with all the infor on this board, i am getting scared to apply for gas

[amherstguy]

can someone comment on why to apply for gas now? it seems that everyone on this board is concerned with the fields future and its huge projected paycuts? i am about to apply this year but now i am seriously reconsidering it

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[urge]

Paycuts are coming, for all specialists. How bad will it be? Hard to say. Maybe primary care will become the new "ROAD". I wish I could be of more help, but the bottom line is we don't know.

 

[AK_MD2BE]

can someone comment on why to apply for gas now? it seems that everyone on this board is concerned with the fields future and its huge projected paycuts? i am about to apply this year but now i am seriously reconsidering it

I am with you Amherst guy as I am also an MS4 that is becoming leery of going into Anesthesiology.
Can anyone provide some "reassurance"?

 

[Hockeyguy]

Imagine how scary it is for us about graduate? I have talked to several excellent groups who have bassically stated "in any other year we would offer you a job on the spot....but with this nightmare scenario likely to play out in some form we have to hold off..." Its understandably scary for all of us. Hang in there and get involved!

 

[hoyden]

can someone comment on why to apply for gas now? it seems that everyone on this board is concerned with the fields future and its huge projected paycuts? i am about to apply this year but now i am seriously reconsidering it

If your interest in the specialty is mostly money driven you should look somewhere else - Anesthesiology is a tough specialty which requires a lot of personal sacrifice. If your interests are wide, you may want to consider other specialties. Everything depends on the balance you are looking for.

 

[amherstguy]

its not about the money. its about having a job/job security. if a field is so volatile, which i get the impression on this board, it would suck to go into it and not have a job after 5 or 6 years! im not looking to make bank but hold down a job and not worry that a nurse might take it away from me! i think thats a pretty legit concern...

 

[hoyden]

its not about the money. its about having a job/job security. if a field is so volatile, which i get the impression on this board, it would suck to go into it and not have a job after 5 or 6 years! im not looking to make bank but hold down a job and not worry that a nurse might take it away from me! i think thats a pretty legit concern...

By no means I meant to insult you, but money IS an issue, especially a balance between the effort put into the everyday work/time/reimbursement/lifestyle.

 

[jwk]

By no means I meant to insult you, but money IS an issue, especially a balance between the effort put into the everyday work/time/reimbursement/lifestyle.

Uh huh. Please tell me you didn't vote for the chosen one, like many in your age group, because if you did, you reap what you sow.

This is the problem that hasn't been addressed in healthcare "reform". Sure, there are those who go into medicine and don't look for big bucks - but paying back those $250k student loans takes money.

 

[pgg]

can someone comment on why to apply for gas now?

Because you like the specialty?

Paycuts are coming, for all specialists. How bad will it be? Hard to say. Maybe primary care will become the new "ROAD". I wish I could be of more help, but the bottom line is we don't know.

I don't think primary care will ever be attractive to us ROADites because most ROADites hate clinic. I wouldn't do FP and torture myself with a patient every 15 minutes if it paid $400K/year.

its not about the money. its about having a job/job security.

If you're flexible about where you live and are willing to move, you'll have a job. From the sound of this board, it sometimes seems like some people would rather be unemployed than leave their 50-mile-radius comfort zone ... but virtually every state has non-urban areas that need physicians of all specialties. And $300K goes a lot further in that inland town of 100,000 than it does in San Francisco or New York City.

 

[foxtrot]

its not about the money. its about having a job/job security. if a field is so volatile, which i get the impression on this board, it would suck to go into it and not have a job after 5 or 6 years! im not looking to make bank but hold down a job and not worry that a nurse might take it away from me! i think thats a pretty legit concern...

This is a legitimate concern. I would really think long and hard about your decision.

 

[Chrysanthemum]

I can't believe what crappy businessmen/women so many doctors and med students are. There are a lot of residents and med students that I've spoken to who are so blasé about this whole issue.

You guys have put years of hard work and dedication into training and you're just sitting back and letting the government take control of your future? "Well whatever happens is gonna happen. I'll just have to adjust to it." I've heard this from so many people it's just sickening.

Do you realize that we will become indentured servants if this bill is passed? We will be paying off your med school debt to the government until we're 70 years old! - The same government who is trying to reduce our salaries by 66% -

Not to mention that there are people making >100K a year doing things like landscaping or teaching phys. ed in high school. How does that even compare to the years of studying and payless training that we endure to save people's lives??

What about the stress that comes with handling someone's life in your hands, the long hours of work and study, the sleepless nights on-call, time spent away from our families dedicated to patient care, our med school debt, and not to mention the risk of lawsuits with every patient we see.

Everyone expects doctors to help other people purely out of the kindness of their hearts and by all means most of us love to help patients in need but the care that we provide is priceless.

If someone came into the hospital dying and asked for help we could easily be like "Ummm NOPE! Sorry we don't take your insurance... it just doesn't pay enough. Howeverrr, I do notice that you parked a big classic Cadillac outside... tell you what mister... give me the keys to that Caddy and I'll make sure that you'll live to see another day."

That is the power that we possess! Now I'm not saying that we should ever do that... but that just goes to show how priceless our "service" is...yet a major price tag is being put on it by Obama and these private insurance companies. We should be getting paid a lot more than we already are and to reduce it even more is straight up robbery!

