Future of Anesthesiologists

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GA8314 said:
What PGG said.

In fact, we don't even DO regular OR cases. It's strictly OB. That's it. Anything else goes to the regular call guy who is on home pager call.

And PGG is correct, the service doesn't pay for itself. We lose money on these shifts. Another reason we pay a reasonable wage of $130/hr. But, the rest of our business subsidizes it and we agreed to 24/7 OB call.

The point is that you can make $1500 with just a little willingness to sleep in a sh.tty call room, risk the random C-section, or a couple epidurals. Even those can make for a rougher day the next day since we consider these shifts "extras" and don't get the next day off. But, if you are recently out of residency, these are the voluntary shifts I would highly recommend to substantially augment your income.

The other point is that most jobs simply do not offer that level of augmented income, for simply doing what I've described. Do 4 of those shifts and that's an extra $6k/month. For the work, it's great pay actually. This is what many of us have the chance to do. We should feel lucky. Yes, I've said it. Lucky.
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We dont get paid necessarily for what we do..... but the burden of liability..... and sitting up on O.B.....believe me.. one nasty case... one incompetent obstetrician... you will wish you never agreed to the 130 an hour because you will be involved in a multi million dollar lawsuit that will drag on for 11 years... I bet you will not consider yourself lucky at that point playa....

I personally... personally.. in 14 years... have saved hospitals multi million dollar lawsuits at least a dozen times... That I know of.. is that worth 130 bucks an hour?
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criticalelement said:
We dont get paid necessarily for what we do..... but the burden of liability..... and sitting up on O.B.....believe me.. one nasty case... one incompetent obstetrician... you will wish you never agreed to the 130 an hour because you will be involved in a multi million dollar lawsuit that will drag on for 11 years... I bet you will not consider yourself lucky at that point playa....

I personally... personally.. in 14 years... have saved hospitals multi million dollar lawsuits at least a dozen times... That I know of.. is that worth 130 bucks an hour?
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Man you must have done something truly heinous in a past life.
 
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The average epidural brings in around $800, and a Blue Cross C-section around is $1500. 2 epidurals and a C-section and you have brought in $3200. We put up with OB because it can supplement the rest of the anesthesia department. There was great competition to cover OB at some of the "eat what you kill" places I interviewed with. It went to the older partners for a reason.
 
Impromptu said:
The average epidural brings in around $800, and a Blue Cross C-section around is $1500. 2 epidurals and a C-section and you have brought in $3200. We put up with OB because it can supplement the rest of the anesthesia department. There was great competition to cover OB at some of the "eat what you kill" places I interviewed with. It went to the older partners for a reason.
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18 years of potentially huge liability should come with great pay.
 
I guess it depends on your payor mix, pgg. We have low Medicaid in our OB. Fortunately, that also eliminates the morbidly obese and lawyer happy crazies to a large extent. Additionally we don't do high risk OB. So no VBACs. Just the low hanging fruit!


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Impromptu said:
The average epidural brings in around $800, and a Blue Cross C-section around is $1500. 2 epidurals and a C-section and you have brought in $3200. We put up with OB because it can supplement the rest of the anesthesia department. There was great competition to cover OB at some of the "eat what you kill" places I interviewed with. It went to the older partners for a reason.
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that's a nice payer mix to have an average reimbursement of $800 per epidural
 
Impromptu said:
The average epidural brings in around $800, and a Blue Cross C-seIl D is spot the F on. That last sentence needs to be in bold at the top of this forum, and then it needs to get mailed out and hand delivered to a few of our more disgruntled members. ction around is $1500. 2 epidurals and a C-section and you have brought in $3200. We put up with OB because it can supplement the rest of the anesthesia department. There was great competition to cover OB at some of the "eat what you kill" places I interviewed with. It went to the older partners for a reason.
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The payer mix will make or break you. It's true that a busy privately insured OB practice is just about the most lucrative situation you can have in anesthesia. On the other hand, sitting on OB call babysitting 1 MC epidural for $16/hr (and no stipend) is about as soul sucking as it gets.
 
