How Long?

[Anesthesia_Guy]

How does everyone think this anesthesia "boom" will last? My guess is another year or so.

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[ProEra]

Why not forever? At some point within the next 5 years, the last of the baby boomers have to ride into the sunset. Those anesthesiologists who graduated residency in the late 80s and early 90s are still hanging around. And once they’re gone, the next cohort of attendings who graduated residency in the late 90s is very small, comparatively.

As of right now, you probably need 1.5 new graduate millennials for every 1 retiring baby boomer. Most new graduate millennials and eventually gen Zs aren’t interested in working the crazy hours of generations past.

And for those concerned about the rapid expansion of CRNA schools, I doubt those graduates will be putting in big hours considering their big leap in per hour pay over the last few years.

So it seems to me that demand will still be around for several years. Pair that with the increasing demand for anesthesia services for GI procedures, IR procedure, cath lab procedures, EP procedures which seems to increase every year.

 

[Planktonmd]

Why not forever? At some point within the next 5 years, the last of the baby boomers have to ride into the sunset. Those anesthesiologists who graduated residency in the late 80s and early 90s are still hanging around. And once they’re gone, the next cohort of attendings who graduated residency in the late 90s is very small, comparatively.

As of right now, you probably need 1.5 new graduate millennials for every 1 retiring baby boomer. Most new graduate millennials and eventually gen Zs aren’t interested in working the crazy hours of generations past.

And for those concerned about the rapid expansion of CRNA schools, I doubt those graduates will be putting in big hours considering their big leap in per hour pay over the last few years.

So it seems to me that demand will still be around for several years. Pair that with the increasing demand for anesthesia services for GI procedures, IR procedure, cath lab procedures, EP procedures which seems to increase every year.

That is a very optimistic view of the future.
I agree that you will need 2-3 of the new guys to replace one of the old guys since they will all want to work as little as possible. The downside to that is if they do a third of the work they will likely get paid a third of the money by pure market dynamics and they will compete with CRNAs as equals.
Also the future of health care in the U.S. will be some sort of single payer system which will likely result in across the board drop in pay.
So, the good news : You will all have jobs, the bad news you will take a big pay cut.

 

[medicine2wallstreet]

No the new grads will want to work even harder because we had more student loan debt than y'all ever had. Hell the government had to put student loan pay back on pause because it's about to cripple our economy. We will work incredibly hard coming out of the gate to make that money back. Can y'all old men just go yell at some clouds or something.

 

[aneftp]

If we are worry about the EM. Collapse.

That’s because you got various mid levels plus IM:FP docs who can do 80% of what real EM docs can do. And probably do 95% of the job at suburban urgent care centers.

Only saving grace is crna’s aren’t taking less money.

An hourly w2 per diem CRNA at my place makes around $150/hr plus access to benefits if they choose. That’s just hourly w2 per diem. The 1099 locums are close to $200/hr. No paid leave for either one of those.

The full time w2 crna’s make equivalent of $100/hr plus paid vacation /holiday (11 weeks), pension plus 403 Roth/or pretax 457b. But most of
The w2 full time crna’s work only 7 days a month. 24 hourly shifts.

It’s pick ur poison if you are anesthesia management trying to figure how to staff on a daily basis with docs and CRNAs. The full time w2 crna’s aren’t available every day.

The per diem w2 crna’s aren’t exactly cheap either.
The locums crna’s are the most expensive.

It’s a chess game with management. Make docs hourly @220 hr equivalent plus benefits/health care pension plus 9 weeks off plus paid holidays seems to be the sweet spot. That comes out to around 450k no calls daytime for 40 hours for day time doc. For docs looking for daytime spot. But even those docs want a free day off as well. No one wants to work 5 days a week.

Then the night and weekends slots are a different beast with docs. Who will
Cover that. That’s a different job. Those docs want extra pay for extra time off. So they will get 26 weeks off. For
The same pay.

Or they can make 600k with 15 weeks off for njght coverage. Plus benefits worth another 50k.

 

[Volatile]

I don’t think many anesthesiologists would work night coverage for 600k with 15wks off. I certainly wouldn’t. That sounds terrible.

