http://www.asahq.org/about-asa/news...ysician-anesthesiologists-applaud-va-decision
As a resident, I am very happy to hear this.
As a resident, I am very happy to hear this.
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VA Ruling
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Victory is sweet indeed.
For those such as myself who donate to the ASA PAC and state PAC this is great victory; we can enjoy it for the moment but there is still so much to be done to stop the AANA propaganda machine.
According to the AANA, CRNAs have a minimum of 7-8 years of focused education in nurse anesthesia, most CRNAs are masters prepared, and by 2025, new CRNAs will be required to have a doctorate degree to practice. Firing back, the association says that 25%, or approximately 12,000-13,000 anesthesiologists, are not board certified. “That’s a big number, a scary statistic, and a fact,” Quintana says.
The bottom line? “Nurse anesthetists are extremely well-prepared to provide the high-quality of care that they do, and as the research has shown, they do it as well as an anesthesiologist whether or not they are supervised by a physician,” Quintana says. “Another way to look at it is like this: Isn’t it amazing that the profession of nurse anesthesia has been able to achieve equal outcomes in anesthesia educating CRNAs in a lesser amount of time?”
The bottom line? “Nurse anesthetists are extremely well-prepared to provide the high-quality of care that they do, and as the research has shown, they do it as well as an anesthesiologist whether or not they are supervised by a physician,” Quintana says. “Another way to look at it is like this: Isn’t it amazing that the profession of nurse anesthesia has been able to achieve equal outcomes in anesthesia educating CRNAs in a lesser amount of time?”
It is.
The AANA will try again ...
Maybe I ought to start giving money to the ASA and ASAPAC again. I quit this year because I was disgusted with their inability to accomplish or even attempt anything.
Yes, the veterans waiting in line for their anesthesia is truly tragic.
It's hard to take these people seriously.
What do you guys think about taking a va job right out of training? Pay is better than any amc I've seen. Long term not as good as partnership in private practice but probably better lifestyle. Will this mic move hurt me if I want to find a pp gig later on?
Agree. The fact that we are having this conversation means that Doctors may have won the battle, but still will probably lose the war.
I'm in a different specialty, but I declined to allow an NP student to "shadow" me a while back because I don't agree with training my replacements. Hey, if you think you can do my job with less training, maybe YOU should be teaching ME stuff. 🙂
Not all VA are operated the same.
The ones that have job openings all the time usually are
1. In less than desirable places or smaller towns.
2. In big cities but work "harder" than other VAs
If you see an ad with a 2 week window to apply at usajobs.gov. It generally means it's not a real job opening.
They give preferences to Vets first. Than internal transfers. Than regular joes.
Of course if you know the chief or someone on the inside, you may get a leg up.
Pay is lower (mid to high 200s). Less vacation.
But you do get
1. generally better work hours
2. better benefits
You can make 50-100K more for an AMC 350-400K. What's 100K worth to you? That's where the hazy numbers/work hours come into play.
Of course if you can make 500k and up plus 9-10 weeks off, than the decision to go to private practice becomes a no brainer. You take the private practice job if you are younger and more eager.
Just curious... to all the senior members out there...
What does it take for MD 's to stand tall and chime in to initiate /maintain MD only practice where possible. Now this may mean huge paycuts to all the esteemed senior colleagues out there....Meanwhile the cash cows seem to want to lean on to this fact i.e save money or make more profit by using CRNAS is several practice models...
Theoretically if a PP group hired 5 more anesthesiologists instead of 9 CRNA's and paid them less(probably fresh grads etc) you would still pay more or less the same ..
Is this a possibility ?
What does it take for MD 's to stand tall and chime in to initiate /maintain MD only practice where possible. Now this may mean huge paycuts to all the esteemed senior colleagues out there....Meanwhile the cash cows seem to want to lean on to this fact i.e save money or make more profit by using CRNAS is several practice models...
