What's wrong with anesthesiology?

[Noyac]

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We are quick to crucify the past practitioners for supervising nurses from the lounge or even outside of the hospital. We don't hesitate to place the blame on them for ruining our good standing in the medical society and ruining anesthesiology as a whole.

But our current members are no different at times. We go home after lunch. We drive the nicest cars. We have the biggest homes. Take the best vacations. And on and on. Everyone is watching. Society is willing to throw doctors under the bus because "the doctors" have it so good in their eyes. We are an easy target to someone working 8-5 with 2weeks vacation making <$100,000/yr. We look priveledged to regular people and it doesn't matter to them what it took on our part to get there. They don't care that I gve up my 20's while they were partying theirs asses off having a good 'ol time. It's all about the impression we give now. Jealousy, maybe but it doesn't matter because to others we have it made and they don't.

Which brings me back to anesthesiologists. We are seen as the priviledged physicians. We make good money and we have good schedules. Nobody cares how stressful it is or anything like that. All they see is us either releasing each other as if we are interchangeable. Going home mid day. Driving nice cars taking great vacations. And on and on. They don't know we were up at 3am doing heroic deeds from time to time. And they don't care.

So how do we change this or do we even care. Here's a hint, we had better care.

 

[gasdoc77]

A start would be to stop giving the impression to lay folk that we are swimming in it. I cringe every time I read the Yahoo articles about the highest paid physicians. That's BS. We are nowhere near the top. I am convinced that others are sandbagging those surveys. We have abysmal Medicare reimbursement (some of the worst!).

 

[Mman]

We make good money and we have good schedules. Nobody cares how stressful it is or anything like that. All they see is us either releasing each other as if we are interchangeable. Going home mid day. Driving nice cars taking great vacations. And on and on. They don't know we were up at 3am doing heroic deeds from time to time. And they don't care.

Part of the problem is that we don't "have good schedules". We work a lot. I believe most surveys put anesthesiologists at or near the top of phyisican work hours. My schedule is an example. Do I have days where I get out early and have the rest of the day to go golf or wander around town? Sure. But I'm also working overnight in house call about 3 times a month. I'm also staying late (9 PM or later) and home on beeper call another 4-6 times a month. I'm also working shifts on the weekends. So if somebody sees me golfing Tuesday morning, they might think I'm living the easy life but they fail to see I'm already scheduled to work about 65 hours that week and am on call from home for more.

 

[Triple AAA]

As for our schedules, people always forget that surgery and anesthesia go hand in hand. We come in when the first surgeons come in and leave when the last surgeons leave. Unless you work in a strictly outpatient center, you will have call, sometimes quite frequently. We may stay well into our post call days as well, if the schedule is busy enough.

 

[Yangkower]

This is comes up a lot with nurses that I work with. I am always quick to remind them that I pay 4000-5000 dollars per month for student loans that I cannot deduct from my taxes. I also drive a 10 year old car with stuff falling off of it. I also like to remind them when I worked all night and unlike them I get no extra pay for it. I think I almost have them feeling sorry for me.

 

[urge]

This is comes up a lot with nurses that I work with. I am always quick to remind them that I pay 4000-5000 dollars per month for student loans that I cannot deduct from my taxes. I also drive a 10 year old car with stuff falling off of it. I also like to remind them when I worked all night and unlike them I get no extra pay for it. I think I almost have them feeling sorry for me.

They don't feel sorry. They think you are an idiot.

 

[urge]

I think the biggest problem with anesthesia is that we hand off our cases routinely to go home early. It gives the impression that we don't care.

I hate handing off or taking over cases. The second person is never vested in the case.

 

[pgg]

I think the biggest problem with anesthesia is that we hand off our cases routinely to go home early. It gives the impression that we don't care.

I hate handing off or taking over cases. The second person is never vested in the case.

Totally agree. I mentioned my negative opinion of our "break culture" in another thread the other day, and my irritation at having to assign people to do nothing but give breaks each day. At least one person responded as if I'd said something sacrilegious.

I can't stop putting people on break duty, there's be a mutiny, but I try to set an example of refusing them and finishing my cases, even if I have to stay a little later.

