What does the "new generation" want?

[militarymd]

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I want to hear from you new guys who think that I'm selling out your profession.

Exactly what you are so bitter and fearful about....

Exactly what you WANT to happen in the next 5, 10, 15 years...

Be concise and list specifically what your gripe is and how you want it changed...

And be realistic.....don't list something like "I want all the crna's to die" or something like that.

 

[Surfer]

I want the same opportunities you had.

I have worked very hard to be in this position. I will continue to work very hard. I provide a very valuable service to my patients, I intend to be compensated fairly for my services.

Here's the thing, it's not a question of "If they can do it, why not?" Because in medicine the low lying fruit is where the money is. By accepting the difficult/challenging/dangerous cases (particularly on patients that often do not pay their bills) we are providing a service to society that nobody else can provide. Nobody. Not mid-levels, not anybody. We are the only ones that can provide that service, and the only ones that want to. In order to assure society that people are still in position to do so, we need to protect the low-lying fuit.

The low-lying fruit is what makes medicine worthwhile. It breaks up the stress of difficult cases. It reimburses well. It is fun. In our specialty, like many other specialties, the nurses are trying to steal the low-lying fruit. They have no intention of reaching up high, on the distal branches, reaching from a precarious ladder to get the fruit nobody else wants to pick. Its true for GP, it's true for Anesthesia, and it's true for lots of other docs.

Its the law of unintended consequences. If you don't protect this financial set-up, eventually nobody will be willing to to do the difficult cases and there will be millions of CRNA's willing to do eyeballs and knees.

I'm opposed to the proliferation of CRNA schools, and any other business enterprise that promises to train people to grab the low-lying fruit.

 

[SleepIsGood]

I want patients to be able to access the best quality healthcare. I want transparency. Patients should know EXACTLY who their anesthesia provider is. Is he a physician or nurse. The patient should dictate this care.

 

[Jeff05]

i don't want "super" partners to skim 250-500k+ off my salary for the next decade+...
i am pain/anesthesia.
i WILL work hard.
i will take tons of call.
i will eat it when the partner has to leave early. and i'll smile while doing it.
etc.
i will work with the crappy surgeons everyone hates.
i will stay LATE.
however, i would like some POTENTIAL equity in the practice for my efforts.
so far, it's not an option in desirable areas. because our older colleagues TAKE TAKE AND TAKE.

however, i DO know that it's the world we live in. decision about next 3-5 years in progress.

 

[Coastie]

I want to hear from you new guys who think that I'm selling out your profession.

Exactly what you are so bitter and fearful about....

Exactly what you WANT to happen in the next 5, 10, 15 years...

Be concise and list specifically what your gripe is and how you want it changed...

And be realistic.....don't list something like "I want all the crna's to die" or something like that.

Partners with good biz sense
A nice blended unit

 

[SleepIsGood]

- I want to work hard. Quality improvement should be entertained, but if you're a complainer or don't contribute, you should be booted.
- I believe if you work hard and you contribute, you should be awarded appropriately...ie not taken advantage of by 'older, lazy partners".
- I do agree though, one has to put in the 'time'...I dont think this 'time' should be too prolonged however. Partnership ideally should be within 1-2 years, 3 at the max
-Physician only practices should be the standard of care. I believe better patient outcome will then occur. I think most patients would prefer this sort of practice as well IF they knew their options.
-I believe if you want to/like to do a fellowship you should. ONe shouldnt ideally have to do it because they fear CRNA encroachment.

 

[militarymd]

I want the same opportunities you had.

My mentor has been doing this for 30 some odd years. He started in California, and has worked his way across the country to Florida. I shoot the sh it with him all the time...hoping to learn more.

And you know what? I don't have the opportunities he had 30 years ago. HE doesn't have the same opportunities that HE had 20 years ago. HE doesn't have the same opportunities HE had 10 years. I won't have the same opportunities that I have now in 10 years.

That's life Surfer dude.....opportunities change...IN ALL areas of business.

I have worked very hard to be in this position. I will continue to work very hard. I provide a very valuable service to my patients, I intend to be compensated fairly for my services.

What's "fairly"? YOU have no control over this. Fair is determined by numerous factors...organization structure of your employment situation, payer mix, overhead, efficiency of your practice, etc.

The ONLY influence (besides self improvement) you have over this is through ASAPAC...and I dare say I've done more for you than you have.

Here's the thing, it's not a question of "If they can do it, why not?" Because in medicine the low lying fruit is where the money is. By accepting the difficult/challenging/dangerous cases (particularly on patients that often do not pay their bills) we are providing a service to society that nobody else can provide. Nobody. Not mid-levels, not anybody. We are the only ones that can provide that service, and the only ones that want to. In order to assure society that people are still in position to do so, we need to protect the low-lying fuit.

The low-lying fruit is what makes medicine worthwhile. It breaks up the stress of difficult cases. It reimburses well. It is fun. In our specialty, like many other specialties, the nurses are trying to steal the low-lying fruit. They have no intention of reaching up high, on the distal branches, reaching from a precarious ladder to get the fruit nobody else wants to pick. Its true for GP, it's true for Anesthesia, and it's true for lots of other docs.

Its the law of unintended consequences. If you don't protect this financial set-up, eventually nobody will be willing to to do the difficult cases and there will be millions of CRNA's willing to do eyeballs and knees.

Do you know where crna's have INDEPENDENT practice? It's NOT where the "low lying fruit" grows. Right now, they usually work independently where DOCTORS don't want to work.....that's right places where doctors with high senses of ENTITLEMENT DO NOT want to go. Are YOU ready and willing to step up to the plate to go to these places?

