7-Figure Anesthesia Salaries?

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^^^sounds like corporate medicine.
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criticalelement said:
Very astute. BEfore the AMCs there were private groups screwing docs left and right. It was rampant. The big management groups are just those little private groups on steroids. They were the most successful at screwing docs so they grew. For example, NAPA was at one hospital 20 years ago. They were formed through independent docs at Long Island Jewish in New Hyde Park, NY. IN fact when they were formed there were articles written about how bad it was for anesthesia. They had a residency that dissolved as a result of it. They have been screwing docs over for YEARS. Except now they dont have ot make you a partner. All management companies are evil. When you work for them you are making a deal with the devil. I cant even believe they are legal.
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Management companies control about 35% of the market right now. That slice will grow to over 50% by the time a MS-3 completes his/her residency in Anesthesiology. This means most Med Students will be making "a deal with the devil" once they match into this field.
 
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criticalelement said:
Very astute. BEfore the AMCs there were private groups screwing docs left and right. It was rampant. The big management groups are just those little private groups on steroids. They were the most successful at screwing docs so they grew. For example, NAPA was at one hospital 20 years ago. They were formed through independent docs at Long Island Jewish in New Hyde Park, NY. IN fact when they were formed there were articles written about how bad it was for anesthesia. They had a residency that dissolved as a result of it. They have been screwing docs over for YEARS. Except now they dont have ot make you a partner. All management companies are evil. When you work for them you are making a deal with the devil. I cant even believe they are legal.
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Is NAPA that bad..? they have a new residency program at NSLIJ, and they seem pretty serious about being a top notch program
 
Just spewed latte on my list...hahaha
BLADEMDA, I like you...not a gas passer, just an ICU Intensivist-Nocturnist- newly minted/boarded. Learning the ropes, most in my fellowship took jobs with EmCxxx. Can't even type or breath the word. I'm fearful of my future.
 
Mman said:
Did your son have a pediatric anesthesiologist doing the case solo? Or was it a pediatric anesthesiologist supervising a CRNA? We provide the latter, not the former. And if a patient didn't agree with that I'd have to tell them that I'm not aware of any hospital within at least 500 miles that would do something different.

As a patient you can advocate for whatever you want for yourself, but are you willing to go a long ways away to find it?
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It was a childrens hospital and I asked the peds anesthesiologist point blank if they would do the whole case or if a crna was involved. Luckily they were solo. It might have helped that i asked the surgeon when scheduling if I could request that. In any case, im not sure if I would have walked if it was supervision - it was a low risk case so probably not.

But its definitely ridiculous that people have no choice of their anesthesia provider for planned procedures. I supervise a couple derm PAs and patients are asked at the time of scheduling if they are OK seeing a PA or if they want to see an MD. The pa's are fine with acne and warts but just last month a pa (thankfully not mine) missed a melanoma for a year that then met to lungs (was calling it an SK). So in any specialty it doesnt matter if its only 0.1% of cases, Id rather have the most trained person taking care of me.
 
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doctalaughs said:
It was a childrens hospital and I asked the peds anesthesiologist point blank if they would do the whole case or if a crna was involved. Luckily they were solo. It might have helped that i asked the surgeon when scheduling if I could request that. In any case, im not sure if I would have walked if it was supervision - it was a low risk case so probably not.

But its definitely ridiculous that people have no choice of their anesthesia provider for planned procedures. I supervise a couple derm PAs and patients are asked at the time of scheduling if they are OK seeing a PA or if they want to see an MD. The pa's are fine with acne and warts but just last month a pa (thankfully not mine) missed a melanoma for a year that then met to lungs (was calling it an SK). So in any specialty it doesnt matter if its only 0.1% of cases, Id rather have the most trained person taking care of me.
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See the thing is there is no evidence that it makes a bit of difference to have MD only vs ACT. And your comparison to seeing a PA in the clinic is not relevant either since in the ACT model the physician is seeing the patient, examining them, coming up with a plan, and ensuring it is carried out properly. It's not like they are choosing between having the anesthesiologist or the CRNA. They are getting the anesthesiologist in either one. When our peds anesthesiologists do a gastroschisis case or TE-fistula repair, they are in the room for 60-90% of the case anyway even though the CRNA is there too.
 