 

[kazuma]

I think the biggest problem with anesthesia is that we hand off our cases routinely to go home early. It gives the impression that we don't care.

I hate handing off or taking over cases. The second person is never vested in the case.

I agree, I try to finish cases whenever I can especially if they are pediatric or complex cases. Sometimes it sucks because I'll have to relieve a nurse after my case finishes. A while ago someone came to relieve me at 3pm as I was pre-24 hr call, but I told them I'd stay a couple hours until my case finished. After the case finshed I was rewarded with an add on 6 hour elective spine case which finished after 11pm and I had to be back for my 24 hr shift at 6am.

Attendings can be the worst offenders, occasionally I'll have 3-5 attendings call into the room to notify me they are "taking over". They may or may not actually make a physical appearance in the room. I have a lot of respect for the attendings who stay late and finish cases with me when they could have been home hours earlier.

While its not always practical, I think in most circumstances finishing your cases the professional thing to do

 

[Ignatius J]

I think you paint with a broad brush.

I am in a physician only practice. It is 100% do your own cases. It is the way to go and I love it. I rarely get a break when I am in the OR because all of the partners are doing their cases. We bust it in between to drop off the patient, set up, and go see the next patient.

When **** goes bad, we don't have 5 anesthesia personnel descending on the OR from the physician's lounge. It's just one guy. Maybe another anesthesiologist in between cases that will drop what he is doing if it gets very bad. As a result, I feel respect from nurses and surgeons. If I am in the hospital, I am treating patients hands-on 99% of the time (unless there is a case delay), not sitting at a computer or circulating around signing charts and leaving.

 

[deleted171991]

I think you paint with a broad brush.

I am in a physician only practice. It is 100% do your own cases. It is the way to go and I love it. I rarely get a break when I am in the OR because all of the partners are doing their cases. We bust it in between to drop off the patient, set up, and go see the next patient.

When **** goes bad, we don't have 5 anesthesia personnel descending on the OR from the physician's lounge. It's just one guy. Maybe another anesthesiologist in between cases that will drop what he is doing if it gets very bad. As a result, I feel respect from nurses and surgeons. If I am in the hospital, I am treating patients hands-on 99% of the time (unless there is a case delay), not sitting at a computer or circulating around signing charts and leaving.

+1. I work in the same kind of practice mostly, but I think we are going the way of the dinosaurs.

 

[Ignatius J]

+1. I work in the same kind of practice mostly, but I think we are going the way of the dinosaurs.

Yeah, haven't been out here long enough to get the pulse on what the prognosis is long-term. Currently the group is doing whatever we need to do to preserve our existence for the foreseeable future. Hopefully it continues.

 

[cognitus]

This is comes up a lot with nurses that I work with. I am always quick to remind them that I pay 4000-5000 dollars per month for student loans that I cannot deduct from my taxes. I also drive a 10 year old car with stuff falling off of it. I also like to remind them when I worked all night and unlike them I get no extra pay for it. I think I almost have them feeling sorry for me.

$4000-5000???? What's the interest rate on that??

 

[BuzzPhreed]

So how do we change this or do we even care. Here's a hint, we had better care.

Greed, apathy, and lack of knowing how to lead. That's the problem. Too many "nice" guys trying to be "friends" with the CRNAs.

 

[Wan2BanMD]

I also think people don't pay attention to the sacrifices doctors make, both personally AND ECONOMICALLY, to become doctors. Im gonna be digging myself out of this $300K hole for awhile, even if I am making > $250K before taxes, not to mention the absurdly high interest rates on these loans. People are ignorant, and I have not problem spelling out the reality to anyone who says doctors get too much money.

 

[IlDestriero]

I also think people don't pay attention to the sacrifices doctors make, both personally AND ECONOMICALLY, to become doctors. Im gonna be digging myself out of this $300K hole for awhile, even if I am making > $250K before taxes, not to mention the absurdly high interest rates on these loans. People are ignorant, and I have not problem spelling out the reality to anyone who says doctors get too much money.