 

[ssmallz]

I can't believe what crappy businessmen/women so many doctors and med students are. There are a lot of residents and med students that I've spoken to who are so blasé about this whole issue.

You guys have put years of hard work and dedication into training and you're just sitting back and letting the government take control of your future? "Well whatever happens is gonna happen. I'll just have to adjust to it." I've heard this from so many people it's just sickening.

Do you realize that we will become indentured servants if this bill is passed? We will be paying off your med school debt to the government until we're 70 years old! - The same government who is trying to reduce our salaries by 66% -

Not to mention that there are people making >100K a year doing things like landscaping or teaching phys. ed in high school. How does that even compare to the years of studying and payless training that we endure to save people's lives??

What about the stress that comes with handling someone's life in your hands, the long hours of work and study, the sleepless nights on-call, time spent away from our families dedicated to patient care, our med school debt, and not to mention the risk of lawsuits with every patient we see.

Everyone expects doctors to help other people purely out of the kindness of their hearts and by all means most of us love to help patients in need but the care that we provide is priceless.

If someone came into the hospital dying and asked for help we could easily be like "Ummm NOPE! Sorry we don't take your insurance... it just doesn't pay enough. Howeverrr, I do notice that you parked a big classic Cadillac outside... tell you what mister... give me the keys to that Caddy and I'll make sure that you'll live to see another day."

That is the power that we possess! Now I'm not saying that we should ever do that... but that just goes to show how priceless our "service" is...yet a major price tag is being put on it by Obama and these private insurance companies. We should be getting paid a lot more than we already are and to reduce it even more is straight up robbery!

Thats all well and good but unfortunatly there's not much we can do. America is voting and nonphysicians outnumber physicians. America likes the idea of universal health care and they want it on the cheap. If this many legislatures and the prez want this to pass it will. We can't form a union and unless we have the entire healthcare profession united, we can't make much of a stand or we look like "greedy doctors trying to justify their pay checks". I agree that we do deserve to make the salaries we are making right now and then some for the hard work we've put in but unfortunatly, that will have to be determined when we start selling our services @ market value by not taking insurance.

For anyone applying to anesthesia the issues discussed will apply to every specialty not just ours. Go into the one you like b/c you never know what the future holds

 

[hoyden]

Uh huh. Please tell me you didn't vote for the chosen one, like many in your age group, because if you did, you reap what you sow.

Would be really interesting what age group you put me in and who is the chosen one?


Actually it would be even more interesting to find out which words have led to this conclusion?

This is the problem that hasn't been addressed in healthcare "reform". Sure, there are those who go into medicine and don't look for big bucks - but paying back those $250k student loans takes money.

 

[Bertelman]

its not about the money. its about having a job/job security. if a field is so volatile, which i get the impression on this board, it would suck to go into it and not have a job after 5 or 6 years! im not looking to make bank but hold down a job and not worry that a nurse might take it away from me! i think thats a pretty legit concern...

If you are a hard worker and competent, I don't foresee you having problems keeping a job. You may not get your pick of location, but I can't recall too many physician specialties that were literally placed out of their livelihood.

Anesthesia may have some stormy weather ahead, but the death of the specialty is way overblown. If you enjoy the field, and don't expect to make >300k per year, you should be fine. I really don't believe we'll drop much below 200k. 10 years from now, I wouldn't be surprised if we're not far from where we are now. Don't underestimate the power of smart, motivated individuals to find creative was to extract money from govt and insurance machines. This specialty has survived many challenges. I'm sure plenty of people were calling for the death of the field in the 90's but that clearly never happened.

 

[Coastie]

The fact that our board is full of strategies to overcome the government takeover is all the more reason to join our specialty.

No heads in the sand here.

 

[OneFellSwoop]

I may be an optimist here, but if Obama's "pay for quality" rather than the way it is done today (paid more for doing more) becomes reality, doesn't anesthesiology stand to potentially benefit (or just not suffer as much as some other specialties) as it has become one of the safest specialties in medicine while taking care of patients when they are about as close to death as medically possible, not only that, but brought back from that brink with just the occasional PONV and pain? Not to mention the pain control provided during labor, developing safer (ie higher QUALITY) regional anesthestic techniques all in the name of patient's safety, comfort, and improved QUALITY of their OR or labor experience.

I know that the paying for quality began as a primary care idea, but if the gov't runs things, it seems like that type of reinbursement would go across the board. Just a thought, and if I'm misunderstanding something, let me know.

 

[maceo]

I can't believe what crappy businessmen/women so many doctors and med students are. There are a lot of residents and med students that I've spoken to who are so blasé about this whole issue.

You guys have put years of hard work and dedication into training and you're just sitting back and letting the government take control of your future? "Well whatever happens is gonna happen. I'll just have to adjust to it." I've heard this from so many people it's just sickening.

Do you realize that we will become indentured servants if this bill is passed? We will be paying off your med school debt to the government until we're 70 years old! - The same government who is trying to reduce our salaries by 66% -

Not to mention that there are people making >100K a year doing things like landscaping or teaching phys. ed in high school. How does that even compare to the years of studying and payless training that we endure to save people's lives??

What about the stress that comes with handling someone's life in your hands, the long hours of work and study, the sleepless nights on-call, time spent away from our families dedicated to patient care, our med school debt, and not to mention the risk of lawsuits with every patient we see.