Mman said:
See the thing is there is no evidence that it makes a bit of difference to have MD only vs ACT. And your comparison to seeing a PA in the clinic is not relevant either since in the ACT model the physician is seeing the patient, examining them, coming up with a plan, and ensuring it is carried out properly. It's not like they are choosing between having the anesthesiologist or the CRNA. They are getting the anesthesiologist in either one. When our peds anesthesiologists do a gastroschisis case or TE-fistula repair, they are in the room for 60-90% of the case anyway even though the CRNA is there too.
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The difference between MD vs ACT is the amount of time the provider in the room will actually take care of the patient vs. taking care of her smartphone. It doesn't apply to Pedi, but it applies to everything else. Plus there is zero guarantee that they will follow the physician's plan to a T.That's why I don't trust them; just different professional standards.
 
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FFP said:
The difference between MD vs ACT is the amount of time the provider in the room will actually take care of the patient vs. taking care of her smartphone. It doesn't apply to Pedi, but it applies to everything else. Plus there is zero guarantee that they will follow the physician's plan to a T.That's why I don't trust them; just different professional standards.
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If they don't follow my plan to a T, they get fired. It's the simple. That's why you employ them directly. And no it doesn't apply to everything else but pedi, it applies to everything. Just like the ICU attending can cover 16 or 24 critically ill patients, the anesthesiologist can cover 2-4 at once.
 
Ezekiel2517 said:
Classic. Med students and residents pls read this article - http://jama.jamanetwork.com/article.aspx?articleid=1785467 . so you know what to think when you hear "there is no evidence".
Sorry to slightly derail thread
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I'm sorry. Perhaps you'd have appreciated it if I said the best retrospective analysis done to date and risk adjusted suggest that an ACT model has the lowest mortality of any possible anesthesia model (lowest - ACT, 2nd lowest - MD only, worst - CRNA only).

So it's not "there is no evidence". It's there is evidence and it suggests. Happy?
 
Mman said:
If they don't follow my plan to a T, they get fired. It's the simple. That's why you employ them directly.
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Good luck with that. It's happening less and less. Why do you think we still have militant CRNAs even in ACT places? Nobody gets fired anymore for not following a physician's orders.
 
FFP said:
Good luck with that. It's happening less and less. Why do you think we still have militant CRNAs in this country?
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Good luck with what? It happens more and more. Why? Because they crank out too many CRNA grads and it's easier and easier to replace them. If they don't like it, hit the road. We get 20 applicants for every CRNA position we advertise.
 
Mman said:
Good luck with what? It happens more and more. Why? Because they crank out too many CRNA grads and it's easier and easier to replace them. If they don't like it, hit the road. We get 20 applicants for every CRNA position we advertise.
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The bigger the corporation, the more bureaucratic and complicated the firing, especially if the physician is not a partner. ;)
 
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FFP said:
The bigger the corporation, the more bureaucratic and complicated the firing.
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Not in a right to work state it isn't. Pretty simple. We employ approximately 90 FTEs worth of CRNAs/AAs. Not sure why you think it has to be "complicated and bureaucratic" to fire somebody.

In an academic hospital where they work for the hospital or school of nursing? Of course. That's a terrible situation. Most of the worst CRNAs I've ever encountered worked in academic hospitals. In a private group where they are employed by the group? That's as little red tape and bureaucracy as you can ever have.
 
FFP said:
This is why:
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And I'm specifically not talking about that. If you work at an academic hospital, well sucks to be you when it comes to dealing with the crap staff, but you signed up for it.
 
Mman said:
And I'm specifically not talking about that. If you work at an academic hospital, well sucks to be you when it comes to dealing with the crap staff, but you signed up for it.
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Yes, it's my fault, for refusing all those partnership track offers left and right. It's not only CRNAs who are overproduced nowadays. ;)

In most of the real world, anesthesiologists are fastly becoming the servants, not the masters. But it's always refreshing to find out the view from a partner's ivory tower.
 
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FFP said:
Good luck with that. It's happening less and less. Why do you think we still have militant CRNAs even in ACT places? Nobody gets fired anymore for not following a physician's orders.
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Agreed.
Boggles my mind.
I think it has to do with if the nurse doesnt agree with it, she/he wont do it.