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FFP said:
18 years of potentially huge liability should come with great pay.
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21 years in my current state.

Mman said:
It's called malpractice insurance
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Yep, and its why tail ain't cheap!

SaltyDog said:
The payer mix will make or break you. It's true that a busy privately insured OB practice is just about the most lucrative situation you can have in anesthesia. On the other hand, sitting on OB call babysitting 1 MC epidural for $16/hr (and no stipend) is about as soul sucking as it gets.
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So, you don't want to be a resident again? :p
 
GA8314 said:
Now, what you can't do is go out and buy a $60k Mercedes, a Mcmansion, a Country Club membership. Live a NICE, comfortable life, and do some simple things and this is a great gig.
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You can probably still do some of those things, just not all of them...
 
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criticalelement said:
You didn't just say that, did you?
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yes i did. very few states have juries that would ever exceed the policy on a malpractice insurance claim. so yes, I said it. I do plenty of high risk OB. My personal savings are not at risk.
 
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Mman said:
yes i did. very few states have juries that would ever exceed the policy on a malpractice insurance claim. so yes, I said it. I do plenty of high risk OB. My personal savings are not at risk.
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Not to mention the vast majority of cases will settle w/o going to trial for some amount within your policy limits.

There exists a bit of an unwritten agreement between malpractice attorneys and the insurers to not exceed policy limits unless there has been some egregious error with very large provable damages.
 
Mman said:
yes i did. very few states have juries that would ever exceed the policy on a malpractice insurance claim. so yes, I said it. I do plenty of high risk OB. My personal savings are not at risk.
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So it's ok to be sued as long as they settle for 2,999,999?

Not ok with me. I wan't no part of it, and you don't either! I will answer for everyone. I have had to deal with it and it ain't pretty. Even if they settle. Even if it goes away. Believe me it takes something away. Not to mention that a settlement WILL go into the NPDB and it will severely limit your future employment. Most jobs want "clean" applicants.

DEpending on what state you live in and the cap on malpractice judgements, your personal savings IS at risk. There was just a 52 million dollar jury verdict in NYS last week.
 
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criticalelement said:
So it's ok to be sued as long as they settle for 2,999,999?
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I didn't say it was OK, I said that's why I pay for malpractice insurance. And in most states you have almost no chance of getting sued for beyond your policy limit.
 
Mman said:
I didn't say it was OK, I said that's why I pay for malpractice insurance. And in most states you have almost no chance of getting sued for beyond your policy limit.
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Even if your statement were true, which it isn't, what about the issue with the NPDB? Is that ok too?
 
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criticalelement said:
Even if your statement were true, which it isn't, what about the issue with the NPDB? Is that ok too?
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it is true and without question. Also don't see how the NPDB is placing my personal wellbeing at risk.

Does medmal need further reformation (more in some places than others)? Sure. It's a poor system. I dislike it. But let's not act like doing OB anesthesia on some high risk patients deserves some sort of hazard pay like going to a war zone.
 
Being in the data bank will close you out to a lot of jobs.. They just dont wanna deal with it. Right or wrong, it will limit your options.
 
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criticalelement said:
Being in the data bank will close you out to a lot of jobs.. They just dont wanna deal with it. Right or wrong, it will limit your options.
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fig2.jpg
 
http://www.blog.greatzs.com/2015_04_01_archive.html


Never fear, Medscape has a follow up poll asking precisely this question. As to be expected, the more money one makes, the higher the net worth one will attain. In this case, anesthesiologists come in fifth among all physicians, with an average net worth of $2.68 million. The doctors with the highest net worth are the orthopedists. Not surprising since they also make the most money. The lowest net worth belong to family physicians.