I'm opposed to the proliferation of CRNA schools, and any other business enterprise that promises to train people to grab the low-lying fruit.

This applies to anesthesia residencies.....we are training ourselves out of business.

 

[militarymd]

I want patients to be able to access the best quality healthcare.

That's beyond a discussion about the politics of anesthesia

I want transparency.

That will rarely happen in business as it applies to new associates. My LLC offered 100% transparency to all of the people I hired, but that is EXTREMELY rare. That decision will be dependent on the owners of the business. No legislation will change that.

My group paid EVERYONE the same, including the 5+ people who ultimately got let go....but we're rare.

Patients should know EXACTLY who their anesthesia provider is. Is he a physician or nurse. The patient should dictate this care.

They do already, and most of the time, they don't really care.

 

[militarymd]

i don't want "super" partners to skim 250-500k+ off my salary for the next decade+...

That's up to the individual corporations. No legislation will change that.

i am pain/anesthesia.
i WILL work hard.
i will take tons of call.
i will eat it when the partner has to leave early. and i'll smile while doing it.
etc.
i will work with the crappy surgeons everyone hates.
i will stay LATE.

You had better do that, if you want to be successful.

however, i would like some POTENTIAL equity in the practice for my efforts.
so far, it's not an option in desirable areas. because our older colleagues TAKE TAKE AND TAKE.

You know what...that sure sucks...but it's business....it's like that in ALL business.....why is it that you feel entitled to a part of SOMEONE else's business. If you think it is unfair, then start your own business and take away their contract.

however, i DO know that it's the world we live in. decision about next 3-5 years in progress.

It's competition....so you do know.

 

[militarymd]

- I want to work hard. Quality improvement should be entertained, but if you're a complainer or don't contribute, you should be booted.
- I believe if you work hard and you contribute, you should be awarded appropriately...ie not taken advantage of by 'older, lazy partners".

Read all of the above....WHY do YOU feel ENTITLED to WHAT the owners of a group is willing to offer you? If you think you can do it better, form a corporation, and compete for the contract when the contract is up for renewal.

- I do agree though, one has to put in the 'time'...I dont think this 'time' should be too prolonged however. Partnership ideally should be within 1-2 years, 3 at the max
-Physician only practices should be the standard of care. I believe better patient outcome will then occur. I think most patients would prefer this sort of practice as well IF they knew their options.
-I believe if you want to/like to do a fellowship you should. ONe shouldnt ideally have to do it because they fear CRNA encroachment.

is that a little bit of LAZINESS creeping into your "wants"? I've ALWAYS maintained...ADVANCED training .....AND fewer slots.

 

[militarymd]

Sounds like the majority of what I hear is that it is not the crna's.

It's the business arrangement in anesthesia.

Allow me to tell a story.

My uncle is an electrical engineer. He's got a PHd. He taught at a university, and while he was teaching, he developed some gadget which allowed him to start a corporation and market the product.

He's now retired....BUT continues to draw income from his corporation....He doesn't make anything anymore...he doesn't spend a day at the office anymore.

Well, I had dinner with him a couple of months ago, and I talked with him about my corporation, and how I got it off the ground.

When we started talking about how we paid everyone, he was SHOCKED and DISAPPOINTED that I was foolish enough to pay everyone the same...as in I am LOSING profit by paying other doctors the same as me.

I tried to explain that as doctors, we all kind of do the same work, and should be compensated equally.

His answer, as a business man, was that it doesn't matter...the owner who started and took the risks and invested the time to get it going DESERVES to take profit...FOREVER

His exact phrase to me "you are stupid"...broken english.

That's a viewpoint from a BUSINESS man.

...and medicine....it's business...probably one of the bigger rackets in our economy.

 

[SleepIsGood]

Like you mentioned...it's a little different with Medicine. Medicine is more dynamic. Physicians are liable, they take the same 'risk', if not more if they are working more.

Having said that..I think if you 'buy into' the practice...For example, the junior buys in and sort of compensates the 'owner'....the profit should be equal from that point onwards. IN this model, the new partner is also taking risk and investing into the group.

MilMD....I think fundamentally as much as we hve our arguments...the principle here is that the 'new generation' of docs in anesthesia do not want to be taken advantage of. As you know, as the competitiveness of anesthesia has inceased, so has the quality of the crop. There were a lot of groups that took advantage of anesthesiologists previously, since most were foreign born,etc. THese foreign born ones sometimes had no option and worked for whatever they could get.

I don't know if you read the ASA newsletter my friend. I encourage you to pick up the new one. There are PLENTY of physicians in both private practice and academics that are encouraging doctors to fight for their patient's safety and fight against nurse encroachment. This is especially true among pain providers. If you are telling us that PP docs are not as concerned about this issue, you are clearly living in the old times. AGAIN, read this months ASA newsletter and you will have a different opinion.

I think the new ASA lifeline campaign is phenomenal. Nurses trying to play doctor is becoming more common. As doctors we can not simply rely on the ASAPAC. I encourae EVERYONE to donate to it. However, as Dr. Lubenow in his article in the ASA newsletter pointed out, it is up to each and everyone of us to safe guard paient safety. In Louisiana, it was just ONE pain practioner that filed suit when he felt CRNAs were trying to do pain independently. He was successful in thwarting their efforts.

 

[militarymd]

Like you mentioned...it's a little different with Medicine. Medicine is more dynamic. Physicians are liable, they take the same 'risk', if not more if they are working more.