 

[Iso4ane]

I don’t think many anesthesiologists would work night coverage for 600k with 15wks off. I certainly wouldn’t. That sounds terrible.

If its 4 nights a week 6p-6a, with 15 weeks off, thats only 337 a hour. If it's not a busy system, that's not terrible, But, if you're guaranteed to work every night, then more may be required.

 

[periopdoc]

The anesthesia market goes in about 10 year cycles. We are around the mid-point of the high cycle. We have a solid 4-5 years of income increases before things even start going south... assuming the wider economy doesn't completely tank in the interim.

 

[GravelRider]

How does everyone think this anesthesia "boom" will last? My guess is another year or so.

What’s going to change in the next year?

I also hardly call this a “boom.” A boom was when private practice partnerships were the norm and it wasn’t hard to come close to or exceed a million dollars a year and still take 8-12 weeks of vacation. A bunch of old timers I know tell me that 20 years ago was the real anesthesia “boom.” Then those “boomers” (pun intended) sold their practices for an even bigger pay day as they glided into retirement. What’s happening now is people finally realized they were being overworked and under payed by their employers. I think this is more of reversion to the mean. The days of the big bucks private practice gigs are probably gone, but so are the days where people agree to that 350k salary with 4 weeks vacation that calculates out to about $120/hr. The current generation is simply not going to agree to sleep in a hospital waiting for some trauma for $120/hr (rightfully so).

What could possibly bring down the current market is if a whole bunch of ASCs, endoscopy centers, and procedural offices start closing shop due to the cost of nursing and anesthesia. If that happens, you could have an influx of available CRNAs and anesthesiologists on the market.

 

[Fpg1245]

Barring single payer. Supply demand still reign.

At least demand for procedures that require anesthesia is high.

Question is now how many new residency programs have opened and how many are planned.

5 years ago EM was having a good run. Then covid hit and now there’s a residency program in every hospital it seems!!

 

[turnupthegas]

Decreased supply. Increased surgical volume. I think we got a while to go. Maybe a couple of years.

 

[mmag]

The anesthesia market goes in about 10 year cycles. We are around the mid-point of the high cycle. We have a solid 4-5 years of income increases before things even start going south... assuming the wider economy doesn't completely tank in the interim.

The job market was terrible 10-12 years ago.

 

[ryanjmy]

Why not forever?

Lol. I bet the ceo of blockbuster said the same thing in the 90s. Just like blockbuster some technology will make all of us obsolete. Better drugs, AI, robots or all the above.

 

[dannyboy1]

Lol. I bet the ceo of blockbuster said the same thing in the 90s. Just like blockbuster some technology will make all of us obsolete. Better drugs, AI, robots or all the above.

Nothing will ever take place of a human being needing to deliver anesthesia. The credentials of that human however….

 

[nycitygas]

The job market was terrible 10-12 years ago.

I agree. I graduated in 2013 and market was horrible

 

[linkin06]

Lol. I bet the ceo of blockbuster said the same thing in the 90s. Just like blockbuster some technology will make all of us obsolete. Better drugs, AI, robots or all the above.

netflix offered to sell itself to blockbuster for $50 million, and they said no.

 

[UscGhost]

Market will be good for awhile...at least 5-10 years

High surgical volume (might dip a bit in a recession but probably not that much)

Low volume of replacements (Docs coming out prefer lifestyle, families, etc. So 1.5 new docs needed to replace 1 old doc). CRNAs don't want to work in hospitals in my area

Continued retirements of existing older docs

Only issue will be the increased gap between payors reimbursement and labor cost. Hospitals will not like the increased annual stipend costs, so it's unpredictable how they will handle it. This eventually may cause the incomes to level off from their current trajectory.

Supply significantly favors anesthesiologists right now.

 

[neutro]

Focus on the now and quality of work and self-improvement - not the future.

Secondly, you are not calculating the quality and experience of some anesthesiologist that demands a premium pay. That is always mis-stated.

Even in a big market, anesthesiologists with a clean profile who can sit their own cases, can do blocks efficiently, can manage difficult cases, CRNAs and surgeons AND do it with a pleasant attitude and are never late are like a unicorn. Find me on that doesnt want to clock out and wants to finish the day without OT expectation because they are passionate about their work, and I will buy you dinner...