Everyone expects doctors to help other people purely out of the kindness of their hearts and by all means most of us love to help patients in need but the care that we provide is priceless.

If someone came into the hospital dying and asked for help we could easily be like "Ummm NOPE! Sorry we don't take your insurance... it just doesn't pay enough. Howeverrr, I do notice that you parked a big classic Cadillac outside... tell you what mister... give me the keys to that Caddy and I'll make sure that you'll live to see another day."

That is the power that we possess! Now I'm not saying that we should ever do that... but that just goes to show how priceless our "service" is...yet a major price tag is being put on it by Obama and these private insurance companies. We should be getting paid a lot more than we already are and to reduce it even more is straight up robbery!

\


your preaching to the choir. weve heard it well we know it we live it we use lube everyday when we bend over.. anything else you want to say. Short of all of us staying home for months on end (which is never going to happen) we are at their mercy. thanks for coming.

 

[maceo]

Because you like the specialty?



I don't think primary care will ever be attractive to us ROADites because most ROADites hate clinic. I wouldn't do FP and torture myself with a patient every 15 minutes if it paid $400K/year.



If you're flexible about where you live and are willing to move, you'll have a job. From the sound of this board, it sometimes seems like some people would rather be unemployed than leave their 50-mile-radius comfort zone ... but virtually every state has non-urban areas that need physicians of all specialties. And $300K goes a lot further in that inland town of 100,000 than it does in San Francisco or New York City.

you can like your specialty all you want but if you cant find a job anywhere where you will be happy. guess what? you aint gonna be happy.

I would definitely do fp if i had to do it over again. I would find a job seeing patients (low accuity), 8 hours per day. and roll out at the end of 8 hours.. no call no weekends no errors. anything over 8 hours.. negotiate overtime..

the op has made a great point.. this specialty is in for some big surprises in the future..

 

[CambieMD]

Apply to anesthesiology because you like anesthesia and not just the idea of not rounding and making more $$$ than pcps.

I do not like what may happen to health care. I would never consider another profession because I love medicine.

Obama has it all wrong. There is no mention of cutting the waste out of health care. How much of every dollar spent on health care actually goes towards direct patient care.

One last note. Please try to keep your med school debt as low as is possible. Try to pay at least your quarterly interest. Albert Einstein said that compound interest was the greatest invention of the century. Try to keep your principal as low as you can. I am down to 25 k. I also send my payment off as soon as I get my bill. The interest is on less and it is compounded daily.

Cambie

 

[amherstguy]

so much for any reassurance , nobody has really addressed the issue of job security in gas. also btw didn't the new proposed reimbursement schema actually up gas by 6%?! what makes this field more volatile than something like cards or gi?

 

[maceo]

so much for any reassurance , nobody has really addressed the issue of job security in gas. also btw didn't the new proposed reimbursement schema actually up gas by 6%?! what makes this field more volatile than something like cards or gi?

more and more physician only groups will be taken over by groups that have 4 docs and 15 crnas.. vs 16 docs . this is gonna cause a problem at some point unless the docs are retiring in droves

 

[BLADEMDA]

more and more physician only groups will be taken over by groups that have 4 docs and 15 crnas.. vs 16 docs . this is gonna cause a problem at some point unless the docs are retiring in droves

I predict 2-3 docs and 20 CRNAs in about ten years.

 

[BLADEMDA]

militarymd

Anesthesiologist

Last Online: 13 Hours Ago 05:10 AM
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Re: AMA backs public plan... against ASA wishes
Quote:
Originally Posted by armygas
I hear you and understand, but in many many many of the civilian places I have worked, the anesthesiologists didn't do anything but surgical anesthesia services.

For example, in Large teaching hospitals, when do you ever see Anesthesiologists running the ICU? I haven't at least in Denver, Baltimore, St. Louis, El Paso, Albequerque, and some others.

Also, I have worked in many community civilian hospitals, same thing applies.

I remember reading your posts where you mention that US Anesthesiology is nothing like the European Model in which they do run that setting, but I don't see it here.


yup , and those guys WILL be replaced by you guys.

 

[BLADEMDA]

militarymd

Anesthesiologist

Last Online: 13 Hours Ago 05:10 AM
Join Date: Nov 2006
Posts: 302 Downloads: 0
Uploads: 0

Re: AMA backs public plan... against ASA wishes
Quote:
Originally Posted by armygas
I hear you and understand, but in many many many of the civilian places I have worked, the anesthesiologists didn't do anything but surgical anesthesia services.

For example, in Large teaching hospitals, when do you ever see Anesthesiologists running the ICU? I haven't at least in Denver, Baltimore, St. Louis, El Paso, Albequerque, and some others.

Also, I have worked in many community civilian hospitals, same thing applies.

I remember reading your posts where you mention that US Anesthesiology is nothing like the European Model in which they do run that setting, but I don't see it here.


yup , and those guys WILL be replaced by you guys.

Anesthesiology is UNLIKELY to survive intact over the next 20 years. If the AANA doesn't destroy it then Obamacare will.