If you think some nurse or Joe punch clock who will probably work until he physically can't anymore and retire with little to show for 40+ years of labor, dependant on social security, gives a shït about your $250k of debt, you're delusional.
Your income in anesthesia, even if cut by 1/3 will still be 5+ times the average family income in America. In a few years you will do things and have opportunities that others only dream of. You will take vacations twice a year that families save years to do once, and you won't give it a second thought. Don't ever cry remotely poor, you will sound like an entitled dingus.

 

[BuzzPhreed]

The problem is that most of the rest of the world all thinks we make $1,000,000+/year and that most of us are distant, disinterested, and arrogant dicks. That's the real problem. And that's why they have no problem suing us when something goes wrong, whether or not it was actually our fault. That can only be battled with an individual change of attitude at the bedside.

 

[Ipassgas]

The problem is that most of the rest of the world all thinks we make $1,000,000+/year and that most of us are distant, disinterested, and arrogant dicks. That's the real problem. And that's why they have no problem suing us when something goes wrong, whether or not it was actually our fault. That can only be battled with an individual change of attitude at the bedside.

Buzz, I think you're flat out wrong.
We have the same problem congress people have.

Uniformly, in every state, going back as far as you want to, Americans hate congress. Hate it. It doesn't do enough. It does too much. They never work. They give themselves raises. They're disconnected. They're privileged. They're out of touch.

But I love MY congressperson. He/she connects with me in those tv ads, promising to fight the good fight for me! I have a voice in Washington! I can never vote against MY candidate! My person is wonderful, it's all of those OTHER jokers messed up congress members ruining the country! If only those OTHER people voted right, like for MY guy, we'd be perfect!

Now replace congressperson with doctor, and we're still speaking the truth.

My doctor cares and works hard for me! It's all those OTHER doctors killing babies making a billion dollars a year on MY tax dollars. THOSE doctors golf every day, but not mine. My doctor works hard and loves me!

People are skeptical of things for a reason. They say they want their doctor well compensated because they know they want a doc who isn't dissatisfied and frustrated.
They just want OTHER people's doctors to live on food stamps.

If you can figure out how to change people's opinions about what is acceptable for others, you can win every Nobel peace prize for eternity. In fact, they'd quit giving it out, as there'd be no need.

ETA: This is the reason that representatives have an 80% chance of being re-elected, and except for a few bad cycles in the 70's, senators approach an 80% re-election rate (1964-2012).
People hate congress, but love their congressman/woman.
I saw this very starkly in my grandparents. In one sentence they'd say throw the bums out, but I'm voting for the incumbent. And all doctors do is play golf, except my guy, he works so hard and cares about me!
I couldn't make it up if I wanted to.

 

[BuzzPhreed]

Buzz, I think you're flat out wrong.
We have the same problem congress people have.

Uniformly, in every state, going back as far as you want to, Americans hate congress. Hate it. It doesn't do enough. It does too much. They never work. They give themselves raises. They're disconnected. They're privileged. They're out of touch.

But I love MY congressperson. He/she connects with me in those tv ads, promising to fight the good fight for me! I have a voice in Washington! I can never vote against MY candidate! My person is wonderful, it's all of those OTHER jokers messed up congress members ruining the country! If only those OTHER people voted right, like for MY guy, we'd be perfect!

Now replace congressperson with doctor, and we're still speaking the truth.

My doctor cares and works hard for me! It's all those OTHER doctors killing babies making a billion dollars a year on MY tax dollars. THOSE doctors golf every day, but not mine. My doctor works hard and loves me!

People are skeptical of things for a reason. They say they want their doctor well compensated because they know they want a doc who isn't dissatisfied and frustrated.
They just want OTHER people's doctors to live on food stamps.

If you can figure out how to change people's opinions about what is acceptable for others, you can win every Nobel peace prize for eternity. In fact, they'd quit giving it out, as there'd be no need.

Interesting perspective. Thanks for sharing.

 

[Consigliere]

We are quick to crucify the past practitioners for supervising nurses from the lounge or even outside of the hospital. We don't hesitate to place the blame on them for ruining our good standing in the medical society and ruining anesthesiology as a whole.