Having said that..I think if you 'buy into' the practice...For example, the junior buys in and sort of compensates the 'owner'....the profit should be equal from that point onwards. IN this model, the new partner is also taking risk and investing into the group.

MilMD....I think fundamentally as much as we hve our arguments...the principle here is that the 'new generation' of docs in anesthesia do not want to be taken advantage of. As you know, as the competitiveness of anesthesia has inceased, so has the quality of the crop. There were a lot of groups that took advantage of anesthesiologists previously, since most were foreign born,etc. THese foreign born ones sometimes had no option and worked for whatever they could get.

I don't know if you read the ASA newsletter my friend. I encourage you to pick up the new one. There are PLENTY of physicians in both private practice and academics that are encouraging doctors to fight for their patient's safety and fight against nurse encroachment. This is especially true among pain providers. If you are telling us that PP docs are not as concerned about this issue, you are clearly living in the old times. AGAIN, read this months ASA newsletter and you will have a different opinion.

I think the new ASA lifeline campaign is phenomenal. Nurses trying to play doctor is becoming more common. As doctors we can not simply rely on the ASAPAC. I encourae EVERYONE to donate to it. However, as Dr. Lubenow in his article in the ASA newsletter pointed out, it is up to each and everyone of us to safe guard paient safety. In Louisiana, it was just ONE pain practioner that filed suit when he felt CRNAs were trying to do pain independently. He was successful in thwarting their efforts.

You've got to be kidding....You ARE kidding right?

Expansion of nursing practice has been GOING ON FOREVER....Physician restriction of nursing practice has been GOING ON FOREVER......the push and shove has been going on forever.

The only reason it is on YOUR radar screen right now is because of $$$$....or less of it.

 

[mille125]

Sounds like the majority of what I hear is that it is not the crna's.

It's the business arrangement in anesthesia.

Allow me to tell a story.

My uncle is an electrical engineer. He's got a PHd. He taught at a university, and while he was teaching, he developed some gadget which allowed him to start a corporation and market the product.

He's now retired....BUT continues to draw income from his corporation....He doesn't make anything anymore...he doesn't spend a day at the office anymore.

Well, I had dinner with him a couple of months ago, and I talked with him about my corporation, and how I got it off the ground.

When we started talking about how we paid everyone, he was SHOCKED and DISAPPOINTED that I was foolish enough to pay everyone the same...as in I am LOSING profit by paying other doctors the same as me.

I tried to explain that as doctors, we all kind of do the same work, and should be compensated equally.

His answer, as a business man, was that it doesn't matter...the owner who started and took the risks and invested the time to get it going DESERVES to take profit...FOREVER

His exact phrase to me "you are stupid"...broken english.

That's a viewpoint from a BUSINESS man.

...and medicine....it's business...probably one of the bigger rackets in our economy.

Several points:

1) First I agree with your uncle. I wouldnt go as far to call you stupid because anyone who has succeeded in business like you is not stupid. You are trying to do the fair thing and that is admirable. However, your setup of paying everyone equally from day one is not fair to you. You took an enormous risk to set up your practice. That risk is now much less for new docs.
Lets say that I have a company. I get 10 more limited partners to contribute financially for a share of the profits. For simplicity lets say that I put in 50K and each of them put in 5K for a total of 100K. Therefore I own 50 percent and each of them own 5%. The business is very profitable and three years late 3 other investors want to buy in and we want to accept them. Should they expect to also pay 1K for each 1%? Would any business owner do this? The answer is absolutely not. The business would get an independent evaluation and a value will be assigned to each share. These shares may now be worth 5 to 10 times more. Therefore, it is fair for the new owners to pay 5K or more per 1%. Although your situation is not the same, it is similar. You can still be fair in compensation but everyone should not be paid the same from day 1 without a buy-in. At my practice, a new associate is paid less then me for two years. He then buys in and we make the same (given that we are working the same). New docs need to realize what is fair and what is not fair to all involved.

2) The fact that we open SRNA schools and train them is stupid. This is again motivated by greed on the chairman level. This needs to end. Close all MD associated SRNA training schools and I think that you will get the AANA's attention.

3) We should contribute to our ASAPAC.

4) I do not like the current supervision model. Every MD should do their own cases at least some of the time. If a nurse practitioner works in a PCP's office, would she see all patients and the PCP would just supervise. No way. This needs to change.

5) I disagree with decreasing our numbers (and I am sure the military is going to tell me the error of my ways).

 

[militarymd]

One thing that I'm sensitive about is being called unfair....the other names that people call me doesn't bother me (racist, bigot, etc) ......I don't know why...but "unfair" is something that really bothers me....maybe I'll go see a shrink some day and get analyzed to figure out what in my history makes me adverse to the term "unfair".

And I knew that as we were getting off the ground that some people would have to go.....ie not going to be part of my big picture and future....sooo...same $$$ for everyone...actually some of them got paid MORE than me based on our little compensation system, but when it was time to go....they had to go.

As for how many of us we need......you and I just have a different assessment of how things are going to be in our future.....I feel that fewer but better trained anesthesiologists is the way to go....just difference in opinion there.

With the same pool of $$$....the pie will be bigger if cut into fewer pieces.

