What happened in the mid to late 90's?

[RussianJoo]

Everyone is trying to predict the future.. what will Maobama's health care plan mean for anesthesia, will the crna's take over and how will this affect the future anesthesiologists?

Well I am trying to look to the past for answers on what the future will bring. I noticed that in the mid to late 90's there were many programs that went unfilled and to say that anesthesia was not a popular residency might be an understatement. Today however, the number of applicants is increasing and the number of unfilled spots is decreasing every year, this drive is probably fueled by the high starting salary and the ease of finding work anywhere in the country.

So what happened in the mid 90's? Why did anesthesia become so unpopular? were anesthesiologists really making that much less money than they are now? Was the job marker really that over saturated with anesthesiologists that it was very hard to find a job after graduating? What was the unemployment rate for anesthesiologists during those times?

Seems like those times were the hardest for the field of anesthesia and thus the lack of interest from the graduating med students. So if anyone could recall how tough it really was during that time maybe it can put a perspective of how tough it might get in the near future with some of the changes that are about to happen.

I am sure there are a few attendings on here that were either practicing or in residency during that time and can fill me in on what it was like.


Thank you in advance for your comments.

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[wAyRadikull]

65 looks and no bites? Must be a busy day, hopefully tomorrow we'll get some answers.

But seriously though, it would be really cool if some of the OGs on here could fill us young guns on what anesthesia was like in the 90s. I've heard that the market was bad and all that stuff but no concrete.. "this is how it was".

It would be helpful to know the history of anesthesia so we know what we're running up against, whether its time, nurses or the government haha. Always better to be locked and loaded then be caught by surprise.

 

[RussianJoo]

ok thank you very much for posting.. have you heard of any new grad not being able to find a job at all?

what you're describing could easily happen in a couple of years and I already see some trends in it.. partnership tracks are getting longer, salaries are still up but once the national health care comes it will most definitely drop. and replace private groups with exclusive hospital contracts to HUGE AMC organisations who have so many doctors and so much money that it's impossible for anyone to compete with them, it's like Walmart placing small mom & pop shops out of business.

 

[RussianJoo]

it's gonna suck when i am going to have to struggle in this years match to just get any anesthesia residency at all and then in 3 years or so i would be able to walk into decent mid tier university program and match without a problem. but such is life..

 

[mcgreen]

In the early 1990 there was big push for primary care at the exclusion of specialists. The hype over the coming of Hillary care caused a tightening of hiring in anesthesia, compounded with relative over supply of anesthesiologists due to the specialties expansion in the 1980s. The employment difficulties of anesthesia’s was widely reported and med student lost interest in ranking anesthesia residencies causing many residences not to fill.

 

[InductionAgent]

it's gonna suck when i am going to have to struggle in this years match to just get any anesthesia residency at all and then in 3 years or so i would be able to walk into decent mid tier university program and match without a problem. but such is life..

I wouldn't get bent out of shape over what you think might happen. In any case, if that kind of turn of events would get you especially upset, then are you choosing anesthesiology for the right reasons?

 

[cfdavid]

I wouldn't get bent out of shape over what you think might happen. In any case, if that kind of turn of events would get you especially upset, then are you choosing anesthesiology for the right reasons?

I think RJ's just reflecting on his circumstances as all of us do. Surely, it would be preferable to be graduating into a solid job market which for newly minted MSIV's, like RJ and myself, may not be the case given current trends overall.

 

[gman33]

In the mid-90s, was it the case that practicing anesthesiologists were just exploiting new grads due to a relative over-supply?

My guess is that reimbursement was at the same level or higher than present.
Is this field more subject to those types of cycles than others?
By that I mean, I would guess it's difficult to start your own practice, where in other fields that is not the case.

 

[maceo]

In the mid-90s, was it the case that practicing anesthesiologists were just exploiting new grads due to a relative over-supply?

My guess is that reimbursement was at the same level or higher than present.
Is this field more subject to those types of cycles than others?
By that I mean, I would guess it's difficult to start your own practice, where in other fields that is not the case.

Wall Street Journal came out with an article that said that anesthesiology was a dying field. This coupled with the NO jobs or little paying jobs led to nobody goign into anesthesia. I think in my opinion we are headed back to the same scenario as 10- 15 years ago, just judging from my conversations with recruiters.

 

[RussianJoo]

I wouldn't get bent out of shape over what you think might happen. In any case, if that kind of turn of events would get you especially upset, then are you choosing anesthesiology for the right reasons?

you wouldn't be upset over the fact that you could have gotten much better training if you were applying for residency in the mid 90's? I mean sure you can't change what happens but still.. I want to get into the best residency i can so i can get the best training.. I think it's only natural to be upset over something like that.

 

[RussianJoo]

Wall Street Journal came out with an article that said that anesthesiology was a dying field. This coupled with the NO jobs or little paying jobs led to nobody goign into anesthesia. I think in my opinion we are headed back to the same scenario as 10- 15 years ago, just judging from my conversations with recruiters.

yep i would have to agree with this statement. good thing i am interested in CCM and thus the general anesthesia market won't affect me that much.

 

[maceo]

yep i would have to agree with this statement. good thing i am interested in CCM and thus the general anesthesia market won't affect me that much.

you know they are training nurse practicioners to be ICU attendings right?

 

[Planktonmd]

Exactly.
It was the fear of impending radical changes of the health care system and Medicare cuts that made every one want to go to primary care specialties in the early 1990s.
That was a time when an internist or FP made more money than an anesthesiologist.
History has a tendency for repeating itself doesn't it?