Theoretically if a PP group hired 5 more anesthesiologists instead of 9 CRNA's and paid them less(probably fresh grads etc) you would still pay more or less the same ..
Is this a possibility ?
Veterans administration prefers to hire Board Certified Anesthesiologists. The pay scale is lower (much lower?) than most private practice jobs. Even your typical AMC pays more money but the work-load is of course greater. I can see those just wanting to have a good lifestyle opt for the VA but I think a few years of actual doing anesthesia will make you a better provider.
As for working for the VA right out of residency then going into private practice I imagine that would take some adjusting to. Rarely are busy private practices anything like the VA in terms of volume and speed in terms of patient care.
Again, I would argue a fellowship in Pain or Cardiac would be good choices for those wanting a VA gig out of fellowship in case one changes jobs during his/her career.
Finally, why take a VA job over an academic one if you are a young grad? After 5 years in academia that job should pay significantly better than any VA gig. After 10 years the gap should be even wider. Certainly, if money is a non issue then a VA gig can make good sense.
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Could some locations transition from ACT model to MD only? Sure, it'd be expensive and hard to do, but it could be done. Many could never make the switch. There simply aren't enough anesthesiologists in the country to accommodate that. Put it this way, we are currently up to somewhere near 75 physicians and maybe 200 AAs/CRNAs in our various locations. They are all operated in an ACT model. To transition that to MD only, we'd probably need to hire about 100 anesthesiologists in addition to hiring replacements for people that retire. That's not easy to do.
ACT model is not the enemy. It is a proven good safe care model that can work for everybody. It ensures physician supervision of nurse anesthetists. In some ways it is superior to MD only care since as a physician you can personally care for the patient in PACU if needs arise while the room keeps moving along and in busy hospitals it provides more bodies able to help in an emergency situation should the stuff hit the fan. MD only locations simply don't have as many physicians out of an OR at any one point during a day to provide assistance if needed. Besides, if an ICU attending can manage 16+ critically ill patients at a time, surely a BC anesthesiologist can handle 2 to 4 patients, some (or most) of which are ASA 1-2s having minor surgery, at a time.
If you want to die fighting for MD only care, you will die. Pick a fight you can win.
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deleted171991
It's not so expensive anymore. I have seen places where docs are paid so little during the day that 3 docs cost close to what 1 doc and 3 CRNAs would. Given the CRNA shortage and rising salaries, and the doc overproduction and decreasing salaries (in my market), you might see ACT practices going back to MD.
And no ICU attending can manage 16+ ICU patients every single day, especially if many critically ill, and not cut his veins after a while (just the rounds would take 6 hours). You only need one to crash, and it can fill your day.
Covering many patients at the same time is unsafe, and it's a recipe for disaster, sooner or later. There should be no more than 2:1 coverage for anything above ASA 3 or intermediate/high-risk procedures.
And no ICU attending can manage 16+ ICU patients every single day, especially if many critically ill, and not cut his veins after a while (just the rounds would take 6 hours). You only need one to crash, and it can fill your day.
Covering many patients at the same time is unsafe, and it's a recipe for disaster, sooner or later. There should be no more than 2:1 coverage for anything above ASA 3 or intermediate/high-risk procedures.
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I have maintained an all MD/DO practice for 12 years now. I have fought hard to keep the midlevels out mostly because I have managed to recruit physicians that enjoy doing their own cases. If I had a bunch of money hungry hacks, then the midlevels would be inevitable since they are a decent way to get **** done. And I've worked with some that are pretty good. But I would still rather do my own cases.
It doesn't have to mean huge pay cuts either unless we are talking about the lazy individuals who care less about their pts than their financial statements who are making bank while running a mill.
It's true that it takes less anesthesiologists to do the work of a midlevels. I estimate 1 doc = 1.5+midlevels. This depends on the practice though. When you factor this in, you quickly see that midlevels don't save money and only add to the work of the docs therefore, making matters worse in the daily grind.
