what happened to anesthesia in the 90s?

[heathermed]

I've heard a lot of people mention the dire straits of anesthesia as a profession during the 90s. Can someone please give me a history lesson and shed some light on what happened and why? What caused the resurgence?

I'm very curious...
thanks

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[pgg]

The short version is that there was widespread fear - nay, terror - that the looming cloud of Hillarycare and a bunch of uppity CRNAs were going to destroy anesthesiology, drasticly reducing both reimbursement and the need for physician anesthesiologists.

Medical students were frightened off. No one wanted to get on a sinking ship. Residency programs went about 1/2 filled, and many people who did go into anesthesia were US or foreign grads who sucked too much to get into a good specialty.

When the worst year's class of these go-getters took their written boards, more than half failed.

But then the CRNAs failed to take over, the payment cuts never materialized, and years of unfilled residency classes led to a shortage of anesthesiologists ... supply & demand led to an anesthesia world filled with a lot of marginal anesthesiologists making $400K/year.

Anethesia is moderately competitive now because people noticed what a cool high paying specialty it is.

We're on the downslope of that bubble now.

 

[Sergio99]

The short version is that...

Yes, that is a pretty accurate description, except for the part,

...the payment cuts never materialized...

Payments have been decreasing steadily since then.

Another part that is wishful thinking is,

...anesthesiologists making $400K/year...

This may be true in certain isolated parts of the country, depending on the type of practice, but not everywhere.

 

[pgg]

Yeah, my narrative was a little tongue-in-cheek, but it was the "short version" ...

I remember being in college back then, with sort of an inkling of interest in anesthesia, reading that anesthesia was going to be a nurse job soon.

 

[RussianJoo]

also wasn't there a high unemployment rate and attendings were making a little more than crna's?

so kind of like what we're seeing these days with chairman Maobama threatening more cuts, and CRNA's winning practice rights in cali?

I think the popularity for anesthesia is still increasing, i would imagine more people applied to the field this year than last.

 

[Sergio99]

Yeah, my narrative was a little tongue-in-cheek, but it was the "short version" ...

I remember being in college back then, with sort of an inkling of interest in anesthesia, reading that anesthesia was going to be a nurse job soon.

Hello,

Actually, you were pretty much correct, for such a short version of the story. I think another factor was the corporatization of medicine. As doctors, the MBAs think they own us, insurance companies think they own us, the government thinks it owns us, hospital administrators think they own us, lawyers think they own us, and as anesthesiologists, on top of all of that, surgeons think they own us. Well, of course, surgeons think they own the world, so we are just one little element inside that world that they own, but this is not new. Oh, and I was forgetting nurses, they also think they own us.

Everybody wants to get the first and biggest share of the pie, so they invent ways of diverting the money out of our way so they can skim the cream before it gets to us, such as more layers of bureaucracy where dollars get filtered and reduced.

And regarding CRNAs, it doesn't cease to amaze me how arrogantly they think they can replace us, and that they know as much as or more than we do. With 34 years in the profession (started residency in 1976), I still find stuff I don't know and need to learn. How can these supermen and superwomen called CRNAs know everything from day one? And they want to boss us around. I have heard them tell with their very own words, "if we can't make you do what we want from here, we will do it from above; we will study health administration and be your bosses." And this was not an idle threat; some of the people involved in this discussion did go to business school and became health administrators.

So this is what has happened in the 90s to anesthesia. Because of what you accurately described in your summary, it was a more aggravated version of what happened to medicine in general. I had forgotten some of the details. You just reminded me of those days.

 

[orangele]

I was an anesthesiology resident when the "crash" occurred and as I recall it was related to a study coming out about a relative oversupply of anesthesiologists in the foreseeable future as pasted below. Basically the incorrect predictions of this study, scared the graduating medical student classes away from anesthesiology. I recall that starting jobs for my graduating class pretty much dried up, with some of my classmates getting offers less than for what the CRNAs were being paid at the affiliated VA hospital. I even recall a first yr resident asking my advise about leaving the residency to go to internal medicine since the outlook looked so bleak and he did indeed leave the program. After 3-5 years though the picture began to completely change, and it became apparent that a shortage was developing, and the job market greatly improved.

http://www.asahq.org/Newsletters/2001/04_01/eckhout.htm

 

[heathermed]

So from my limited experience, it seems that the circumstances that created the 90s panic is somewhat re-materializing with obama care and crna gaining more rights. Yet, anesthesia residency is more competitive than ever! is there a disconnect here?

 

[RussianJoo]

So from my limited experience, it seems that the circumstances that created the 90s panic is somewhat re-materializing with obama care and crna gaining more rights. Yet, anesthesia residency is more competitive than ever! is there a disconnect here?

yeah that's what i said a few posts above. i think this time people don't want to fall for the scare tactic, it's like the boy that cried wolf. hopefully things don't turn as bad as they were in the 90's.

 

[nlfru]

So from my limited experience, it seems that the circumstances that created the 90s panic is somewhat re-materializing with obama care and crna gaining more rights. Yet, anesthesia residency is more competitive than ever! is there a disconnect here?

Do a search... EVERY year is the most competitive ever. The truth is that it is really not that super competitive. Applicants just apply to a lot of programs for some reason or another. There is a current anesthesia bubble that is deflating. Without question, it should reinflate at some point and the cycle will repeat. IMHO.

 

[MCYan]

I remember multiple attendings at various programs telling me that there was some article posted on front page of NY times basically bashing the specialty of anesthesia just a short while before residency apps were due.

 

[pgy13]

I remember multiple attendings at various programs telling me that there was some article posted on front page of NY times basically bashing the specialty of anesthesia just a short while before residency apps were due.

Actually it was the Wall St. Journal.

 

[badasshairday]

Does anyone have a link or access to that article? It would be interesting to see what it said.

 

[RussianJoo]

a quick search brings up the thread with basically the same title which was started by me. in it you'll find a link to the WSJ article.

http://forums.studentdoctor.net/showthread.php?t=639063&highlight=Anesthesia

 

[karizma098]

even when there were jobs - the mentality of other health care practitioners was that 'anesthesiology is an over flooded field, i can screw new grads and make money on them '.

my old man came out of residency and too a job for ~ 100 k / year in indiana. after his first year working for the surgicenter he realized the docs were making about 185 grand profit on his services. he quit, moved 20 miles away and started working independently. as the years went on, the fear died down, business went up , and everything was fine. don't worry so much.