Blade

 

[BLADEMDA]

1. Friday, July 17.
2. 1. The Ways and Means Committee and the Education and Labor Committee approved H.R. 3200 with a few revisions.
   2. Beginning in 2013, qualified health plans – including a public option – would participate in a health insurance exchange. The public option would be self-funding after receiving an initial $2 billion for start-up costs (repaid over 10 years). Payment rates for providers would be based on Medicare rates with a 5% add-on for practitioners participating in Medicare. The implication is that the add-on would disappear and payments to physicians and other practitioners would drop to amounts equal to Medicare in 2016.
      Note that President Obama has expressed support for giving the Medicare Payment Advisory Commission (MedPAC) new power as an executive-level agency to determine Medicare reimbursement of providers. This shift of authority from the legislative to the executive branch surfaced in legislation (S. 1110) introduced May 20 by Sen. Jay Rockefeller (D-WV), chair of the Senate Finance Health Care Subcommittee. MedPAC currently can and does make recommendations, but it has no power to implement them. If MedPAC were to become an executive agency rather than a Congressional advisory body, its recommendations on physician payment and other cost reductions would automatically become law unless opposed by a joint resolution of Congress. It seems likely that Medicare payment rates would drift lower if legislators could no longer be lobbied to prevent cuts. Combine this scenario with Medicare payment rates for services provided to all patients enrolled in the future public option as well as in Medicare, and the specialty of anesthesiology will be in serious trouble.
   3. Provider participation is voluntary but presumed, and providers must act to opt out of the public option.
   4. One-half of the cost of the package would be covered through an income surtax on the wealthiest 1.2% of Americans. Adjusted gross incomes of $350,000 to $500,000 (married couples) would see a 1% surcharge. Families with incomes exceeding $500,000 would pay an additional 1.5% to 5.4% (at the $500,000 level, this would mean a surtax of $1,500, or 0.3% of income, in the Committee’s example). The other half would come from Medicare/Medicaid savings.
   5. The financing provisions noted above are a small part of the entire HCR package. Even more fundamental are the requirements that both individuals and employers pay a tax if they fail to obtain or offer health insurance. A 35-page summary of H.R. 3200, and the full text of the bill, are available on the Ways and Means Committee’s website.
3. The Energy and Commerce Committee, home to many of the Blue Dog Democrats, did not approve the bill. Expect to see efforts to amend H.R. 3200 before the Committee votes later in the week.

 

[BLADEMDA]

This, as we have echoed ASA in repeatedly saying, is anesthesiology’s life-or-death issue. ASA posted its response to the AMA letter on its website on Friday afternoon, withholding support from H.R. 3200 and seeking to dispel any confusion about the schism.

 

[BLADEMDA]

Based on Today's Medicare rates an Anesthesiologist working around 55 hours a week would earn $170,000 or so per year TOTAL. So, after malpractice and benefits a 100% Medicare case load for an Anesthesiologist generates around $110,000 income based on a 55 hour work week.

It gets better. Medicare is likely to slash those rates over time to control costs. Hence, you will be Lucky to earn over $100K take home in about ten years if ObamaCare passes as proposed by the House.

That is true change you can believe in.


If the AANA doesn't get you then Socialized Medicine based on Medicare will.

 

[yasawa]

Everyone just needs to stop freaking out. Apply to anesthesia because you love it(as previously stated). Anyone who has done international rotations or has worked abroad knows that you will always have job security in anesthesia. My father is an anesthesiologist and has worked in norway, sweden, UK, NZ, australia, france, etc. He trained here in the states(MGH) but just loved to travel so that's what we did growing up. He still does 3 months abroad every year. The scandinavian countries have been utilizing CRNAs for the same amount of time if not longer than the US. They are just as prevalent in the academic and "PP" setting as they are here in the US. These countries have national healthcare with some PP hospital/clinic settings and anesthesiologists are doing extremely well. In Norway, anesthesia is still one of the most competitive specialities and most popular. Many compare them to neurosurgeons in terms of prestige! All med students there would love to go into it but its too competitive. Contrary to what BLADE and many others think, the ratio of MD's to CRNAs will most likely not change too drastically. CRNA salaries are so high that they are outcompeting themselves in certain markets. In some academic settings anesthesiologists start at 180,000 while CRNAs are starting at 130,000. For these departments, they are not gaining much by taking on more CRNAs who do not take call, do not publish, and do not bring in research dollars. Again, stop freaking out. Anesthesiology will survive as it has in every country with nationalized healthcare . If this damn bill passes, you may get paid less but you will also be working 40hrs max/wk. You will have job security, you will be making more than the avg person and you will pay off your loans. The important thing now is to man up, call your representatives, send out daily emails and tell them your opinions. Donate to the ASA! (and cancel your AMA membership! they are f'ing losers!

 

[pgg]

the op has made a great point.. this specialty is in for some big surprises in the future..

With all this catastrophic doom'n'gloomin' I don't see how anything short of an asteroid impact could be a surprise to anyone.

And even then, I could see about half breathing a sigh of relief because armageddon stopped Obamacare.

more and more physician only groups will be taken over by groups that have 4 docs and 15 crnas.. vs 16 docs . this is gonna cause a problem at some point unless the docs are retiring in droves

Some of the current salary downturn is surely driven by older anesthesiologists who've seen their retirement accounts hurt badly in the last year and have decided to keep working. They will (of course) still retire at some point ... whether that's in 2 years or 5 or 10 is debatable. Point being, despite this year's non-retirement increase in MD supply, we probably will see more than the usual number of anesthesiologists retiring in the next few years.

With an older fatter America demanding more healthcare services, and the MD supply returning to the expected curve after the current nonretirement bubble passes ... I just don't see any looming problems with the ability to find a job in our field. Less money, probably. But there'll be work for us to do.