Group chairmen know this.

They know that the difference between paying someone $300/hour and $350/hour for a much superior product is worth it.

So I would say, high quality anesthesiologists will always be in demand.

And one can figure that out after a week of working with someone.

 

[neutro]

That is a very optimistic view of the future.
I agree that you will need 2-3 of the new guys to replace one of the old guys since they will all want to work as little as possible. The downside to that is if they do a third of the work they will likely get paid a third of the money by pure market dynamics and they will compete with CRNAs as equals.
Also the future of health care in the U.S. will be some sort of single payer system which will likely result in across the board drop in pay.
So, the good news : You will all have jobs, the bad news you will take a big pay cut.

It's funny you mention this. Juts yesterday I was chatting with the chairman of the practice that I cover for, and they hired two young anesthesiologists and they are being let go after 6 months due to work ethic issues.

The hospital I cover is by no means a busy place - in fact its a boutique hospital with 95% outpatient surgery with good payor mix and overall healthy population and well-cared for patients.

He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends.

It costs money to hire and recruit.

My experience has been similar trying to hire for my practice. One person we spoke to, wanted $650K with 12 weeks off and wanted to do his own cases all the time (meaning no pre-ops, no supervision/direction, no leadership, no management of CRNAs etc - which is the real challenging part of any anesthesia practice - not even once in a while. We all rotate as a group with this duty).

Give me 4 gall bladders to do than that and I'd gladly take it vs. doing 40 pain and GI cases with 4 CRNAs and doing all breaks, lunches, pre-ops etc etc. But we all have to work and share the laborious parts of our practice. He didn't want to.

I fully understand quality of life and its importance. But at certain point, newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.

I dont know...maybe Im old school...

 

[chessknt]

Barring single payer. Supply demand still reign.

At least demand for procedures that require anesthesia is high.

Question is now how many new residency programs have opened and how many are planned.

5 years ago EM was having a good run. Then covid hit and now there’s a residency program in every hospital it seems!!

This logic doesn't work in medicine. Many pediatric and adult medical subspecialties are on substantial demand mostly because their pay is so poor nobody goes in to them. The entire game is dictated by CMS billing rules and they have been quite bold about making huge changes with minimal forethought over the last few years.

 

[gunnershow]

It's funny you mention this. Juts yesterday I was chatting with the chairman of the practice that I cover for, and they hired two young anesthesiologists and they are being let go after 6 months due to work ethic issues.

The hospital I cover is by no means a busy place - in fact its a boutique hospital with 95% outpatient surgery with good payor mix and overall healthy population and well-cared for patients.

He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends.

It costs money to hire and recruit.

My experience has been similar trying to hire for my practice. One person we spoke to, wanted $650K with 12 weeks off and wanted to do his own cases all the time (meaning no pre-ops, no supervision/direction, no leadership, no management of CRNAs etc - which is the real challenging part of any anesthesia practice - not even once in a while. We all rotate as a group with this duty).

Give me 4 gall bladders to do than that and I'd gladly take it vs. doing 40 pain and GI cases with 4 CRNAs and doing all breaks, lunches, pre-ops etc etc. But we all have to work and share the laborious parts of our practice. He didn't want to.

I fully understand quality of life and its importance. But at certain point, newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.

I dont know...maybe Im old school...

Just because the rest of you sold out for ACT doesn't mean he has to. You can call your own shots in this market. I refuse to work with CRNAs as well.

 

[chessknt]

I disagree. The reason their pay is depressed is because their barriers to entry are way lower than most other fields in medicine. 3 years of training for most of them vs 4+ for most others. That’s a huge difference in specialization and it shows up in the mid level replacement they’re seeing.

They’re more easily replaceable by Midlevels given the short length of training and lax regulation of their Midlevels. Crnas, in contrast to online NPs, take at least 3 years to train, and have onerous case requirements that need tertiary medical centers. Primary care isn’t that way, so it’s much easier to make an “equivalent” on paper to depress salaries.