Give 10 mg of ROCURONIUM.. If she/her interprets this to mean..."clean the latrine". SHe/he wont do it. It should be a fireable offense. ALAS, i still got some time before i retire..
 
Mman said:
Not in a right to work state it isn't. Pretty simple. We employ approximately 90 FTEs worth of CRNAs/AAs. Not sure why you think it has to be "complicated and bureaucratic" to fire somebody.

In an academic hospital where they work for the hospital or school of nursing? Of course. That's a terrible situation. Most of the worst CRNAs I've ever encountered worked in academic hospitals. In a private group where they are employed by the group? That's as little red tape and bureaucracy as you can ever have.
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UNtil you fire Nancy CRNA who is best friends with SUE CRNA who is JED CRNA girlfriend who has the goods on MICHAEL MD who got drunk with CEO MD at the xmas party and they slept together who is mentors to several newbie CRNAS and they all threaten to go to administration about YOU if you fire nancy crna. Follow my drift. You can still fire her and have every right to fire her but now you have to deal with it. And most anesthesiologist are pretty yella if youknow what i mean
 
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Mman said:
Good luck with what? It happens more and more. Why? Because they crank out too many CRNA grads and it's easier and easier to replace them. If they don't like it, hit the road. We get 20 applicants for every CRNA position we advertise.
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Same. We get more former NICU and PICU nurses than we could ever hire. They know the score when they interview.
 
Mman said:
I'm sorry. Perhaps you'd have appreciated it if I said the best retrospective analysis done to date and risk adjusted suggest that an ACT model has the lowest mortality of any possible anesthesia model (lowest - ACT, 2nd lowest - MD only, worst - CRNA only).

So it's not "there is no evidence". It's there is evidence and it suggests. Happy?
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Do you have a link to this? I have trouble believing that a chart monkey supervising a cRNA is better than an anesthesiologist in the room the whole time. If you're talking mortality, considering the low, low, low intraoperative mortality in anesthetics these days, they would have had to retrospectively analyze hundreds of thousands if not millions to have an adequate power. And I'm sure confounders abound in those.
 
Ignatius J said:
Do you have a link to this? I have trouble believing that a chart monkey supervising a cRNA is better than an anesthesiologist in the room the whole time. If you're talking mortality, considering the low, low, low intraoperative mortality in anesthetics these days, they would have had to retrospectively analyze hundreds of thousands if not millions to have an adequate power. And I'm sure confounders abound in those.
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If it takes million to detect a difference, then there is no meaninful difference.

Sitting the stool yourself while the computer charts vitals adds nothing. As long as you have the judgement to keep a closer eye on sick patients and crnas self-aware enough to ask for help when they need it, ACT is as safe as it gets. If you disappear and they don't call when they're in trouble, then ACT isn't great.
 
The Best care, albeit the mos expensive, is MD only care. The next best is the ACT which also happens to be the most cost effective care provided your goal is to minimize patient morbidity to the same level as MD only care. Then there is the AANA level of care or the Russian Roulette strategy where you roll the dice and hope that CRNA is actually qualified to work solo on your family member.

Lack of Evidence is not the same as Evidence Based Medicine and what we get with Solo CRNA care is pure propaganda without any evidence that these second tier providers can deal with intraop emergencies; in fact, our anecdotal evidence suggests just the opposite which is why the solo CRNA is usually found doing low acuity cases, outpatient only anesthesia or in rural America where the hospital won't pay the money for an Anesthesiologist.

Fortunately, most solo CRNAs do not want to work above their educational level so they stick with low acuity cases like Gi and Cataracts. When CRNAs work to the extent of their licensure they can deliver safe, effective care. The problem is we can't agree on the level of care these Midlevels can safely deliver to patients on a routine basis. Their SRNA mills produce a diverse group of graduates many of whom are barely able to function in an ACT model.

Hence, the most cost effective anesthesia care in the USA remains the ACT model; but, the best care is provided by one qualified, independent Anesthesiologist caring for one patient.
 
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nolagas said:
If it takes million to detect a difference, then there is no meaninful difference.