Several points:

1) First I agree with your uncle. I wouldnt go as far to call you stupid because anyone who has succeeded in business like you is not stupid. You are trying to do the fair thing and that is admirable. However, your setup of paying everyone equally from day one is not fair to you. You took an enormous risk to set up your practice. That risk is now much less for new docs.
Lets say that I have a company. I get 10 more limited partners to contribute financially for a share of the profits. For simplicity lets say that I put in 50K and each of them put in 5K for a total of 100K. Therefore I own 50 percent and each of them own 5%. The business is very profitable and three years late 3 other investors want to buy in and we want to accept them. Should they expect to also pay 1K for each 1%? Would any business owner do this? The answer is absolutely not. The business would get an independent evaluation and a value will be assigned to each share. These shares may now be worth 5 to 10 times more. Therefore, it is fair for the new owners to pay 5K or more per 1%. Although your situation is not the same, it is similar. You can still be fair in compensation but everyone should not be paid the same from day 1 without a buy-in. At my practice, a new associate is paid less then me for two years. He then buys in and we make the same (given that we are working the same). New docs need to realize what is fair and what is not fair to all involved.

2) The fact that we open SRNA schools and train them is stupid. This is again motivated by greed on the chairman level. This needs to end. Close all MD associated SRNA training schools and I think that you will get the AANA's attention.

3) We should contribute to our ASAPAC.

4) I do not like the current supervision model. Every MD should do their own cases at least some of the time. If a nurse practitioner works in a PCP's office, would she see all patients and the PCP would just supervise. No way. This needs to change.

5) I disagree with decreasing our numbers (and I am sure the military is going to tell me the error of my ways).

 

[Southpaw]

If today we're producing too many anesthesiologists then we definitely need to train fewer. We should all agree on this. Oversupply equals lower pay. Demand for your field drives up your value. From my viewpoint today's average anesthesiology resident is vastly different than the residents of a decade ago. There's not one single FMG in my entire program and I met very very few during interviews, simply because this field has gotten more competitive regardless of what the naysayers on this board believe.

I want a job that allows me to pay off my student loans and provide comfortably for my family, and I want to work with people who'll work as hard as I'm willing to work. If I'm unable to find something like this when the time comes, I'd like to have the knowledge and networking capacity to start my own practice and compete for contracts in areas I'd like to work. I want my field to carry a bigger voice within medicine and demand more respect.

 

[SleepIsGood]

I got to call a spade a spade.

I dont believe MilMD is paying all his employees equally. I just don't. I think he's trying to garner sympathy points here to make him look fair. Have you read the guy's posts?

Sorry man, I need to see your books to really believe you...nothing personal.

Like I said, I dont think in a 'socialistic' approach to medicine. I think if you work harder, you should earn more. I also believe if you 'buy in', you've 'paid your dues'. That's how it's done in law, regular business,etc. If you claim medicine has a business aspect to it, why should it's model differ from other business models in that regard?

However, ultimately its about patient safety. There is no question in my mind that a PHYSICIAN who went to 4 years of medical school. Who like Dr. Bacon states, performed 2 years of that doing clinical work. Who then did another 4 years of residency and perhaps then went to do a fellowship and is board certified is not more qualified. Of course she/he is more qualified and can better safe guard patients when they are unconscious and undergoing surgery.

 

[deleted126335]

Sounds like the majority of what I hear is that it is not the crna's.

It's the business arrangement in anesthesia.

Allow me to tell a story.

My uncle is an electrical engineer. He's got a PHd. He taught at a university, and while he was teaching, he developed some gadget which allowed him to start a corporation and market the product.

He's now retired....BUT continues to draw income from his corporation....He doesn't make anything anymore...he doesn't spend a day at the office anymore.

Well, I had dinner with him a couple of months ago, and I talked with him about my corporation, and how I got it off the ground.

When we started talking about how we paid everyone, he was SHOCKED and DISAPPOINTED that I was foolish enough to pay everyone the same...as in I am LOSING profit by paying other doctors the same as me.

I tried to explain that as doctors, we all kind of do the same work, and should be compensated equally.

His answer, as a business man, was that it doesn't matter...the owner who started and took the risks and invested the time to get it going DESERVES to take profit...FOREVER

His exact phrase to me "you are stupid"...broken english.

That's a viewpoint from a BUSINESS man.

...and medicine....it's business...probably one of the bigger rackets in our economy.

There is a difference between patenting a gadget and owner of a physician practice. Let's say You personally own the contract. You decide to move to Hawaii to pursue a life of surfing financed by collecting monies from the practice. Eventually the other docs will resent you and attempt to stop sending you those checks. Right or wrong. That's business too. Granted that's an extreme example.

You obviously expect a high level of commitment and performance from the docs in your practice. What you have to give in return is a real ownership stake, not a subpartnership- otherwise you will wind up with highly paid civil servants, or guys laying awake at night figuring out how to become your equal or force you out while praying you get hit by a bus. That's human nature. It won't be true for everyone, but it will be true for most. You are either an owner or a temporary employee. If a temporary employee, the level of sacrifice that most are willing to make is less, no matter how much you are paid.

I totally agree with a stipend or comp time off for those docs who have administrative skills and do things like hospital committees, department chairman, medstaff politics, etc as those are valuable services. But if someone does build an anesthesia practice from a chaotic situation, their ability to get a lifetime annuity out of the practice is going to be low- Unless the hospital and the owner are willing to tolerate a mediocre department.

 

[SleepIsGood]

If today we're producing too many anesthesiologists then we definitely need to train fewer. We should all agree on this. Oversupply equals lower pay. Demand for your field drives up your value. From my viewpoint today's average anesthesiology resident is vastly different than the residents of a decade ago. There's not one single FMG in my entire program and I met very very few during interviews, simply because this field has gotten more competitive regardless of what the naysayers on this board believe.