 

[Coastie]

militarymd

Anesthesiologist

Last Online: 13 Hours Ago 05:10 AM
Join Date: Nov 2006
Posts: 302 Downloads: 0
Uploads: 0

Re: AMA backs public plan... against ASA wishes
Quote:
Originally Posted by armygas
I hear you and understand, but in many many many of the civilian places I have worked, the anesthesiologists didn't do anything but surgical anesthesia services.

For example, in Large teaching hospitals, when do you ever see Anesthesiologists running the ICU? I haven't at least in Denver, Baltimore, St. Louis, El Paso, Albequerque, and some others.

Also, I have worked in many community civilian hospitals, same thing applies.

I remember reading your posts where you mention that US Anesthesiology is nothing like the European Model in which they do run that setting, but I don't see it here.


yup , and those guys WILL be replaced by you guys.

What's wrong with milmd?

 

[BLADEMDA]

Let's talk $$$-Medicare Dollars

I am going to SIMPLIFY things so Bertelman will understand how poorly medicare treats Anesthesiology relative to Cardiology.

First, let us say an average unit is $65 per unit for most insurance companies. This unit represents what you get paid for doing a case.
An average Anesthesiologist bills 10,000 units per year. If you had 100% private insurance with no stipend then your 1099 income would be around $650,000.

But, here comes Medicare. Medicare pays $17 per unit. So, if you have 100% Medicare then you collect $170,000 for those 10,000 units.

Now, for simplicity sake Cardiology does MUCH better. an invasive Cardiologist gets 75-80% of his/her insurance rate for Medicare. This means that Medicare pays the Cardiologist the equivalence of $48.75 per unit. Not bad. The cardiologist could easily "survive" ObamaCare on 100% Medicare and still earn a very good living.

But, you are "Anesthesia" and get paid $17.00 per unit. The Cardiologist is still getting paid 286% more than you are from Medicare.

When Socialized Medicine/Medicare for the masses arrives which camp do you want to be a member of?

Blade

 

[BLADEMDA]

· It would be unsustainable for the medical specialty of anesthesiology to operate within a public plan option based on Medicare payment rates.

· Payment levels for anesthesia services provided through the new "public health insurance option" must be fixed.

As we have stated in the past, these massive reform proposals inevitably include many issues - both good and bad - that will impact our specialty. We believe that this public option based upon Medicare rates represents the most important of these issues with regard to the well-being of our specialty. As such, it requires our immediate attention. We ask that you please do your part.

The health care reform effort has risen to a new level with the introduction of House legislation. With one Senate bill already under consideration and another one expected to be released soon, it is imperative that we echo our consistent message - that it would be unsustainable for the medical specialty of anesthesiology to operate within a public plan option based on Medicare payment rates.

Michael C. Lewis MD

President: Florida Society of Anesthesiologists

 

[BLADEMDA]

The only person I would advise to enter the field of Anesthesiology is a Nurse or someone looking for a part-time career.

Over the long run Medicare will become the defacto payer and possibly, the only payer in the U.S.

 

[yasawa]

I'm pretty sure every anesthesia program that I interviewed at last year either ran the ICU or had a strong presence in the ICU. At my home school the ICU was co-directed by anesthesia and medicine. At my current program, anesthesia in in charge of the SICU, CTICU and is co director of the MICU. Of all the graduating seniors that I talked to last year while interviewing at various programs, most were wither doing CC or a Peds fellowship. I just finished my PICU rotation and the attending told me that he has seen an increase in the number of graduating pediatric seniors going into an anesthesia residency after finishing peds so that they can do PICU/Peds Anesthesia. Again, it depends on how academic your school is. At my program 90% of last years CA-3s did a fellowship.

 

[Bertelman]

Let's talk $$$-Medicare Dollars

I am going to SIMPLIFY things so Bertelman will understand how poorly medicare treats Anesthesiology relative to Cardiology.

Thanks for the shout-out. Don't act as though I've never seen those numbers before. You started a thread dedicated to the exact topic just a few days ago. You gave me the same "lecture" about reimbursement a couple months ago. Even before that, I had a more informative lecture from the business manager of our department.

I'll offer my own wisdom- Cardiology will be hit harder than Anesthesiology. You make too many assumptions, like we will all be forced to endure 100% Medicare populations. That's just foolish.

 

[BLADEMDA]

Thanks for the shout-out. Don't act as though I've never seen those numbers before. You started a thread dedicated to the exact topic just a few days ago. You gave me the same "lecture" about reimbursement a couple months ago. Even before that, I had a more informative lecture from the business manager of our department.

I'll offer my own wisdom- Cardiology will be hit harder than Anesthesiology. You make too many assumptions, like we will all be forced to endure 100% Medicare populations. That's just foolish.

Disagree with you completely. Cardiology may take a 20% hit but this reduction by CMS is based on pretty decent reimbursement. In addition, Cardiologists can NOT be replaced by Midlevels claiming to be equal to a Physician. Cardiac disease is a reality in the U.S. and many more people will need interventions.

CRNAs are glad to accept Medicare and can function Independently depending on State Law. Thus, Anesthesia is at great risk of being displaced by "cheaper" nurses.

Over the next ten years more Medicare, not less, will be an economic reality. In addition, if and when a "public option plan" becomes available then Medicare will become the defacto norm for reimbursement rates.