Direct primary care is not influenced by CMS either. They have so much demand that it’s actually viable for a meaningful percentage of their workforce to go pure cash concierge service. Huge plus to that field

You think there are pediatric pulm/GI midlevels? You think there are adult rheum midlevels? You think a pediatric GI is 3 years of training?

These fields are complicated and not prone to mid-level intrusion because of that. You can't just practice a procedure a few dozen times and be good to go. The e/m billing punishes non procedural specialties who don't own infusion centers and that is the problem. CMS could murder anesthesia billing just as easily as they have e/m of they think you guys are costing too much. They kicked CC in the balls last year and inpatient medicine this year.

 

[GravelRider]

It's funny you mention this. Juts yesterday I was chatting with the chairman of the practice that I cover for, and they hired two young anesthesiologists and they are being let go after 6 months due to work ethic issues.

The hospital I cover is by no means a busy place - in fact its a boutique hospital with 95% outpatient surgery with good payor mix and overall healthy population and well-cared for patients.

He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends.

It costs money to hire and recruit.

My experience has been similar trying to hire for my practice. One person we spoke to, wanted $650K with 12 weeks off and wanted to do his own cases all the time (meaning no pre-ops, no supervision/direction, no leadership, no management of CRNAs etc - which is the real challenging part of any anesthesia practice - not even once in a while. We all rotate as a group with this duty).

Give me 4 gall bladders to do than that and I'd gladly take it vs. doing 40 pain and GI cases with 4 CRNAs and doing all breaks, lunches, pre-ops etc etc. But we all have to work and share the laborious parts of our practice. He didn't want to.

I fully understand quality of life and its importance. But at certain point, newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.

I dont know...maybe Im old school...

Some millennials are approaching a decade or more of practice by now. You think it was a bad hire based on generational category or just a bad hire?

I once had a boomer try to hand off a 3 hour trauma that was hemodynamically unstable and about to be brought to sicu because “he leaves at 5.” I promptly said “no thanks,” but offered to help him transport to sicu. A tantrum ensued, but having little kids gives me innate immunity to tantrums and histrionics.

 

[pgg]

Just because the rest of you sold out for ACT doesn't mean he has to. You can call your own shots in this market. I refuse to work with CRNAs as well.

Well - it sounds like this guy joined a practice (appears to be a private group at that) that employed an ACT model, and then decided he didn't want to do that, and became a squeaky wheel for the non-ACT assignments. Not really shouldering his fair share of the ACT work. Which virtually none of us enjoy.

It's a rare person who genuinely prefers ACT work over solo work, and I daresay a large percentage of the ones who do, have been to some degree institutionalized by a lifetime of ACT work to the point that they'd struggle to function independently. You know the kind of people I'm talking about.

So I get what you're saying. One can minimize or altogether refuse ACT work, and that's pretty appealing to almost all of us, but the time to make that stand is before you accept a job.

 

[chessknt]

There are Midlevels who essentially run the inpatient services in all of those fields.

The biggest issue is that peds GI and pulm aren’t gonna be pushing the volume of procedures that the adult side of those specialties do. The demand is not nearly as high in aggregate as it is for screening colos and EGDs for adults

CMS has already murdered anesthesia billing to nearly the maximum possible. It has had no effect on us and essentially because our services are highly in demand and private insurance patients demand those services.

Pediatric specialties are not procedural enough to be viable in private practices, so they will get farmed out to academic tertiary centers which artificially depress doctor salaries.

If you could get a decent census of patients whose parents have jobs in GI, and push 10+ scopes per procedure day in pediatric GI, you’d make a huge amount of money.

Critical care is easily farmable to Midlevels. They round on all the patients, write all the notes, and template everything with minor adjustments from the doctors in every big hospital I’ve ever worked in. These Midlevels can be trained in 3 months to be supervised by a doctor with CC training

A lot of inaccurate assumptions and information in here but I'll just pick the CMS bone with anesthesia--you think they can't kill anesthesia? They just need to adjust unit values (not the monetary value but the actual units per case and time units that dictate how all the other payors act) down to where the outpatient specialists bill so it is impossible to generate 10k+ units/yr and you're down to the 4-5k units/yr that outpatient specialists get, then maybe you'll appreciate how much scrounging the non proceduralists have had to do all these years while CMS continues to slash and burn. Thinking that private insurance will just increase payments to you to keep the status quo especially after the no surprises act is magical thinking.

