand it, Anesthesia pays better than pain right now. bread and butter Anesthesia cases are easy money. Per hour pain probably pays as much (if not more) than Anesthesia. If anesthesia salaries fall, pain would be a nice fallback with a better lifestyle . Agree that the Long term effectiveness of procedures is unclear, but (at least as I understand it) their main purpose is to allow patients to participate in PT/avoid spine surgeries.

Peds: Are there practices that allow crnas to work independently with small children? I can’t imagine parents would be okay with this (as a parent I certainly wouldn’t). There’s always going to be a place for a peds anesthesiologist I think.

Critical care: Even if you can’t find an icu job, with a good icu fellowship, you’re going to be the guy your group turns to for advice on challenging cases. I think an icu trained anesthesiologist is valuable to most practices. Secondly, if anesthesia salaries fall, critical care salaries will look more attractive.

 

[deleted171991]

Critical care: Even if you can’t find an icu job, with a good icu fellowship, you’re going to be the guy your group turns to for advice on challenging cases. I think an icu trained anesthesiologist is valuable to most practices. Secondly, if anesthesia salaries fall, critical care salaries will look more attractive.

Nobody cares much about one's ICU fellowship in the anesthesia real world (except as "this guy might leave us for a combined job, don't invest in him"). Plus, if one doesn't practice critical care, that fellowship becomes vaporware in 5-10 years.

 

[Rocky222Balboa]

I don’t know. You’re telling me your partners don’t ask you for help with sicker cases? That’s certainly not the case in my neck of the woods (Recent grad, academic hospital). The icu docs are some of the most Badass and respected in our hospital, especially in the middle of covid.

 

[deleted171991]

I don’t know. You’re telling me your partners don’t ask you for help with sicker cases? That’s certainly not the case in my neck of the woods (Recent grad, academic hospital). The icu docs are some of the most Badass and respected in our hospital, especially in the middle of covid.

They were among the most badass in my residency, too (some of them), at least knowledge-wise. Not many people will contradict me either when I open my mouth in an M&M, especially if the patient came from the ICU. But most people don't care. It doesn't translate into a higher salary, or even just better job safety (when I used your logic and asked for a higher salary for an anesthesia job, I was literally told that I was not being hired for my ICU fellowship).

Actually, since one will know more, it will be much harder for one to make a surgeon happy and do a case that shouldn't be done. Exactly because one has seen a lot more of the bad stuff that can happen. So I tell them once or twice, and then do whatever the heck they want; you can't fix stupid (and it's not worth losing my job).

There is exactly one form of respect one should care about (because that's the REAL measure, which is simply not there for most fellowship graduates):

 

[deleted162650]

You’re telling me your partners don’t ask you for help with sicker cases?

I ask the cardiac guys.

 

[deleted171991]

I ask the cardiac guys.

Exactly!

Some of the cardiac people will come and ask me, when about an ICU patient, but that's rare and the boss doesn't see that.

 

[Southpaw]

I ask the cardiac guys.

and they respond ‘just a sec let me ask my surgeon what drips they want!’. Sorry I kid I kid (sorta kinda...)!

Seriously though - I know you’re in PP so is there even a CC anesthesiologist to ask? I personally ask the critical care folks. They’re always on point.

 

[dannyboy1]

I don’t know. You’re telling me your partners don’t ask you for help with sicker cases? That’s certainly not the case in my neck of the woods (Recent grad, academic hospital). The icu docs are some of the most Badass and respected in our hospital, especially in the middle of covid.

If the patient is sick the best option is a spinal. If general is needed, art line, etomidate, roc, tube, gas. Phenylephrine is a good drug. If bleeding, give blood. Local + minimal sedation if the surgery allows for it. There is your advice. Your welcome.

 

[deleted162650]

I know you’re in PP so is there even a CC anesthesiologist to ask?

We have one.

In reality, I ask the smart guys. Fellowship and smart don’t always correlate real well. It just so happens that we have 3 super smart cardiac guys.