Overall, those interested in "living the good life" should look elsewhere in Medicine for a career. Unlike Bertelman I know Neurosurgery, Cardiology, Derm, etc, will not only survive but prosper.

Those who don't mind driving a Kia while their former classmates own a 7 series should stay the course and become a "glorified CRNA" in a field where Advanced Nurses are reimbursed at the same amount as a Physician.

Blade

 

[Bertelman]

Overall, those interested in "living the good life" should look elsewhere in Medicine for a career. Unlike Bertelman I know Neurosurgery, Cardiology, Derm, etc, will not only survive but prosper.

If you "know" so much about the future of healthcare, you should move to D.C. and help them differentiate their asses from a hole in the ground. Anyone who "knows" what the future holds is lying.

Cardiologists may not be replaced by midlevels, but they can see far fewer referrals, as primary care learns to treat CAD and CHF with the protocols they have developed.

Just to clarify the issue, I want to confirm that you believe with absolute certainty that

1) All states will allow CRNAs to practice independently in any practice setting
2) All anesthesiologists will work for less money and more hours than a CRNA
3) All anesthesia practices will treat only Medicare patients, only at current Medicare rates (or worse)
4) All hospitals will hire CRNAs to replace the bulk of their anesthesiologists.

If you agree with the above, then you should quit advising us to join the ASA or get involved. Clearly we have lost the battle, and will all be searching for jobs in 2 years. You should embrace CRNAs instead of fighting with them online, because it is clear they will be telling you what to do in 2 years. You should also send a letter to Anesthesiology, because clearly there are thousands of other physicians who would like to know their fate from the all-knowing Blade.

 

[CambieMD]

I think that less anesthesiologists will be needed in the future because we will mostly supervise CRNAs. This has happened in other specialties already. Many primary care groups have a couple of NPs. They have taken a docs job.CRNAs are essentially mid level providers.

You cannot compare anesthesiologists to cardiologist or GI docs. They own their patients. We do not.

The future may not be as bright as we would want it to be but the sky is not falling either.

Cambie

 

[kmurp]

Based on Today's Medicare rates an Anesthesiologist working around 55 hours a week would earn $170,000 or so per year TOTAL. So, after malpractice and benefits a 100% Medicare case load for an Anesthesiologist generates around $110,000 income based on a 55 hour work week.

It gets better. Medicare is likely to slash those rates over time to control costs. Hence, you will be Lucky to earn over $100K take home in about ten years if ObamaCare passes as proposed by the House.

That is true change you can believe in.


If the AANA doesn't get you then Socialized Medicine based on Medicare will.

Umm; you forgot to include overhead cost such as billing....

 

[BLADEMDA]

If you "know" so much about the future of healthcare, you should move to D.C. and help them differentiate their asses from a hole in the ground. Anyone who "knows" what the future holds is lying.

Cardiologists may not be replaced by midlevels, but they can see far fewer referrals, as primary care learns to treat CAD and CHF with the protocols they have developed.

Just to clarify the issue, I want to confirm that you believe with absolute certainty that

1) All states will allow CRNAs to practice independently in any practice setting
2) All anesthesiologists will work for less money and more hours than a CRNA
3) All anesthesia practices will treat only Medicare patients, only at current Medicare rates (or worse)
4) All hospitals will hire CRNAs to replace the bulk of their anesthesiologists.

If you agree with the above, then you should quit advising us to join the ASA or get involved. Clearly we have lost the battle, and will all be searching for jobs in 2 years. You should embrace CRNAs instead of fighting with them online, because it is clear they will be telling you what to do in 2 years. You should also send a letter to Anesthesiology, because clearly there are thousands of other physicians who would like to know their fate from the all-knowing Blade.

Medicare over the next twenty years will become a larger and larger portion of our patients. Hence, the vast majority of Anesthesiologists will be seeing $17 per unit for more than 50% of their cases in the near future.

Second, I am commenting on fields which are procedure based that can not be performed by Midlevels or Family Docs. This includes Neurosurgery, Invasive Cardiology, Interventional Radiology, etc. These fields are likely to remain in high demand as our population ages. Will Medicare keep paying 75% of current Commercial Insurance? Doubtful. But, I would rather start high (like today) and get cut 20-25% over the next 10-20 years then start low (like today) at $17 per unit and go nowhere in getting increases.

Anesthesiology is a very poor choice from a purely fiscal perspective looking out over 20 years. Does this mean you should choose something else? That is up to you. But, those looking to live the good life should really look elsewhere. By the time Bertelman figures out I was right about this issue his Kia will need replacing.

Blade

 

[BLADEMDA]

If you "know" so much about the future of healthcare, you should move to D.C. and help them differentiate their asses from a hole in the ground. Anyone who "knows" what the future holds is lying.

Cardiologists may not be replaced by midlevels, but they can see far fewer referrals, as primary care learns to treat CAD and CHF with the protocols they have developed.

Just to clarify the issue, I want to confirm that you believe with absolute certainty that

1) All states will allow CRNAs to practice independently in any practice setting
2) All anesthesiologists will work for less money and more hours than a CRNA
3) All anesthesia practices will treat only Medicare patients, only at current Medicare rates (or worse)
4) All hospitals will hire CRNAs to replace the bulk of their anesthesiologists.