 

[crash2500]

I agree. I graduated in 2013 and market was horrible

Not as bad as 2017

 

[Coffee PRN]

Well - it sounds like this guy joined a practice (appears to be a private group at that) that employed an ACT model, and then decided he didn't want to do that, and became a squeaky wheel for the non-ACT assignments. Not really shouldering his fair share of the ACT work. Which virtually none of us enjoy.

It's a rare person who genuinely prefers ACT work over solo work, and I daresay a large percentage of the ones who do, have been to some degree institutionalized by a lifetime of ACT work to the point that they'd struggle to function independently. You know the kind of people I'm talking about.

So I get what you're saying. One can minimize or altogether refuse ACT work, and that's pretty appealing to almost all of us, but the time to make that stand is before you accept a job.

It actually sounds more like they were just in the talking stages--and he was complaining about the new grad's expectations of salary, time off, and doing MD only cases. I see nothing wrong with making your expectations clear with the practice and saving everyone's time. What's wrong with refusing to settle for a mediocre package and demanding more? Settling for what was given to us is how this field ended up with years of stagnating salaries and supervision ratios. If we, as a collective, all demanded more in par to what we bring to the hospital and refused to settle, we would make it a better job environment for everybody.

newly minted docs have to realize that this is a service based profession and after spending over a decade to be an anesthesiologist, the first 5-7 years as an attending should be spent in honing your craft and making yourself desirable and marketable.

I dont know...maybe Im old school...

Hard disagree. Newly minted anesthesiologists are already highly desired and valuable to a practice. Gone are the days that they smile and say "thank you sir" for giving them a below market wage to supervise 4:1 for 3 years just for the chance at becoming a partner. At a practice that may not even exist 3 years from now.

 

[abolt18]

Well - it sounds like this guy joined a practice (appears to be a private group at that) that employed an ACT model, and then decided he didn't want to do that, and became a squeaky wheel for the non-ACT assignments. Not really shouldering his fair share of the ACT work. Which virtually none of us enjoy.

It's a rare person who genuinely prefers ACT work over solo work, and I daresay a large percentage of the ones who do, have been to some degree institutionalized by a lifetime of ACT work to the point that they'd struggle to function independently. You know the kind of people I'm talking about.

So I get what you're saying. One can minimize or altogether refuse ACT work, and that's pretty appealing to almost all of us, but the time to make that stand is before you accept a job.

Neutro described 2 scenarios. The first was the 2 new guys getting let go from his friend's group for wanting pay equality and to have a good schedule (early out, no weekends, whatever). As it's described they're obviously presented as lazy and greedy or whatever. I imagine the scenario could just as well be that the new guys want to be paid the same as the old guys for the same work, and they want to leave early some days like the old guys... But who knows.

The second scenario, the one that didn't want to work with crnas, wanted 12 weeks off, and $650K, was just an applicant they talked to, not someone they hired.

 

[ambiturner]

Not as bad as 2017

2015-17 was probably the worst time to finish since 2000. A lot of the top practices were either evaluating selling to AMCs, and therefore not taking new partners, had recently sold out, or were going to sell out and offering the same partnership package without the partnership/buyout money. A lot of the people I knew who finished in 2013 at least ended up getting a lump sum with the buyout, although they probably had just as hard a time finding a job as those in the next few years.

 

[vector2]

2015-17 was probably the worst time to finish since 2000. A lot of the top practices were either evaluating selling to AMCs, and therefore not taking new partners, had recently sold out, or were going to sell out and offering the same partnership package without the partnership/buyout money. A lot of the people I knew who finished in 2013 at least ended up getting a lump sum with the buyout, although they probably had just as hard a time finding a job as those in the next few years.