So yes it is possible. But you must make sense of numbers to people that only understand numbers. These people are usually CFO's that have zero knowledge of anything other than numbers.
I hate to be the party pooper but the fight isn't exactly over. There is a 30 day comment period still to go. This is a comment from the VA:
The VA gave some background on its decision to leave the nurse anesthetists out of getting full practice authority. "We received 104,256 comments against granting full practice authority to VA CRNAs," the authors noted. "The American Society of Anesthesiologists lobbied heavily against VA CRNAs having full practice authority. They established a website that would facilitate comments against the CRNAs, which went as far as providing the language for the comment. These comments were not substantive in nature and were akin to votes in a ballot box."
So as we are now in a strong position, but we are still in need of support. Make comments but make them personal.
The VA gave some background on its decision to leave the nurse anesthetists out of getting full practice authority. "We received 104,256 comments against granting full practice authority to VA CRNAs," the authors noted. "The American Society of Anesthesiologists lobbied heavily against VA CRNAs having full practice authority. They established a website that would facilitate comments against the CRNAs, which went as far as providing the language for the comment. These comments were not substantive in nature and were akin to votes in a ballot box."
So as we are now in a strong position, but we are still in need of support. Make comments but make them personal.
I agree it's not over. It will never be over. Even if it's passed in the final rule. There will be continued challenges.
But remember the AANA also had canned response they sent to the public as well.
It's just a nasty fight
Isn't there a possibility of losing or turning rusty with acquired skills if you supervise all the time ?
Yes but these people practice in a realm of midlevels were outcomes are sort of like, "if the pt gets through this case without dying then all is well."
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deleted162650
MD only doesn't necessarily mean an absolute pay cut. My MD only practice makes about the same $/doc as many ACT practices. MD only does require more docs staying late and less vacation time however. I would argue that it's a helluva lot less stressful and more enjoyable than puttin on your roller skates and "covering" 4 rooms though.
Depends what you mean by "supervise" ...
If you mean sign the charts and drink coffee while the CRNAs run wild and do their own thing, yes, in time you will be a pathetic pale shadow of what you were because you're not actually doing anything.
If you mean see all the patients in preop, and in PACU, and do all the blocks lines epidurals ?TEE, and are present for every induction and every emergence, and handle consults from whoever's screening preops before DOS, and get to the OR for critical events or complex patients, then you are likely to gain experience 4x as fast if you're supervising 4:1.
My group has traditionally been MD/DO only but over the last few years we've been forced to hire CRNA's to meet the site demands of the hospital because we have not been able to recruit enough docs. We practice in a major city making well above the numbers I see people on this forum quoting. But we work a lot. The days are long and you can work all night when on call. And I find that most new grads just do not want this lifestyle. They would much rather work for an AMC making much less. We've actually even had a few applicants ask if they can work for us as an employee with fixed hours and no calls. So to answer your question- we've found it impossible to stay MD/DO only, unfortunately.
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deleted171991
Versus a "partnership track"? I bet. 😉
Nobody sane would sacrifice family time mostly to put money in somebody else's pockets. It's a matter of incentives, that's how humans function. You just didn't offer the right ones.
Not at all in my practice. We are very hands on. Our CRNA's do not do blocks, epidurals or lines. Most don't even care to do spinals. So we do all of these and the CRNA's are fine with this.
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deleted171991
Two words: private practice. Actually three; I forgot "partners".
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deleted171991
If you don't want to share the big bucks, don't expect others to accept the big work. 😉
To quote the lefties: equal pay for equal work. If you want to take a small management fee for being the genius who got the contract with the hospital and runs the business, fine, but otherwise there is absolutely nothing your racket does that the employee couldn't.
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deleted162650
So then why not hire employee non-partner track docs instead of CRNAs?? They get what they want and you get to make money off them in perpetuity. Seems like a win win + you avoid the PITA that are CRNAs
I hear your beef here but please tell me what you think all the hours I have spent in administrator after administrators office for the past 12 yrs convincing them that this practice is better as all MD? Yeah this practice that some new grad wants to waltz into and reap all the benefits that I have worked my arse off for. I have hired new grads many times and they frequently come in with absolutely zero concept of what the members of the group they feel "equal" to have done for them even before they entered residency or medical school in some cases.