If you agree with the above, then you should quit advising us to join the ASA or get involved. Clearly we have lost the battle, and will all be searching for jobs in 2 years. You should embrace CRNAs instead of fighting with them online, because it is clear they will be telling you what to do in 2 years. You should also send a letter to Anesthesiology, because clearly there are thousands of other physicians who would like to know their fate from the all-knowing Blade.

Bertelman,

I know you don't like it when I post my "negative" comments about Anesthesiology. However, my statements are based on decades of experience and observation. If you choose to be a pollyanna then so be it.

As for "knowing their fate" the writing is on the wall. Just read it.

1. I believe the AANA will eventually secure the right to practice Independently in all settings. It may take 1-30 years but it will happen. Others with experience agree with me.

2. All Anesthesiologists will work for less money in the near future. Less than a CRNA? It depends on fellowship and practice setting.

3. By 2020 the vast majority of patients in most practices will be CMS. If Obama passes a "public option" the odds of 75% CMS cases or more increases greatly.

4. The majority of hospitals won't care whether a CRNA or MD does the case as long as the "subsidy" is minimal or zero. In the end, the money/cost will be the deciding factor and not just the quality of care.

As for "quiting the fight" my answer to you is never. I believe in our cause and will fight to the end. I ask for every MD to join in the fight. But, in good conscience I must let the Med Students know the odds are against us. We have created a monster who will, in the end, consume us.

Blade

 

[countingdays]

Obama requires doctors to accept the government payor.
Day one after the government 'option' goes into effect, a class action lawsuit will be filed for violation of doctors right to liberty or whatever.
As long as there is any concept of freedom left in this country, we will win, and we'll be able to bargain for fair reimbursement.
The Supreme Court can still save us from the communist takeover.

 

[ProRealDoc]

Bertelman,

I know you don't like it when I post my "negative" comments about Anesthesiology. However, my statements are based on decades of experience and observation. If you choose to be a pollyanna then so be it.

As for "knowing their fate" the writing is on the wall. Just read it.

1. I believe the AANA will eventually secure the right to practice Independently in all settings. It may take 1-30 years but it will happen. Others with experience agree with me.

2. All Anesthesiologists will work for less money in the near future. Less than a CRNA? It depends on fellowship and practice setting.

3. By 2020 the vast majority of patients in most practices will be CMS. If Obama passes a "public option" the odds of 75% CMS cases or more increases greatly.

4. The majority of hospitals won't care whether a CRNA or MD does the case as long as the "subsidy" is minimal or zero. In the end, the money/cost will be the deciding factor and not just the quality of care.

As for "quiting the fight" my answer to you is never. I believe in our cause and will fight to the end. I ask for every MD to join in the fight. But, in good conscience I must let the Med Students know the odds are against us. We have created a monster who will, in the end, consume us.

Blade

Agree with you. The pressure from politicians and public is too great to stem the current tide. Jobs will exists but not at current reimbursements. Subspecialty fellowships that allow functionality outside of the OR are key to survive and remain competitive.

I sure hope I am dead wrong but the way things are going, it's better to be prepared for the worst.

 

[Bertelman]

Bertelman,

I know you don't like it when I post my "negative" comments about Anesthesiology. However, my statements are based on decades of experience and observation. If you choose to be a pollyanna then so be it.

As for "knowing their fate" the writing is on the wall. Just read it.

1. I believe the AANA will eventually secure the right to practice Independently in all settings. It may take 1-30 years but it will happen. Others with experience agree with me.

2. All Anesthesiologists will work for less money in the near future. Less than a CRNA? It depends on fellowship and practice setting.

3. By 2020 the vast majority of patients in most practices will be CMS. If Obama passes a "public option" the odds of 75% CMS cases or more increases greatly.

4. The majority of hospitals won't care whether a CRNA or MD does the case as long as the "subsidy" is minimal or zero. In the end, the money/cost will be the deciding factor and not just the quality of care.

As for "quiting the fight" my answer to you is never. I believe in our cause and will fight to the end. I ask for every MD to join in the fight. But, in good conscience I must let the Med Students know the odds are against us. We have created a monster who will, in the end, consume us.

Blade

Somehow your response above appears so much more reasonable than many of your posts. I guess that's my beef. No one doubts your knowledge or passion for the field. I understand difficult times lay ahead for our field. No one should doubt that. But I think anyone with half a brain can recognize that fact without some of us beating the drum of panic, as though the world we know will cease to exist.

When discussing serious topics, I prefer straight-forward facts and honest opinions instead of talk radio alarmist messages that we'll all be on welfare.

FWIW, I also think your voice is too often condescending, as in the example below when you are clearly talking to everyone else here BUT me, as though I'm the ignorant dunce in the corner, too stupid to comprehend the text you print. psssstttt...i'm right here...i can hear you

, those looking to live the good life should really look elsewhere. By the time Bertelman figures out I was right about this issue his Kia will need replacing

If you can ever realize that I have valid points that just happen to oppose your own, we might be able to have a productive discussion. I'll just take a stab here and guess you've been in practice for 30 years. Could you ever have imagined in 1980 that this would be your reality? OK. Now, tell me how I am supposed to predict what MY future will be in 30 years. I don't believe anyone here who tells me they know what the future of anesthesiology will be, for better or worse. There are too many factors to consider, and too many unknowns at this juncture. It's fair to say it will be different. But brow-beating people into choosing other fields just seems irresponsible to me.