In my group’s infancy, fellowship was a mandatory pre-req to become partner (thankfully that’s no longer the case). The end result is a bunch of mid-career guys that haven’t practiced their sub specialty in years - if ever.

 

[deleted171991]

If the patient is sick the best option is a spinal. If general is needed, art line, etomidate, roc, tube, gas. Phenylephrine is a good drug. If bleeding, give blood. Local + minimal sedation if the surgery allows for it. There is your advice. Your welcome.

Exactly what I was told by a colleague who failed his oral boards, when I wanted to do gentle LMA for a 90 year-old with EF of 20% and ugly baseline EKG.

Etomidate is another marker of people who don't really know what they are doing, no offense. Same for phenylephrine for everybody (I was asked intraop why I preferred ephedrine first, at a HR of 50 and BP of 60/30). Etc.

 

[deleted162650]

If the patient is sick the best option is a spinal. If general is needed, art line, etomidate, roc, tube, gas. Phenylephrine is a good drug. If bleeding, give blood. Local + minimal sedation if the surgery allows for it. There is your advice. Your welcome.

Yup - that’s why I do spinals in all my sick anti-coagulated patients coming down intubated from the unit.

 

[bcole1599]

That's thoracic. Cardiac will probably be the same. Open vascular the same. And I am sure there are others, although not many I can think about. Although, in many places, all these are done with supervised CRNAs, even in a 3:1 model (one cardiac and two non-cardiac rooms per anesthesiologist).

Most cases are not like that. They are bread and butter, just ripe for takeover (and there are cases where outpatient surgeons/proceduralists hire their own experienced CRNA for anesthesia). They are also the biggest moneymakers: the simple elective (semi)outpatient procedures on ASA 1-3 patients.

I'd rather be "eat what you kill" in an endoscopy suite than in a thoracic or cardiac room. Even just an employee, because it's easier and because, sooner or later, some dumb bean counter will wonder why they are paying me more than a CRNA for a room that brings in less money.

Also, ask yourself: why do they rather pay YOU these rates, instead of hiring a permanent doc for the same money? Maybe because they don't want to pay anybody well enough, long-term, hence the reason for having a staffing problem in the first place. These places will always exist, in every country; there is usually a reason people don't want to work/live there. But I am talking about most jobs (which are where most people are, on the coasts and in metropolitan areas), not these outliers.

To those who disagree with me: let's just look again in a decade. Even the most optimistic of my friends agree that things are worse now than 10 years ago. Usually, when the sky is falling in a profession, people tend to not notice it until it's close, because that's when things speed up. See also my post above, about SLOWness in change. Leaders have been advised to do that at least since Machiavelli.

I'm a first-time poster, current MS3 considering anesthesiology and general surgery, so I may be naive on this topic. I've been lurking on these forums for a while and don't want to derail the purpose of the thread. But I am curious to learn more about the pressures facing anesthesiology (and other fields) in the current and future economic climate. It seems like with anesthesia, there are 3 major concerns people worry about:

1) Corporatization of services - economic shifts to an employed (AMC, hospital) model where one may be seen as an employee with less autonomy and as more of a "cog in the wheel" rather than someone who brings business to the hospital
2) Reimbursement rate concerns - speaks for itself, but concern is that these rates will continue to be cut and salaries fall along with them
3) CRNA lobbying - continued political battle for independence that seems to have been raging on for decades now

As far as I can tell, these issues (and others) have been discussed on the forum for well over 10 years. Yet anesthesiologists still seem to be doing pretty well from an employment standpoint per surveys (AAMC, medscape, MGMA, etc). I understand with COVID, the climate has taken a downturn.