In the early 1990 there was big push for primary care at the exclusion of specialists. The hype over the coming of Hillary care caused a tightening of hiring in anesthesia, compounded with relative over supply of anesthesiologists due to the specialties expansion in the 1980s. The employment difficulties of anesthesia’s was widely reported and med student lost interest in ranking anesthesia residencies causing many residences not to fill.

 

[frank51]

Exactly.
It was the fear of impending radical changes of the health care system and Medicare cuts that made every one want to go to primary care specialties in the early 1990s.
That was a time when an internist or FP made more money than an anesthesiologist.
History has a tendency for repeating itself doesn't it?

Absolutely, and I've seen people interested in the field going into another specialty because they don't see a bight future in Anesthesia, I've also seen people interested in other fields go into Anesthesia because of the money, only time will tell. I think Anesthesia tends to be more cyclical than some of the other fields in medicine.

 

[ProRealDoc]

you know they are training nurse practicioners to be ICU attendings right?

Seen lots of NPs in ICUs d/t shortage of intensivists. Some have huge chips on their shoulders for no reason and see themselves as equivalent to ICU attendings.

 

[Powerfade]

Also remember that that as the economy tanks, the older guys' retirement portfolios also tank keeping them in the workforce longer.

 

[Spacedman]

i agree that this is some crucial history to know in preparing for the futre. i also heard from several of the older attendings on the interview trail that the WSJ article really set off a panic. it's still not that clear to me if there really was an oversaturation of the job market, though i don't know what data there is out there for the mid 90s. in any event, i've attached the WSJ article from 1995 if anyone's interested. i think it should be required reading for future anesthesiologists View attachment wsj article.pdf.

 

[RussianJoo]

cool thanks a lot.

 

[izzygoer]

starting 2011 89 million baby boomers will start to become eligible for medicare (not all at once of course) but a large chunk of them within the next decade.

even if one assumes that anything that passes obama is anestheisa neutral....

the reality of current demographics is skewing towards a "less rich" payer mix with less private insurance.

are people replacing baby boomers "richer" in terms of their private insureres. does not seem so... the days of fat private insurance premiums simply are not sustainable in a global economy.

gm among others are collapsing becuase kia and hyundai do not spend 12,500 per employee on health care

along with more and more uninsured means more people going to academic hospitals and getting "charity care" from salaried anesthesiologists.

 

[LongSnow]

A series of bad assumptions caused the dearth of trained anesthesiologists in the mid 1990's:

Bad assumption #1. Better pharmaceuticals and better minimally invasive procedures would drastically reduce the need for surgery, ergo anesthesia. This has occured to some extent, but not nearly the amount predicted by Rand, Wharton, etc.
However, many think there has been an increase in the number of surgeries because of better medical treatment of disease (think PPI's, others) - Safer anesthesitcs,better monitoring, and better medical treatments of disease mean that we can operate on alot of people we would have never thought about anesthetizing in the past.

Bad assumption #2. Hillary Care is here

Bad assumption #3. Nurse anesthesia - not the panacea of cost savings once assumed - need I say more? In fact, the way surgeons are increasinly becoming more specialized and more complicated patients are routinely receiving more complicated procedures, most surgeons I encounter don't want a nurse giving the anesthesia.

4. Bad assumtion number 4- "there are too many anesthesiologist".

So, that is what happens when a bunch of eggheads in an ivory tower try and predict the future.

So - there was never really an oversupply, sugeries did not become more infrequent (quite the opposite), and anesthesia did not become a nursing duty. However, anesthesia groups did delay retirement and defer hiring. This created the current situation we are in now - there are alot of anesthesiologists near retirement, holding on an not wishing to retire because of the economy, and many young one recently starting work. The shortage will continue for a while. Just hope Obama gives us a little lube first before the screwjob. I am expecting a triplewhammy, drop in reimbursement, more reliance on hospital stipend, and increase in taxes. just to what extent is the question, but fortunately I absolutely live my job and I think I will continue with a comfortable existence, as I damn well deserve after the grueling training we have endured!

Peace

 

[jetproppilot]

I came outta residency in 1996.

I landed a job that enabled me to absolve my 200K student loan debt, and simultaneously putta buncha money in the bank.

Times were hard, yes.

Some gravy jobs still out there,

yes.

Same story with my buddies who headed for PP in Vegas in 94/95.

 

[jwk]

Supply and demand are cyclical in anesthesia - or any other field for that matter. When the sky is falling, people going into anesthesia drops, and a few years later, there's a shortage.

 

[RussianJoo]

thank you everyone for your input. really appreciate it.

 

[dienekes88]

A surgeon explained it to me this way:
In the mid-90's people thought Anesthesiology was a dying field probably due to the bad assumptions that LongSnow mentioned. As a result, a lot of spots went unfilled... and more importantly more than a few of the spots that did get filled were filled by people not cut out to be solid anesthesiologists (he actually mentioned that a lot were foreign medical grads, but that seems... unreasonably patriotic...?). So in that period, the guys who were good got the cush jobs. Now 10-15 years later with a lot of people retiring in that time and few people to fill the spots... there's a huge demand for good anesthesiologists. With a static supply - once you fill the max number of residency spots - the price of the now-limited commodity goes up as demand increases.

It makes sense, but he could be wrong.

 

[platon20]

you know they are training nurse practicioners to be ICU attendings right?

Where is this, and give me a link please.

 

[maceo]

Where is this, and give me a link please.

call columbia university school of nursing, or just call the ICU and ask whoever picks the phone up