I want a job that allows me to pay off my student loans and provide comfortably for my family, and I want to work with people who'll work as hard as I'm willing to work. If I'm unable to find something like this when the time comes, I'd like to have the knowledge and networking capacity to start my own practice and compete for contracts in areas I'd like to work. I want my field to carry a bigger voice within medicine and demand more respect.

very insightful...great post 👍

 

[mille125]

One thing that I'm sensitive about is being called unfair....the other names that people call me doesn't bother me (racist, bigot, etc) ......I don't know why...but "unfair" is something that really bothers me....maybe I'll go see a shrink some day and get analyzed to figure out what in my history makes me adverse to the term "unfair".

And I knew that as we were getting off the ground that some people would have to go.....ie not going to be part of my big picture and future....sooo...same $$$ for everyone...actually some of them got paid MORE than me based on our little compensation system, but when it was time to go....they had to go.

As for how many of us we need......you and I just have a different assessment of how things are going to be in our future.....I feel that fewer but better trained anesthesiologists is the way to go....just difference in opinion there.

With the same pool of $$$....the pie will be bigger if cut into fewer pieces.

for clarification I only feel that you are being unfair to yourself not to your associates....

 

[mille125]

If today we're producing too many anesthesiologists then we definitely need to train fewer. We should all agree on this. Oversupply equals lower pay. Demand for your field drives up your value. From my viewpoint today's average anesthesiology resident is vastly different than the residents of a decade ago. There's not one single FMG in my entire program and I met very very few during interviews, simply because this field has gotten more competitive regardless of what the naysayers on this board believe.

I want a job that allows me to pay off my student loans and provide comfortably for my family, and I want to work with people who'll work as hard as I'm willing to work. If I'm unable to find something like this when the time comes, I'd like to have the knowledge and networking capacity to start my own practice and compete for contracts in areas I'd like to work. I want my field to carry a bigger voice within medicine and demand more respect.

My question is are we really producing more anesthesiologists than we should. If I look at 10 hospital departments, most are having trouble finding anesthesiologists especially in rural america. Also if we produce less but the CRNA's produce more, is this a situation that we want?

 

[seinfeld]

This is the prospective or a critical care person who has been in PP for 3 months.

The sickest patients in the hospital lie in the ICU where nurse to physician ratios are well beyond 1:4 . The most rapidly changing phyiology occurs in the operating room where for good reason the ratio of nurse to physician is at most 1:4. I have since starting practice done a mix of my own cases and CRNA supervision. To be honest I feel that patients get the best care when i am paired with a CRNA. Now hear me out before you get all up in arms.

Lets talk Cardiac. Theses cases are usually done solo at my institution. Do a good job at TEE while talking good care of the patient minute by minute is difficult and often unsafe. Our surgeons call it "probe toxicity". Youre looking at getting a good idea of the mitral disease and before you know it the pressure is in the tank. My skills as a MD are better for diagnosis and developing tx plan than actually pushing the drugs or turning the knobs on the ventilator. And by having a CRNA sitting in the room while on pump t i can go and give good quality care to another patient. Coming off pump same thing. Trying to mix up drugs and hang new drips all the while the patient is floundering. trying to look at the echo to dx problems with the new valve or the regional wall motion changes to explain the causes of failure to jump off pump is challenging.

For othro cases I want to be able to provide high quality pain managment ( regional anesthesia for post op pain) which has in our insitution decreased lenght of stay and ability for PT post op. I cant do this for 10-12 patients a day without CRNAs taking care of the patient in the room.

I dont want to have my medical knowledge and skills wasted on personally performing anesthetics for ASA 1 and 2 patients for Low risk, outpt procedures. What i do want is the opportunity to help diagnosis and treat ASA 1 and 2 patients when they become seriouly ill during an operation.

Besideds the reasons mentioned above, if i were a patient i would want 2 people thinking about me not just one.

An in the end by surpervising my group makes more money.

I also agree with the fact that unless MD are willing to go into rural that we have lost political muscle to argue, having come from a rural area i have to say that if my family needs surgery they need surgery, a CRNA is better than a bottle of whiskey and a belt to bite on.

Being the new , young guy in a group of older guys who are not able to do regional as profiicent or with US guidance, TEE, and ICU is frustrating but the surgeons have noticed my skills and have made comments which seems to infused enthusiasm back into the group about gaining new skills.

In the end all i do everday is to be affable, available, and show aptitude and I let the chips fall where they may. If in a couple years i still am on an island then i will move on.

 

[militarymd]

How are AMC's winning and keeping contracts? Owners ARE NOT even physicians.

There is a difference between patenting a gadget and owner of a physician practice. Let's say You personally own the contract. You decide to move to Hawaii to pursue a life of surfing financed by collecting monies from the practice. Eventually the other docs will resent you and attempt to stop sending you those checks. Right or wrong. That's business too. Granted that's an extreme example.

You obviously expect a high level of commitment and performance from the docs in your practice. What you have to give in return is a real ownership stake, not a subpartnership- otherwise you will wind up with highly paid civil servants, or guys laying awake at night figuring out how to become your equal or force you out while praying you get hit by a bus. That's human nature. It won't be true for everyone, but it will be true for most. You are either an owner or a temporary employee. If a temporary employee, the level of sacrifice that most are willing to make is less, no matter how much you are paid.

I totally agree with a stipend or comp time off for those docs who have administrative skills and do things like hospital committees, department chairman, medstaff politics, etc as those are valuable services. But if someone does build an anesthesia practice from a chaotic situation, their ability to get a lifetime annuity out of the practice is going to be low- Unless the hospital and the owner are willing to tolerate a mediocre department.

 

[militarymd]

Why would I need "sympathy"?

Apparently, I have what YOU want.

The only thing I WANT from you all is to give more $$$$ to the asapac.