But our current members are no different at times. We go home after lunch. We drive the nicest cars. We have the biggest homes. Take the best vacations. And on and on. Everyone is watching. Society is willing to throw doctors under the bus because "the doctors" have it so good in their eyes. We are an easy target to someone working 8-5 with 2weeks vacation making <$100,000/yr. We look priveledged to regular people and it doesn't matter to them what it took on our part to get there. They don't care that I gve up my 20's while they were partying theirs asses off having a good 'ol time. It's all about the impression we give now. Jealousy, maybe but it doesn't matter because to others we have it made and they don't.

Which brings me back to anesthesiologists. We are seen as the priviledged physicians. We make good money and we have good schedules. Nobody cares how stressful it is or anything like that. All they see is us either releasing each other as if we are interchangeable. Going home mid day. Driving nice cars taking great vacations. And on and on. They don't know we were up at 3am doing heroic deeds from time to time. And they don't care.

So how do we change this or do we even care. Here's a hint, we had better care.

We may; I know I certainly do. And you know what? I feel not one iota of remorse for it. Guilt? None. I busted my ass to get where I am and sacrificed plenty. I work hard and am compensated accordingly. Those that are jealous or envious or "hate" me for it? So what. They don't even exist to me. What can we do about it?! Who cares - we can do nothing. People have their perceptions and nothing we can do will change them.

 

[Member12344]

If you don't care about the perception, that is fine. You can't change other people. Just please continue to take great care of patients. Keep refusing relief and finish the case yourself. Don't hope to leave early. Stay until things are complete based on your definition of complete. Stay accountable. And affable. Stay idealistic. And altruistic. Keep taking ownership of your patients. Keep pretending they are your loved ones. Keep being a consultant, not just a technician. Medicine is a calling, not just a job. If accomplished with enthusiasm and grace, I suspect any concern about poor perception will melt away at our respective institutions. If not, at least we'll retire (or be fired) on our own terms. And finally, if I'm still able to afford a German car at the end of it all, perhaps all is right in my world?

 

[deleted171991]

If you don't care about the perception, that is fine. You can't change other people. Just please continue to take great care of patients. Keep refusing relief and finish the case yourself. Don't hope to leave early. Stay until things are complete based on your definition of complete. Stay accountable. And affable. Stay idealistic. And altruistic. Keep taking ownership of your patients. Keep pretending they are your loved ones. Keep being a consultant, not just a technician. Medicine is a calling, not just a job. If accomplished with enthusiasm and grace, I suspect any concern about poor perception will melt away at our respective institutions. If not, at least we'll retire (or be fired) on our own terms. And finally, if I'm still able to afford a German car at the end of it all, perhaps all is right in my world?

Let me add </sarcasm>.

 

[Hockeyguy]

So how do we change this or do we even care. Here's a hint, we had better care.

Perception is reality. A little kindness, humility and decorum can go along way to changing that perception. I think a perfect example is our fallen brother Norm AKA UTSouthwestern. I chatted with him frequently and I can't imagine anyone resented that guy.

 

[urge]

aclstest.org

Thread hijack:

1 What is the "National Board of Critical Care Education"?

2 None of the hospitals I have been in accept non AHA acls courses. Isn't that the norm?

 

[deleted171991]

None of the hospitals I have been in accept non AHA acls courses. Isn't that the norm?

It's not. There is an entire industry of online courses.

Honestly, I think the ACLS is a big scam, along the lines of MOCA.

 

[urge]

It's not.

Is anyone interested in Urge's ACLS provider course and card? I'll give you a volume discount.

Hint for the test: Pent Sux Tube!

 

[Hockeyguy]

Thread hijack:

1 What is the "National Board of Critical Care Education"?

2 None of the hospitals I have been in accept non AHA acls courses. Isn't that the norm?

It's a company an ER doc I work with owns and operates. I wrote several test questions and was compensated for that in the interest of full disclosure. I agree ACLS is a scam. Not sure why a cardiac surgeon who stops and starts a heart six times a week needs it to practice and not sure why it matters if its AHA presenting material or someone else. I'm on my med exec staff and we accept it as our by laws don't specify ACLS training be AHA specific. I'll ask about National Board of Critical Care Education.

 

[urge]

I'll ask about National Board of Critical Care Education.