Sitting the stool yourself while the computer charts vitals adds nothing. As long as you have the judgement to keep a closer eye on sick patients and crnas self-aware enough to ask for help when they need it, ACT is as safe as it gets. If you disappear and they don't call when they're in trouble, then ACT isn't great.
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I think your first sentence is just a convenient schtick used against anesthesiologists. Sure, a long plastics case I am sitting on my rear. During hearts, traumas, sick open belly emergencies, and all sorts of other shenanigans, I am not.

Regardless, I fail to see how a board-certified anesthesiologist in the room with the patient the whole time isn't the safest practice. Gun to my head, and a lot of healthcare workers' heads, that is what I would want for my loved one.

Cost-effectiveness is a whole other issue I suppose, although I wonder how my colleagues in ACT models make a bunch more money than I do if that's the most cost-effective model. I thought the ACT model still bills by units just like I do doing my own cases.
 
Ignatius J said:
Cost-effectiveness is a whole other issue I suppose, although I wonder how my colleagues in ACT models make a bunch more money than I do if that's the most cost-effective model. I thought the ACT model still bills by units just like I do doing my own cases.
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But they're billing for 4 cases at a time and youre billing one, though the billing is split with the CRNAs.
The most potential income is when you employ the CRNAs and bill for them as well, paying them a salary and keeping the difference for the partners.
Just like the AMCs are doing to the anesthesiologists as well now.
It was the next logical step.
 
IlDestriero said:
But they're billing for 4 cases at a time and youre billing one, though the billing is split with the CRNAs.
The most potential income is when you employ the CRNAs and bill for them as well, paying them a salary and keeping the difference for the partners.
Just like the AMCs are doing to the anesthesiologists as well now.
It was the next logical step.
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Okay, they have four rooms that bill 15 units each. That's 60 units total.

I have one room I am in and bill 15 units from that room, the same as the other rooms.

It's still the same amount per room that is being billed.

Now are we talking cheapness or efficient? Because there's a difference.

Bottom line is that the same amount is being billed per room, it is just that some extra providers are paid and the anesthesiologist makes more.

This is my understanding.
 
IlDestriero said:
I misunderstood what you said in your post. Though it is the most efficient model when the corporate overlords at the hospital or AMC need to staff 4 ORs and still make a nice profit.
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Or, the payer mix is extremely poor which requires a large hospital subsidy (multi millions) with an all MD model vs a small subsidy with the ACT. This is the same argument CRNAS use to justify their "solo" model: allow us to practice independently and the hospital subsidy goes to zero.

Again, the AMCs use this argument every day to secure hospital contracts: hire us and we will make the subsidy go away
 
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BLADEMDA said:
Or, the payer mix is extremely poor which requires a large hospital subsidy (multi millions) with an all MD model vs a small subsidy with the ACT. This is the same argument CRNAS use to justify their "solo" model: allow us to practice independently and the hospital subsidy goes to zero.

Again, the AMCs use this argument every day to secure hospital contracts: hire us and we will make the subsidy go away
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We are a physician only and take no subsidies for exclusive coverage. Payer mix not bad. Not great either. With proper leadership and fair revenue distribution, it's very possible.
 
Ignatius J said:
We are a physician only and take no subsidies for exclusive coverage. With proper leadership and fair revenue distribution, it's very possible.
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It depends on the payer mix and what the Anesthesiologists view as acceptable income. Physican only requires a good payer mix (over 45 percent commercial/hmo) and/or below national median income.
 
BLADEMDA said:
It depends on the payer mix and what the Anesthesiologists view as acceptable income. Physican only requires a good payer mix (over 45 percent commercial/hmo) and/or below national median income.
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We don't have nearly that would be my guess (haven't seen exact numbers- just going off what I've seen on my cases). As far as acceptable income, thus was my argument against the 1-2 million early in this thread. I'll put it this way, none of us are hurting. Are we going to make 2 million/year? No, but we do well.

It's all about leadership, how much you're willing to limit your ceiling income (as a partner you will make well above the average anesthesiologist), and how much you're truly willing to sync up work productivity and take-home pay. Yeah, with partners disproportionately gobbling up some revenue of the non-partners, it becomes hard to sustain. Those groups are out there.
 