I got to call a spade a spade.

I dont believe MilMD is paying all his employees equally. I just don't. I think he's trying to garner sympathy points here to make him look fair. Have you read the guy's posts?

Sorry man, I need to see your books to really believe you...nothing personal.

Like I said, I dont think in a 'socialistic' approach to medicine. I think if you work harder, you should earn more. I also believe if you 'buy in', you've 'paid your dues'. That's how it's done in law, regular business,etc. If you claim medicine has a business aspect to it, why should it's model differ from other business models in that regard?

However, ultimately its about patient safety. There is no question in my mind that a PHYSICIAN who went to 4 years of medical school. Who like Dr. Bacon states, performed 2 years of that doing clinical work. Who then did another 4 years of residency and perhaps then went to do a fellowship and is board certified is not more qualified. Of course she/he is more qualified and can better safe guard patients when they are unconscious and undergoing surgery.

 

[driedcaribou]

His answer, as a business man, was that it doesn't matter...the owner who started and took the risks and invested the time to get it going DESERVES to take profit...FOREVER

His exact phrase to me "you are stupid"...broken english.

That's a viewpoint from a BUSINESS man.

...and medicine....it's business...probably one of the bigger rackets in our economy.

Thank you for taking the time to share your viewpoints. It is all very interesting and at the same time, distressing to someone who isn't 'there' yet.

 

[deleted126335]

How are AMC's winning and keeping contracts? Owners ARE NOT even physicians.

They are winning and keeping contracts because The existing group provides inadequate service or does not have good business skills.

I am sure that there are many surgeons and hospitals and docs are happy with the AMC situation. But you are not going to find hussling go getters working for them, or those traits will be burned out of them in a few years.

Suppose tomorrow the CEO of your hospital said that the contract for anesthesia service was being turned over to an AMC for "business reasons" and that it was a done deal. And that you were all welcome to stay and work for the new company.
I would bet that most of your docs would either leave or stay and have a different work ethic. I suspect that few if any would work with the same level of vigor that you do now as owners.

 

[militarymd]

They are winning and keeping contracts because The existing group provides inadequate service or does not have good business skills.

I am sure that there are many surgeons and hospitals and docs are happy with the AMC situation. But you are not going to find hussling go getters working for them, or those traits will be burned out of them in a few years.

Suppose tomorrow the CEO of your hospital said that the contract for anesthesia service was being turned over to an AMC for "business reasons" and that it was a done deal. And that you were all welcome to stay and work for the new company.
I would bet that most of your docs would either leave or stay and have a different work ethic. I suspect that few if any would work with the same level of vigor that you do now as owners.

that's the exact point I made to my uncle.....and that is exactly what he expects from employees....which is also exactly what I see in many of our "new generation" of physicians despite what they claim they are willing to do in terms of working hard.

Just look at cop's h1n1 thread...and the response to my attitude toward's work...

and in real life....there is a balance in between...

 

[GasDaddy]

What I want is a job in the location of my choice. I'm honestly over the money thing, I don't care anymore. I'm also in debt like the rest of us. I'm so tired of hearing people talk about it, especially attendings..... its pathetic. Healthcare reform for the sake of shutting these people up and putting them in their place may not be a bad thing.

Anesthesia residency definately needs to change. As it stands now, honestly there isn't THAT much of a difference between what we do in residency vs what crna's do in crna school. They do almost all the rotations we do in residency... getting experience in regional, cardiac, heads, vascular etc; we just do a ton more than they do and we are expected to know every little detail of what we are doing. As students they aren't as confident, don't always get that much autonomy... I guess it depends on the program they are in, but they eventually get good. I think the end product of anesthesiology residency is far superior than the end product of crna school. They get good at doing the intraop stuff, but as far as high level management decisions they tend to fall back on the MD and they like it that way for the most part. Most would rather be part of a care team and do their stuff and get the hell out when they are done and not worry about call, extra liability etc.

If anesthesiologists are really worried about a CRNA take over, one possible solution is to add an additional year of training to residency with emphasis on TEE training and ICU training. That's how its done in europe, the anesthesiologists run the ICU period, with no separation of MICU vs SICU vs Trauma ICU and all that bs..... in Europe it's one general ICU and the anestheiologists run it with the surgeons only there to change dressings. If people are really worried about take over, than thats what needs to be done. And "groups" can have attendings rotate one week at a time through the unit, maybe once a month or every 2 months and the rest doing OR gas. We need to be flexible like that. Do I want to be in the ICU? No, i think it sucks, but if it is run well and efficiently it can be potentially be a fun place; and I would love to have a ton of midlevels helping out in the ICU. No problem with that. Either way, you don't have to end up practicing in the unit at all, but you have the qualifications to work in those settings if necessary.

Another problem is the lack of research in anesthesiology. Last I checked, anesthesiology barely got any grant money for research from the NIH. The field in a way is dead right now, with only regional really stepping up to the plate with new ideas and techniques etc. Not to mention, there really is a shortage of true academic anesthesiologists imho.

Best way to approach it I think is to make changes starting at the residency level on up: change the structure of the residency again.

-GD

 

[deleted126335]

that's the exact point I made to my uncle.....and that is exactly what he expects from employees....which is also exactly what I see in many of our "new generation" of physicians despite what they claim they are willing to do in terms of working hard.

Just look at cop's h1n1 thread...and the response to my attitude toward's work...

and in real life....there is a balance in between...