The net worth also changes with age. Over 90% of physicians less than 28 years old had net worth of less than $500,000. By age 50, about 55% of doctors have a net worth of over $1 million. And when they reach 65 years old, 49% reported net worth of over $2 million. So be patient all you poor medical students and residents. Your time will come.
 
criticalelement said:
the table is bull ****. What diff does it make whether you are a man or a woman
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Likeability. The more one likes one's physician, the less likely to sue for a bad outcome. Women are better at this game.
 
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BLADEMDA said:
http://www.blog.greatzs.com/2015_04_01_archive.html


Never fear, Medscape has a follow up poll asking precisely this question. As to be expected, the more money one makes, the higher the net worth one will attain. In this case, anesthesiologists come in fifth among all physicians, with an average net worth of $2.68 million. The doctors with the highest net worth are the orthopedists. Not surprising since they also make the most money. The lowest net worth belong to family physicians.

The net worth also changes with age. Over 90% of physicians less than 28 years old had net worth of less than $500,000. By age 50, about 55% of doctors have a net worth of over $1 million. And when they reach 65 years old, 49% reported net worth of over $2 million. So be patient all you poor medical students and residents. Your time will come.
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I don't think anesthesiologist are truly the 5th highest earning physicians, considering this pole does not include ENT, Neurosurg, vascular surg, CT surg, etc...but the rest of your point is well taken.
 
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FFP said:
Likeability. The more one likes one's physician, the less likely to sue for a bad outcome. Women are better at this game.
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I doubt it. Still far more men than women who are full-time working anesthesiologists. Since males work more, they do a much higher % of the cases, leading to the higher likelihood of claims.
 
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Ezekiel2517 said:
I doubt it. Still far more men than women who are full-time working anesthesiologists. Since males work more, they do a much higher % of the cases, leading to the higher likelihood of claims.
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That's also a possibility. More cases over a lifetime mean higher chances of getting sued.
 
BLADEMDA said:
http://www.blog.greatzs.com/2015_04_01_archive.html


Never fear, Medscape has a follow up poll asking precisely this question. As to be expected, the more money one makes, the higher the net worth one will attain. In this case, anesthesiologists come in fifth among all physicians, with an average net worth of $2.68 million. The doctors with the highest net worth are the orthopedists. Not surprising since they also make the most money. The lowest net worth belong to family physicians.

The net worth also changes with age. Over 90% of physicians less than 28 years old had net worth of less than $500,000. By age 50, about 55% of doctors have a net worth of over $1 million. And when they reach 65 years old, 49% reported net worth of over $2 million. So be patient all you poor medical students and residents. Your time will come.
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Sadly, not everyone come to anesthesiology at age 29 fresh out of residency
 
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FFP said:
That's also a possibility. More cases over a lifetime mean higher chances of getting sued.
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So compare female/male Anesthesiologists who have similar longitudinal employment times. Some women don't take much time in the grand scheme of things (6-9 months for a few kids vs 12 -16 weeks a year vacay for the good 'ol boy club), not to mention the "mommy track" jobs I've seen a lot of men take.
 
Mman said:
I didn't say it was OK, I said that's why I pay for malpractice insurance. And in most states you have almost no chance of getting sued for beyond your policy limit.
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Do you mean to say that settlements are almost always within policy limits? Because initial lawsuits are commonly for astronomical figures, and judgments are occasionally above limits as well. Settlements are, I agree, essentially always within policy limits, including post judgement settlements. Thus I think the spirit of what you are saying is true: very unlikely to end up on the hook for out if pocket liability.

http://www.medscape.com/viewarticle/809734
 
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Ezekiel2517 said:
I doubt it. Still far more men than women who are full-time working anesthesiologists. Since males work more, they do a much higher % of the cases, leading to the higher likelihood of claims.
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Male physicians are sued with a MUCH greater frequency than female physicians (~2.5x more often). Every malpractice attorney knows this... it's part of medical jurisprudence 101. This has been the case for decades and is absolutely statistically significant across all specialties and regions.