I pointed at Pandora's box. Open it at your own risk.

 

[IlDestriero]

I pointed at Pandora's box. Open it at your own risk.

It's the extra bedroom in his house that has a filing cabinet in the closet. (Nice write off BTW)
Ask your buddy if I can be a board member and sit on his board of directors. I like adding useless things to my CV. It's like nurse title padding, but for the wealthy and educated.

 

[drmwvr]

The biggest problem with anesthesiology is that no where in the world are there found more 6 (7) figure whiners that don't directly generate income for hospitals. We are overhead as far as administrators are concerned. THAT is why anesthesiologists, and by extension and because of,the mid levels, will be for the foreseeable future second class citizens. The OP is correct. We need to shut our mouths, stop the gratuitous justification of ourselves to anyone that will listen and do our own jobs. We call far too much attention to ourselves. I know... heresy. But how's it been going so far?

 

[Consigliere]

The biggest problem with anesthesiology is that no where in the world are there found more 6 (7) figure whiners that don't directly generate income for hospitals. We are overhead as far as administrators are concerned. THAT is why anesthesiologists, and by extension and because of,the mid levels, will be for the foreseeable future second class citizens. The OP is correct. We need to shut our mouths, stop the gratuitous justification of ourselves to anyone that will listen and do our own jobs. We call far too much attention to ourselves. I know... heresy. But how's it been going so far?

Not bad, not bad. I've got 4 houses in 2 states, 3 cars, a boat, and go to vacations at exotic locales. I'm also married with 4 kids. Life is good.

 

[IlDestriero]

Not bad, not bad. I've got 4 houses in 2 states, 3 cars, a boat, and go to vacations at exotic locales. I'm also married with 4 kids. Life is good.

That's exactly what I was thinking.
It's been going great. We grease the engine that funds the hospital. Be careful using discount oil in your fancy engine.

 

[Hockeyguy]

We grease the engine that funds the hospital. Be careful using discount oil in your fancy engine.

A good Anesthesia department is a lot like a plunger. You never really give it much though it when you have one tucked behind the toilet. But if you clog a toilet at a dinner party and there isn't one around - you'd pay any amount to have one.

 

[Mman]

The biggest problem with anesthesiology is that no where in the world are there found more 6 (7) figure whiners that don't directly generate income for hospitals. We are overhead as far as administrators are concerned.

Whiners? The things I whine about SAVE the hospital money. I help them be more efficient in the utilization of their ORs which are insanely expensive (and they are not paying me a penny). I help them create a safer environment for patients which saves them lawsuits. I don't generate income for the hospital, but I help cut their expense to the minimum which is the same thing for the bottom line.

 

[gasdoc77]

A good Anesthesia department is a lot like a plunger. You never really give it much though it when you have one tucked behind the toilet. But if you clog a toilet at a dinner party and there isn't one around - you'd pay any amount to have one.

 

[deleted171991]

Except that this plunger is seen as being more expensive than a plumber.

 

[BuzzPhreed]

Whiners? The things I whine about SAVE the hospital money. I help them be more efficient in the utilization of their ORs which are insanely expensive (and they are not paying me a penny). I help them create a safer environment for patients which saves them lawsuits. I don't generate income for the hospital, but I help cut their expense to the minimum which is the same thing for the bottom line.

^^^^ This.

If you're seen as a "value added" service people will want to keep you around. The problem is the huge machine that has become the modern AMC can often do this so much more efficiently than the little guy. That's why being A-A-A is critical, and forming those relationships with the staff that mean you're a difficult-to-replace asset and not a burden. No one wants to see a different face behind the curtain every week. That's what AMCs and mega-practices offer. There's not necessarily a "relationship" there. And that's important still.

 

[Hockeyguy]

There's not necessarily a "relationship" there. And that's important still.

I agree. It's a lot harder to swipe a pen and uproot a friend someone you consider a friend. If you're perceived as a combative dick, Adios. As the saying goes keep your friends close. Your enemies closer.

 

[Noyac]

Well, this thread has taken a welcome turn.
I really like the dialogue. As a profession we are under the gun. That's all we need to remember.