I agree with your observations. I disagree that this generation is different. They are simply working at the level they have been incentivized to. As we were. Outstanding work ethic, clinical competence, and loyalty have historically been well rewarded beyond self esteem- Meaningful partnership, secure ownership, good income, prestige and the security of knowing that if you kept up the good work these rewards will continue That implied compact has been changed. We are all witness to outstanding physicians in all specialties who have lost out to those who are better at the art of the deal and the politics of medicine, and seen years of loyalty and skillful hard work count for nothing. Not to mention the gobbling of physician practices by hospitals and AMCs. Give a good candidate reason to believe that his hard work and effort will be well rewarded, you will get the level of fidelity that you expect. Most aren't willing to go through the grief because they don't believe the gravy will be there at the end of the road. So the attitude is get what you can now. Just don't stray too far below the pack in terms of effort or output. Really quite reasonable.

 

[militarymd]

I agree with your observations. I disagree that this generation is different. They are simply working at the level they have been incentivized to. As we were. Outstanding work ethic, clinical competence, and loyalty have historically been well rewarded beyond self esteem- Meaningful partnership, secure ownership, good income, prestige and the security of knowing that if you kept up the good work these rewards will continue That implied compact has been changed. We are all witness to outstanding physicians in all specialties who have lost out to those who are better at the art of the deal and the politics of medicine, and seen years of loyalty and skillful hard work count for nothing. Not to mention the gobbling of physician practices by hospitals and AMCs. Give a good candidate reason to believe that his hard work and effort will be well rewarded, you will get the level of fidelity that you expect. Most aren't willing to go through the grief because they don't believe the gravy will be there at the end of the road. So the attitude is get what you can now. Just don't stray too far below the pack in terms of effort or output. Really quite reasonable.

So you and I are on the same page as far as observations of what's going on around us.

I don't know what generation you're from...and perhaps...part of it is my Asian heritage........but potential reward is NOT why I push myself....it's self-esteem......not because of what I may be rewarded with.

In the 11 years when I was in the Navy...I worked the same way I work now....and CERTAINLY I did not get paid more for the extra work.....

Getting ICU training and certification didn't get me more pay.....just double the call of my other Navy partners... but I did it because of pride.

This sense of work ethic I saw in my parents...in my father-in-law....but I'm not seeing it, as much, in this generation.

There is a LOT more of "what do I get out of it?" mentality.

 

[deleted126335]

So you and I are on the same page as far as observations of what's going on around us.

I don't know what generation you're from...and perhaps...part of it is my Asian heritage........but potential reward is NOT why I push myself....it's self-esteem......not because of what I may be rewarded with.

In the 11 years when I was in the Navy...I worked the same way I work now....and CERTAINLY I did not get paid more for the extra work.....

Getting ICU training and certification didn't get me more pay.....just double the call of my other Navy partners... but I did it because of pride.

This sense of work ethic I saw in my parents...in my father-in-law....but I'm not seeing it, as much, in this generation.

There is a LOT more of "what do I get out of it?" mentality.

I am 18 years out of residency. Second job. First job had no hope of parity, worked for a yoyo who didn't take any call and made triple my salary. I became angry, frustrated, and left - when the job market turned. I had to sit still for a few years though. Those who chose to stay race each other for the door every afternoon. Not my way, but I understand their behavior completely. Currently in a high quality, well credentialed practice- the kind where people keep up with the literature and also don't call in sick. Over the years we have had a few docs who were interested in days only, no call, soft ball cases only. They were fine clinicians who were capable of doing much more, just decided that the extra work of ownership wasn't for them. Or knew that they would be leaving the area in a few years. I respected their choice.

I agree with you that pride and self esteem pushing docs is a commodity in short supply. I just don't think that it is a new phenomenon. The other motivating factors that historically pushed docs: ownership, good income, security, prestige are all going away exposing this.

"There is a LOT more of "what do I get out of it?" mentality" It was always there.

 

[SleepIsGood]

I am 18 years out of residency. Second job. First job had no hope of parity, worked for a yoyo who didn't take any call and made triple my salary. I became angry, frustrated, and left - when the job market turned. I had to sit still for a few years though. Those who chose to stay race each other for the door every afternoon. Not my way, but I understand their behavior completely. Currently in a high quality, well credentialed practice- the kind where people keep up with the literature and also don't call in sick. Over the years we have had a few docs who were interested in days only, no call, soft ball cases only. They were fine clinicians who were capable of doing much more, just decided that the extra work of ownership wasn't for them. Or knew that they would be leaving the area in a few years. I respected their choice.

I agree with you that pride and self esteem pushing docs is a commodity in short supply. I just don't think that it is a new phenomenon. The other motivating factors that historically pushed docs: ownership, good income, security, prestige are all going away exposing this.

"There is a LOT more of "what do I get out of it?" mentality" It was always there.

source of realism. Thanks for not painting the new generation as 'entitled" as some would like you to believe.

 

[Jeff05]

to each his own.

my self esteem is not so much related to how many hours i work or how many fellowships i've done, etc. it comes, mostly, from non-work related sources. for me, life is not about work. not sure how many times you plan to live, but i have just this once. would like to NOT spend most of it in a box (OR) or gomer garage (icu).

think of maslow's triangle. the older generations made their life about work because they had to. if they didn't work all the time - they could not provide for their family. my parents did/are still doing it for me. they pushed me up that triangle, so now i'm stuck having to not just work for food, but to self-actualize.

luckily, as a future anesthesiologist/pain guy i can provide a living for my family WITHOUT having to work ALL the time (i hope). that doesn't mean that i have poor work ethic. work ethic is not WHY you work, it's how you work. i'm still going to work really hard - but i know my limits. FOR ME, life is too precious and short to waste most of it away from my family, friends, hobbies, etc. i think this is a reflection of not only young anesthesia, but of young medicine as a whole.