To say that there is "absolutely nothing your racket does that the employee couldn't," is utterly and completely short sighted. The practice of anesthesia aside, it takes years for a new grad to contribute beyond doing cases. If you think this demands equal pay then we will have to completely disagree. And FFP, I know you and I don't often disagree.
So I say,Don't walk into my group and claim to be equal because you know how to do a safe anesthetic. Ever single new grad has a **** ton to learn. And anesthesia is also one of those things they still need to learn. No "you" are not equal. But we think you have what it takes and we are pleased to have you join our practice to continue to hone your skills. Sit back, pay attention, and don't complain. If thats too hard to do then JOIN an AMC and punch a clock like a nurse. But if you want to be a doctor then stick around.
Harsh words, I know. But reality is real. And I'm sure many will think a lot less of me for this post but I only speak what I know.
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deleted171991
I don't think less of you, and I understand where you are coming from. That's why I was talking about a management fee. Or maybe you should have a buy-in for those past "battles", so that people don't take stuff for granted.
Just don't expect vague promises of long partnership tracks (I am hearing even 4 years) to motivate anybody. A bird in the hand... A long track also just reeks of lack of appreciation. Nobody likes to work in a place where s/he doesn't feel respected. People would rather work in a place where everybody makes slightly less, but similar amounts. Actually, one of my colleagues once gave me some really good advice: don't go to work as an employee among partners, you will do all the crappy cases while they make bank.
Somebody has mentioned a great model on this forum: in their group, after 1 year, people are either made partner or fired.
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deleted171991
That's what the management fee is for. Don't tell me that all partners have similar contributions. 😉
I will happily pay the person who works his butt off to keep the group running. I won't work my butt off for the wiseguy whose only merit is that he was there earlier, and who works less than I do. I don't believe in "seniority".
So yeah, you will see people like me trying to get an acceptable salary for a decent amount of work, and have a life, not work their butts off for some extra crumbs from the lords' table, just because we are not part of the local old boys' club. I don't have a problem with working a lot, just with being taken advantage of.
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Sounds like my sister all MD group up north. They work hard. The more u work. The more you make. It's pretty simple very fair group. Hardest worker makes in excess of $700k plus.
My sister has drastically cut her work down. She's full partner but has enough investments she doesn't need to work 55-65 hours any more. So she's working 60% now and pulling in high 200s but she's fine with working Monday-Wednesday plus calls.
But her group is having problems finding new grads for their partnership track. New grads rather be "employee only" 5 days a week rather than employee-partnership track with call.
Depends what the spread different in W2 salary between ur 2 year partnership track and what AMC is paying off the bat
If 2 year partnership track is high 200s like my sister group and AMC is paying in high 300s for new grad. U betcha the new grad will look seriously at the AMC if the work is the same. Cause $100k salary difference for a new grad for an AMC is a lot of money to consider. Even if the ceiling for private partnership is higher
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deleted643396
New grads have heard all the stories about fake partnership tracks and groups selling out while they are "halfway" there. It's not worth it to bust your butt while some old guys collect the money. In my experience, one or two of the partners handle the administration and meetings while the rest are sucking the teet simply because they were there first. These are some of the laziest people I have ever met in my life, but they are partners. There are way too many of these stories out there, so new grads will take the higher initial pay to pay down loans and better lifestyle rather than being fooled into a fake partnership.
Now that's what I call an unfair statement!
I think that quality could be achieved and maintained in either practice models (MD or ACT).
You don't need to sit the stool and squeeze the bag yourself to insure good care.