My question is this: Given that these concerns have persisted for years and anesthesiologists continue to do relatively well from an employment/salary perspective, why do people expect that the bottom will drop out in the next 10-20 years?
Things may not be the same as they were 20 years ago, but isn't that true for several specialties? It seems like more and more, physicians are being employed now and the practice of medicine is changing for virtually everyone. Like I said, I'm still green and am looking for additional perspectives but I do wonder why there seems to be a constant prediction that the sky will fall in 5, 10, 20 years. Here's to hoping it does not.

 

[dannyboy1]

Yup - that’s why I do spinals in all my sick anti-coagulated patients coming down intubated from the unit.

If they are intubated they are already under GA, just plug and play.

 

[deleted171991]

I'm a first-time poster, current MS3 considering anesthesiology and general surgery, so I may be naive on this topic. I've been lurking on these forums for a while and don't want to derail the purpose of the thread. But I am curious to learn more about the pressures facing anesthesiology (and other fields) in the current and future economic climate. It seems like with anesthesia, there are 3 major concerns people worry about:

1) Corporatization of services - economic shifts to an employed (AMC, hospital) model where one may be seen as an employee with less autonomy and as more of a "cog in the wheel" rather than someone who brings business to the hospital
2) Reimbursement rate concerns - speaks for itself, but concern is that these rates will continue to be cut and salaries fall along with them
3) CRNA lobbying - continued political battle for independence that seems to have been raging on for decades now

As far as I can tell, these issues (and others) have been discussed on the forum for well over 10 years. Yet anesthesiologists still seem to be doing pretty well from an employment standpoint per surveys (AAMC, medscape, MGMA, etc). I understand with COVID, the climate has taken a downturn.

My question is this: Given that these concerns have persisted for years and anesthesiologists continue to do relatively well from an employment/salary perspective, why do people expect that the bottom will drop out in the next 10-20 years?
Things may not be the same as they were 20 years ago, but isn't that true for several specialties? It seems like more and more, physicians are being employed now and the practice of medicine is changing for virtually everyone. Like I said, I'm still green and am looking for additional perspectives but I do wonder why there seems to be a constant prediction that the sky will fall in 5, 10, 20 years. Here's to hoping it does not.

Would you be so kind to do a search on the Anesthesiology forum, for your answer? It's all there, discussed ad infinitum. Thank you.

 

[dannyboy1]

Exactly what I was told by a colleague who failed his oral boards, when I wanted to do gentle LMA for a 90 year-old with EF of 20% and ugly baseline EKG.

Etomidate is another marker of people who don't really know what they are doing, no offense. Same for phenylephrine for everybody (I was asked intraop why I preferred ephedrine first, at a HR of 50 and BP of 60/30). Etc.

I have never regretted giving etomidate. And I passed my boards

 

[deleted162650]

If they are intubated they are already under GA

Every post just keeps getting stupider.

just plug and play

The correct term is “Bag and Drag”

 

[deleted171991]

I have never regretted giving etomidate. And I passed my boards

Me neither... in residency. I just don't need it anymore.

It usually speaks about the skill level. Same for the kind of patients one uses pre-induction a-lines in.

Not pointing fingers, by the way. This is all just theoretical and very subjective.

 

[bcole1599]

Would you be so kind to do a search on the Anesthesiology forum, for your answer? It's all there, discussed ad infinitum. Thank you.

Yes, I will keep searching through the old threads. I don't mean to derail the thread, call anyone out, or waste anyone's time. As a student trying to pick between specialties, I am just genuinely trying to understand what exactly changed to make the outlook for the field worse over the course of the last 10 years.

 

[deleted171991]

Yes, I will keep searching through the old threads. I don't mean to derail the thread, call anyone out, or waste anyone's time. As a student trying to pick between specialties, I am just genuinely trying to understand what exactly changed to make the outlook for the field worse over the course of the last 10 years.

We went from X CRNAs to 10X CRNAs.

 

[deleted162650]

We went from X CRNAs to 10X CRNAs.

My practice has gone from 0 CRNAs to 0 CRNAs.

 

[deleted171991]

My practice has gone from 0 CRNAs to 0 CRNAs.

That's still 10X.