 

[BDanes]

What do I want? I want what I have.

I'm an independent contractor that is responsible for myself-no CRNAs.

The only "buy in" I have is to the scheduling/billing company the "group" uses which is to pay them double the overhead for my first 6 months. This is due to the delay of collections for my accounts recievable.

I generally have the flexibility to work with the surgeons I like, and if I dislike them I can request never to work with them again.

Our "group" is composed of independent physicians that share a billing/scheduling company.

We are surgeon based for the most part, which means we have to change locations during the day sometimes. That's a small price to pay for the ability to work with who I choose.

I bill for my services and collect for them from day one. The only blended unit I will ever see is for the call services our group provides to one hospital. During these calls we are compensated by a stipend and also guaranteed the blended units for every case we do. Granted, if someone has higher returns than the blended unit the hospital gets to keep it. But, more often than not we would end up with a handful of nonpayors during a call.

My livelihood will largely be determined by me. If I don't work, I don't get paid. I take vacation when I want. If I need a day off, I take it. If I am unavailable and a jerk, surgeons won't want to work with me. If I piss them off and it reflects badly on the group they would ask me to leave.

Downsides? I have to pay for my malpractice, disability, health and any 401k or pension. Also, I've had to pay for all hospital applications, moving fees, etc. Plus, I haven't seen any money yet due to lag time. I will see a check from the calls--the hospital cuts checks at the end of the month.

Like mil said, there is a price to pay on the front end when you set up your own corporation. But in the end if you are successful it is well worth it.

Also, for anyone who asks, the scheduling is fair for paying cases. The group rotates our group call with the person on call recieving the highest projected payout lineup for the day.

 

[deleted126335]

So you and I are on the same page as far as observations of what's going on around us.

...and perhaps...part of it is my Asian heritage........

This sense of work ethic I saw in my parents...in my father-in-law..

Very possible. I went to an ivy league school. Plenty of ambitious folks. Plenty of Asians. Nobody outworked the asian kids. You should read Malcolm Gladwell's "outliers: the story of success" It has a chapter on the asian work ethic and resulting success out of proportion to their numbers.

Medicine has drawn plenty of workaholics of all ethnicities. Also plenty of folks willing to work really hard-provided the hard work was rewarded. It's the last group that is becoming disenchanted. They are not leaving because they have already invested. It's the drop in work ethic of the last group you notice-because they perceive the hard work and sacrifice won't be tangibly rewarded.

 

[militarymd]

If I HAD to choose....I would want what you have.

The old guy in our group started out like this 30 years ago....

What do I want? I want what I have.

I'm an independent contractor that is responsible for myself-no CRNAs.

The only "buy in" I have is to the scheduling/billing company the "group" uses which is to pay them double the overhead for my first 6 months. This is due to the delay of collections for my accounts recievable.

I generally have the flexibility to work with the surgeons I like, and if I dislike them I can request never to work with them again.

Our "group" is composed of independent physicians that share a billing/scheduling company.

We are surgeon based for the most part, which means we have to change locations during the day sometimes. That's a small price to pay for the ability to work with who I choose.

I bill for my services and collect for them from day one. The only blended unit I will ever see is for the call services our group provides to one hospital. During these calls we are compensated by a stipend and also guaranteed the blended units for every case we do. Granted, if someone has higher returns than the blended unit the hospital gets to keep it. But, more often than not we would end up with a handful of nonpayors during a call.

My livelihood will largely be determined by me. If I don't work, I don't get paid. I take vacation when I want. If I need a day off, I take it. If I am unavailable and a jerk, surgeons won't want to work with me. If I piss them off and it reflects badly on the group they would ask me to leave.

Downsides? I have to pay for my malpractice, disability, health and any 401k or pension. Also, I've had to pay for all hospital applications, moving fees, etc. Plus, I haven't seen any money yet due to lag time. I will see a check from the calls--the hospital cuts checks at the end of the month.

Like mil said, there is a price to pay on the front end when you set up your own corporation. But in the end if you are successful it is well worth it.

Also, for anyone who asks, the scheduling is fair for paying cases. The group rotates our group call with the person on call recieving the highest projected payout lineup for the day.

 

[militarymd]

Very possible. I went to an ivy league school. Plenty of ambitious folks. Plenty of Asians. Nobody outworked the asian kids. You should read Malcolm Gladwell's "outliers: the story of success" It has a chapter on the asian work ethic and resulting success out of proportion to their numbers.

Medicine has drawn plenty of workaholics of all ethnicities. Also plenty of folks willing to work really hard-provided the hard work was rewarded. It's the last group that is becoming disenchanted. They are not leaving because they have already invested. It's the drop in work ethic of the last group you notice-because they perceive the hard work and sacrifice won't be tangibly rewarded.

maybe so.

 

[ProRealDoc]

I want to hear from you new guys who think that I'm selling out your profession.

Exactly what you are so bitter and fearful about....

Exactly what you WANT to happen in the next 5, 10, 15 years...

Be concise and list specifically what your gripe is and how you want it changed...

And be realistic.....don't list something like "I want all the crna's to die" or something like that.

I want every lazy, good-for-nothing, coattail-riding, non-ASAPAC donor anesthesia resident/attending to get caned and then booted out of the specialty.

 

[SleepIsGood]

I want every lazy, good-for-nothing, coat-tail-riding, non-ASAPAC donor anesthesia resident/attending to get caned and then booted out of the specialty.

I agree.