So we have a 2 yr buy in buy in. During the buy in ypu still will make more than an AMC. After the buy in you make a lot more than AMC pay. Do you guys understand how much money you are down over your career going the AMC route. You are busting your butt for some c suite bum to take all your money that was made off your work. Your logic escapes me....help me understand. Do you work for an AMC currently?
Do you have fail safe assurances for new hires (you pay their tail if they don't become full partner?)
While your group may be fair (like my sister group is very fair). They pay people malpractice tail if "don't renew or terminate" their contract after 1 year.
If new hire leaves before 1 year than new hire pays own tail.
So her group is reasonable
But trust is a big issue these days with profitable groups selling out. My sister group has been approached by NAPA and Sheridan in the past before. But an all MD group with 32 full partners and 20 plus employees makes selling out not that great (looking at around 1 mil payout per partner) with 3 year 350k guaranteed from the AMC
After reading the entire document this morning. If you read if very closely.
It seems the VA admin believes the health affairs crna funded article about crna being safe providers.
And the only thing that swung the decision in favor of maintaining status quo was the "access" issue. Clearly there is not an anesthesia "access" problem in the VA system.
The "access" topic has long been a red herring with the AANA politically.
I'm just surprised the ASA doesn't put the AANA words and have them use it against them when the AANA tries to block AA legislation. If AANA is concerned about access. They are doing their darnest like in California to block access for AAs.
AANA has finally been called out on the access topic.
It seems the VA admin believes the health affairs crna funded article about crna being safe providers.
And the only thing that swung the decision in favor of maintaining status quo was the "access" issue. Clearly there is not an anesthesia "access" problem in the VA system.
The "access" topic has long been a red herring with the AANA politically.
I'm just surprised the ASA doesn't put the AANA words and have them use it against them when the AANA tries to block AA legislation. If AANA is concerned about access. They are doing their darnest like in California to block access for AAs.
AANA has finally been called out on the access topic.
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deleted643396
I work for a private practice with a fake partnership track. I didn't even interview with AMCs when I was finishing residency out of principle. That was a mistake. I work about 60-65 hours a week and just had a "raise" in my second year to 300k. I do about 70% my own cases and take in-house call at a fairly busy trauma center with busy OB. I now get 5 weeks vacation. I was completely duped by this whole partnership track private practice thing. If I would have signed on with an AMC or academic place I would have been better off financially and with my lifestyle. We have one or two partners in the practice who go to meetings and handle administrative stuff. The rest of the partners work less than half the hours I work and when they do work, they dump the "hard" cases on the new guys. Shall I go on?
I understand that there are fair and democratic private practices out there. Unfortunately, my story is not uncommon and new grads have heard too many of these stories. People kind of know what they are getting with an AMC. Are they being screwed by making 350k on 50-55 hours a week and 6 weeks vacation? Of course they are, but there is a level of transparency there that they don't get with a lot of private practices. All too often there is a sense of entitlement at these private practices where the guys who were there longer think they deserve something extra simply because they were there longer. When private practices say they can't hire new grads, it's not because of some whippersnapper millennial entitlement syndrome, it's because most private practices are viewed as being shady risks.
Sounds like a North Florida private practice group a couple of people I know who have worked and left! Sounds exactly like it where partners leave at 1/2pm and the work horses take the brunt of the calls and make around 300K!
Anyways, there is a trust issue with many new grads these days cause they hear stories especially in big cities. Maybe the guys in the mid size towns area a little more reasonable and more honest.
No... most private practices now are controlled by crooks and used car salesmen, and those shady characters are either selling out to AMCs or just waiting for a good offer to sell out.
We pay tail no matter when someone leaves. People usually don't leave. Every group and hospital has been approached by AMCs. AMCs are at risk from loosing their contracts to other AMCs. AMC are the used car sales men and women who are constantly knocking on administrations door looking to make a deal. They are present at every big healthcare convention meeting CEOs promising the world and delivery nothing special that the previous group couldn't have done on their own.
Clearly there are certain regions of this country where shady PP groups are prevalent and my guess these are the same areas in which AMCs have done well.