Ignatius J said:
Do you have a link to this? I have trouble believing that a chart monkey supervising a cRNA is better than an anesthesiologist in the room the whole time. If you're talking mortality, considering the low, low, low intraoperative mortality in anesthetics these days, they would have had to retrospectively analyze hundreds of thousands if not millions to have an adequate power. And I'm sure confounders abound in those.
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Study of 2 million anesthetics (basically every case in one state) over a 7 year period. All cases followed for mortality and then cause identified.


My problem with MD only is that it sounds so great, but what happens when the **** hits the fan? How do you take care of the ruptured AAA where you are pushing pressors, loading the Belmont, etc? Or the gunshot to the chest where you get so much edema/blood in the ETT that you have to change the circuit out several times during the case?

In an ACT model, I'm in the room, the CRNA is in the room, probably 2 other CRNAs are in the room, and maybe even another anesthesiologist. Why? How? Because we have lots of people around that can come and help out. When you are MD only, who's helping? Maybe 1 of your partners if you are lucky since everyone else is in a room? The circulating nurse?

ACT model has a lot more resources (physician and CRNA) around to deal with a catastrophe when it happens and that is the overwhelming majority of cases that we really make a difference on.
 
FFP said:
So, yeah, solo MD is not better, no way, no how. For the bean counters, I mean.
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If all we want to do is share anecdotal stories, we can be here all day. I've reviewed plenty of cases of all sorts of anesthesia models as part of legal review. Stories, stories, stories.
 
Mman said:
If all we want to do is share anecdotal stories, we can be here all day. I've reviewed plenty of cases of all sorts of anesthesia models as part of legal review. Stories, stories, stories.
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And I've seen plenty of people who praise the model where they make a lot of money.

I have nothing against the ACT model, as long as it maintains true medical direction (meaning that the CRNA is treated like a good resident, and expected to keep you posted accordingly). Which is not the case in many places.
 
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FFP said:
And I've seen plenty of people who praise the model where they make a lot of money.

I have nothing against the ACT model, as long as it maintains true medical direction (meaning that the CRNA is treated like a good resident, and expected to keep you posted accordingly). Which is not the case in many places.
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So you don't like places that are full of lazy people that don't do their job? Great. Me too.
 
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Mman said:
Study of 2 million anesthetics (basically every case in one state) over a 7 year period. All cases followed for mortality and then cause identified.


My problem with MD only is that it sounds so great, but what happens when the **** hits the fan? How do you take care of the ruptured AAA where you are pushing pressors, loading the Belmont, etc? Or the gunshot to the chest where you get so much edema/blood in the ETT that you have to change the circuit out several times during the case?

In an ACT model, I'm in the room, the CRNA is in the room, probably 2 other CRNAs are in the room, and maybe even another anesthesiologist. Why? How? Because we have lots of people around that can come and help out. When you are MD only, who's helping? Maybe 1 of your partners if you are lucky since everyone else is in a room? The circulating nurse?

ACT model has a lot more resources (physician and CRNA) around to deal with a catastrophe when it happens and that is the overwhelming majority of cases that we really make a difference on.
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Dude, that study is from the '60s/'70s. Come on, now. Not even sure what to think about that.

As far as your question, it's a good one. Quite simply, you learn to be efficient and learn to be a good anesthesiologist. Usually, if it's a big case and **** hits the fan, I have multiple anesthesia techs who can do the mindless stuff like setting up a rapid infuser, get lines and line supplies ready, get airway equipment, etc. Nurses and board runners (mostly RNs where I practice) can help check in blood or even start an IV. Just like running a code, you have to be good at being efficient, clear, and delegating properly.

On rare occasion, if I'm having difficulty with a line or need an extra hand for whatever reason, I can have a partner come in and help out. I've done that twice. Usually just tell the circulator to duck their head in the lounge and see if someone is willing to come in and help.

But yeah, no shortage of help when I need it. Need to be good at delegating and prioritizing, which should have been learned in residency and perfected in private practice. And, knock on wood, never have lost someone in the OR.
 
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Ignatius J said:
But yeah, no shortage of help when I need it. Need to be good at delegating and prioritizing, which should have been learned in residency and perfected in private practice. And, knock on wood, never have lost someone in the OR.
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So you have less skilled help. Sounds lovely. And if you've never lost someone, you haven't been doing it long enough.
 