http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0413-5
 
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caligas said:
Do you mean to say that settlements are almost always within policy limits? Because initial lawsuits are commonly for astronomical figures, and judgments are occasionally above limits as well. Settlements are, I agree, essentially always within policy limits, including post judgement settlements. Thus I think the spirit of what you are saying is true: very unlikely to end up on the hook for out if pocket liability.

http://www.medscape.com/viewarticle/809734
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The majority of settlements + jury awards are for no more than policy limits. Most states have juries that won't go above policy limits.
 
Morzh said:
Male physicians are sued with a MUCH greater frequency than female physicians (~2.5x more often). Every malpractice attorney knows this... it's part of medical jurisprudence 101. This has been the case for decades and is absolutely statistically significant across all specialties and regions.

http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0413-5
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Great, so what? My comment was directed strictly toward the specialty of anesthesiology. It is common sense that if you do a lot more cases than someone else, the chances of a claim or suit against you goes up. i dont care how likable you are.
 
criticalelement said:
We dont get paid necessarily for what we do..... but the burden of liability..... and sitting up on O.B.....believe me.. one nasty case... one incompetent obstetrician... you will wish you never agreed to the 130 an hour because you will be involved in a multi million dollar lawsuit that will drag on for 11 years... I bet you will not consider yourself lucky at that point playa....

I personally... personally.. in 14 years... have saved hospitals multi million dollar lawsuits at least a dozen times... That I know of.. is that worth 130 bucks an hour?
Click to expand...

So, then, what is worth it? $170/hr?? No amount of money? We have risks inherent in our business. We can only do so much to mitigate those risks.
 
GA8314 said:
So, then, what is worth it? $170/hr?? No amount of money? We have risks inherent in our business. We can only do so much to mitigate those risks.
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Whatever number that makes me or you say, "that's not so bad. I will sit up on OB for a whole night for the risk of getting involved in a multi million dollar lawsuit that will drag on for years and sully your career and future and land you on the front page of the daily news". (newsflash) 130 bucks an hour aint it!
 
Honestly that's a ridiculous was to look at things. You could say that about every single day you go to work regardless of whether it's OB, the OR, surgery center, whatever.
 
criticalelement said:
Whatever number that makes me or you say, "that's not so bad. I will sit up on OB for a whole night for the risk of getting involved in a multi million dollar lawsuit that will drag on for years and sully your career and future and land you on the front page of the daily news". (newsflash) 130 bucks an hour aint it!
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There is literally no per hour figure that can make it worthwhile if that is how you think about it. If you are afraid of a lawsuit, don't practice medicine.
 
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Mman said:
There is literally no per hour figure that can make it worthwhile if that is how you think about it. If you are afraid of a lawsuit, don't practice medicine.
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I disagree. Medicine is like playing roulette; it all depends how much you win per amount risked. The latter is just huge in OB.

An employed anesthesiologist is taking twice as much risk as a partner in the same group (and, if we are talking OB, it can be 5-10 times/more). So, for certain types of procedures, it's just not worth the headache. Better do surgicenter crap and make 30% less with half the risk (or less) that one takes by doing employed OB. I too believe that it's not worth the headache at $130/hr in a relatively busy place.

If a partner wants an employee to do a risky case the latter has serious doubts about, the employee should let the partner do it (alone). Better get fired than bankrupt.
 
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FFP said:
If a partner wants an employee to do a risky case the latter has serious doubts about, the employee should let the partner do it (alone). Better get fired than bankrupt.
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malpractice insurance. you aren't going bankrupt
 
criticalelement said:
Stop saying that!!!! It is so simplistic.

going bankrupt is not the only concern with getting sued.
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Perhaps you missed the word "bankrupt" in the post I quoted.

And please learn to read. I did not say or imply that bankruptcy was the only concern of getting sued.
 
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