And if you ever see me in a KIA, I promise it will be pimped out, jacked up 6", with some 18" wheels and fat-ass tires. I'll be rokkin' that ****. Proudly.

 

[2win]

Somehow your response above appears so much more reasonable than many of your posts. I guess that's my beef. No one doubts your knowledge or passion for the field. I understand difficult times lay ahead for our field. No one should doubt that. But I think anyone with half a brain can recognize that fact without some of us beating the drum of panic, as though the world we know will cease to exist.

When discussing serious topics, I prefer straight-forward facts and honest opinions instead of talk radio alarmist messages that we'll all be on welfare.

FWIW, I also think your voice is too often condescending, as in the example below when you are clearly talking to everyone else here BUT me, as though I'm the ignorant dunce in the corner, too stupid to comprehend the text you print. psssstttt...i'm right here...i can hear you



If you can ever realize that I have valid points that just happen to oppose your own, we might be able to have a productive discussion. I'll just take a stab here and guess you've been in practice for 30 years. Could you ever have imagined in 1980 that this would be your reality? OK. Now, tell me how I am supposed to predict what MY future will be in 30 years. I don't believe anyone here who tells me they know what the future of anesthesiology will be, for better or worse. There are too many factors to consider, and too many unknowns at this juncture. It's fair to say it will be different. But brow-beating people into choosing other fields just seems irresponsible to me.

And if you ever see me in a KIA, I promise it will be pimped out, jacked up 6", with some 18" wheels and fat-ass tires. I'll be rokkin' that ****. Proudly.

Bertelman - keep dreaming. Keep the KIA. It will take a while (you are a student - right?) to get a real car.
"I don't believe anyone here who tells me they know what the future of anesthesiology will be, for better or worse."
It similar with the stock market - some people are able to make predictions and they are really good at. Right now I will "sell short" the medical field....except for jobs in administration. When we discuss about the future of anesthesia is about THE MAJORITY - some of us will do really good in any kind of environment. And if you take your info from your "department" - man you have a lot to learn...GLTY

 

[Taurus]

Bertelman,

I know you don't like it when I post my "negative" comments about Anesthesiology. However, my statements are based on decades of experience and observation. If you choose to be a pollyanna then so be it.

As for "knowing their fate" the writing is on the wall. Just read it.

1. I believe the AANA will eventually secure the right to practice Independently in all settings. It may take 1-30 years but it will happen. Others with experience agree with me.

2. All Anesthesiologists will work for less money in the near future. Less than a CRNA? It depends on fellowship and practice setting.

3. By 2020 the vast majority of patients in most practices will be CMS. If Obama passes a "public option" the odds of 75% CMS cases or more increases greatly.

4. The majority of hospitals won't care whether a CRNA or MD does the case as long as the "subsidy" is minimal or zero. In the end, the money/cost will be the deciding factor and not just the quality of care.

As for "quiting the fight" my answer to you is never. I believe in our cause and will fight to the end. I ask for every MD to join in the fight. But, in good conscience I must let the Med Students know the odds are against us. We have created a monster who will, in the end, consume us.

Blade

Yeah, more AA's or CRNA's and fewer anesthesiologists in the future. But it probably means lower wages for everyone as well in the future if MedPAC gets the authority to set reimbursement levels.

Just follow the money. This pie is shrinking fast.

 

[Bertelman]

Bertelman - keep dreaming. Keep the KIA. It will take a while (you are a student - right?) to get a real car.
"I don't believe anyone here who tells me they know what the future of anesthesiology will be, for better or worse."
It similar with the stock market - some people are able to make predictions and they are really good at. Right now I will "sell short" the medical field....except for jobs in administration. When we discuss about the future of anesthesia is about THE MAJORITY - some of us will do really good in any kind of environment. And if you take your info from your "department" - man you have a lot to learn...GLTY

As my tab suggests, I'm a resident. An old one at that (or is it "quite old?). I drive a nice car. It's paid for, and it turns heads. My wife drives a nicer car. Neither are Kias.

Knowing nothing at all about me, I am sure you assumed I was taking advice from an academic attending. I'm wise enough to know who to take advice from. I generally avoid your posts. Of course, you don't know me, so you really don't know what you're talking about. My dept is actually quite good. It's a private practice. They are doing very well in the current environment. Just hired a new guy, while other practices are letting them go. Our business manager could walk circles around anything spinning in your head, be it anesthesia or practice mgmt...PWND.

 

[Gimlet]

I drive a nice car. It's paid for, and it turns heads.

I can vouch for this, having been in Bertelman's vehicle. He rocks a sweet ride...nicer than many attendings' cars in the parking garage at my hospital.

And Bertelman, while you're an "older" resident, I don't think you make the cutoff for "quite old" yet.

 

[darkmansaad]

hey so what exactly have your attendings been saying about this whole situation? I figure they might give a more balanced point of view than the doomsday scenarios on SDN....? Im an MS4 so i dont really pretend to know much about the future if im technically not even part of the present soooo yea whats the consensus in the hospitals?

 

[Bertelman]

I can vouch for this, having been in Bertelman's vehicle. He rocks a sweet ride...nicer than many attendings' cars in the parking garage at my hospital.

And Bertelman, while you're an "older" resident, I don't think you make the cutoff for "quite old" yet.

That was the wifey's.