Mman said:
So you have less skilled help. Sounds lovely. And if you've never lost someone, you haven't been doing it long enough.
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You're probably right. Got a while until retirement, unfortunately.
 
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I always hear people saying get a job in BFE and pay off debt early on. Would being single and without a family be a hindrance to securing a BFE job? Also are BFE practices less likely to hire someone who only plans to stay <3yrs?
 
If I had debt and was single or with a mobile spouse I would have planned on going somewhere fairly remote to pay it off in a few years and jump start my retirement savings. Everyone wants a good long term fit, but these undesirable locations aren't getting dozens of 5 star applicants a year. Get them to give you a signing bonus for a 3 year commitment.
 
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criticalelement said:
http://napaanesthesia.com/about/anesthesia-leadership/

Peruse all the faces of the SELL OUTS of the specialty.

THe sell outs are NOT limited to these faces but the others at the major management companies as well.
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Honestly, people on this board talk about being business minded and adapting to the times. These guys saw the writing on the wall and actually did this, taking charge of their own destiny instead of giving it up to another party. Kudos to them. We should all learn from their example.
 
http://www.bloomberg.com/news/2015-...s-to-change-how-u-s-pays-the-doctor-bill.html

Wow, what are the implications of this for anesthesiology?



Doctors' Pay Will Be Linked to Quality in Historic U.S. Overhaul of Medical Billing?

The Obama administration will make historic changes to how the U.S. pays its annual $3 trillion health-care bill, aiming to curtail a costly habit of paying doctors and hospitals without regard to quality or effectiveness.

Starting next year Medicare, which covers about 50 million elderly and disabled Americans, will base 30 percent of payments on how well health providers care for patients, some of which will put them at financial risk based on the quality they deliver. By 2018, the goal is to put half of payments under the new system.

For doctors and health facilities, the system will tie tens, and then hundreds, of billions of dollars in payments to how their patients fare, rather than how much work a doctor or hospital does, lowering the curtain on Medicare’s system of paying line-by-line for each scan, test and surgery.

“We believe these goals can drive transformative change,” Sylvia Mathews Burwell, secretary of the Health and Human Services Department, said in the statement.

The program would be a major shift for hospitals, health facilities and physicians, eventually more than doubling the reach of programs that the U.S. said has saved $417 million and that have been a model for how the government hopes to influence, and slow down, health spending.

Medicare paid about $362 billion to care providers in 2014, the health department said in a statement, making it the biggest buyer of health care services in the U.S. Paying separately for each procedure, called “fee-for-service,” has long been viewed as an inefficient driver of U.S. health spending, which at more than 17 percent of gross domestic product is the highest in the world.

Broad Reach
The Obama administration’s announcement today is the first time the government has ever set specific goals to steer the nation away from fee-for-service payments.

Medicare’s practices are often echoed by private insurers who cover 170 million Americans. If the U.S.’s plan is successful, non-elderly consumers could eventually see cost savings, though they may also find that doctors and hospitals offer fewer services as they seek to cut waste and maintain profits.

Doctors and hospitals are already facing changes under the Patient Protection and Affordable Care Act, or Obamacare. About 20 percent of Medicare spending is now paid through programs in which health-care providers either take some financial risk for their performance or at least collect and report measures of their quality, the health department said. Expanding that figure was a key goal of the the law.

At Risk
“The people who are delivering care are increasingly at financial risk for the services that are being rendered,” Dan Mendelson, CEO of Avalere Health, a Washington consulting firm, said in a phone interview. “It’s increasingly likely the physician or the hospital is going to make more money if they provide less care.”

The country’s main lobbying groups for doctors and hospitals said they were on board, at least with the broad idea behind the overhaul. “We support secretary Burwell’s goals and plans,” saidMaureen Swick, a representative of the American Hospital Association.

Robert Wah, president of the American Medical Association, said that physicians were worried about additional bureaucracy. “This idea that we’re talking about delivery reform and setting up a system of delivery reform, we’re very supportive of that,” Wah said in an interview in Washington. “The details will be important to see.”
 
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