Horrific time to graduate. 90% of the jobs out there in my region were AMC trash or low paying academic gigs

 

[DazedWanderer]

He said that the millennials he hired are wanting "pay of 25 year legacy partner"

If he thinks that unreasonable, it seems like he is out of touch with the current market. Most groups/hospitals nowadays will gladly pay new grads their market value and immediate financial equity right off the bat (or after 1 yr max), why the hell would anyone bend over backward for some "25 year legacy partner" to skim 30% off the top of your billable earnings for years and pad their own pockets on the back of your labor, then decide "you aren't quite a good fit" and move on to the next chump or they sell out before you make partner? In the current job market new grads have zero reason to waste their time playing these stupid games.

 

[UscGhost]

If he thinks that unreasonable, it seems like he is out of touch with the current market. Most groups/hospitals nowadays will gladly pay new grads their market value and immediate financial equity right off the bat (or after 1 yr max), why the hell would anyone bend over backward for some "25 year legacy partner" to skim 30% off the top of your billable earnings for years and pad their own pockets on the back of your labor, then decide "you aren't quite a good fit" and move on to the next chump or they sell out before you make partner? In the current job market new grads have zero reason to waste their time playing these stupid games.

Financial buy in for a partnership is a scam

There is nothing proprietary about an anesthesia group. Unless the group owns physical assets, then your investment isn't worth anything.

Partnership track required for voting rights, decision making, etc. Fine. But there shouldn't be a pay differential

 

[Beeftenderloin]

He said that the millennials he hired are wanting "pay of 25 year legacy partner and want to clock out at 3 pm shamelessly". LOL. He was mad...Also they don't want to work weekends

Literally all the PP groups in my area have upped their partner track pay from 70-80% of partners to 90-100% starting day 1 with 100% equitable distribution of cases, call, and vacation, regardless of experience. This is the market right now. Good luck hiring if you aren’t offering this as a PP group, at least in my neck of the woods. It’s that or pay 1.5-2x for locums.

 

[finalpsychyear]

Anesthesia is pretty safe for a while if for no reason than the younger gen aren't going to replace the older gen in workload and forget only more surgeries every year. My sibling, a gen z, will be an attending anesthesiologist in 1 year at 28 yo and thinks 390k is a lot working in a saturated area vs driving 35-40 min to get a salary 550-600k. Drives me crazy trying to have this discussion. In the past you'd have to fly to find such a disparity in pay and now a 35-40 min commute is alot.

That being said. My philosophy has always been you never assume things stay hot. You milk it like it's going out of style NOW. I just don't think the newer gen think like that. I also value lifestyle. Haven't worked wknd, night, or holidays in almost 7 years now. Phones and instant gratification via apps for everything has ruined it for young gen. I still remember dial up internet lol. What's going to keep me in medicine longer now is I have no idea what my unborn future kids will do or what work ethic to expect. Probably need to plan for a nest egg that can maybe cover their basics as well so that's what keeps me going super hard as I near a decade into attending hood. Then another 10 after that and maybe secure a nest egg to cover them a bit as well.

 

[james775]

Literally all the PP groups in my area have upped their partner track pay from 70-80% of partners to 90-100% starting day 1 with 100% equitable distribution of cases, call, and vacation, regardless of experience. This is the market right now. Good luck hiring if you aren’t offering this as a PP group, at least in my neck of the woods. It’s that or pay 1.5-2x for locums.

That’s good to know. I am starting cardiac fellowship in July. Gonna start looking more intently around August. I have had initial convos with private practices. No specifics, just friendly hellos. There was one small group, 10 anesthesiologists. I asked how long of a partnership track. He scoffed at the question and said he couldn’t imagine being a partner right out of training and would need at least 2 years. Honestly was a little off putting.

Another group had a 4 year partnership track. Partners making 650, track making 400. Can you imagine losing out on a million dollars and your “coworkers” pocketing it. They just decreased it to 3 years but they still have a ton of posts looking for people.

 

[Anesthesia_Guy]

Another group had a 4 year partnership track. Partners making 650, track making 400. Can you imagine losing out on a million dollars and your “coworkers” pocketing it. They just decreased it to 3 years but they still have a ton of posts looking for people.

Wonder why

 

[GravelRider]

That’s good to know. I am starting cardiac fellowship in July. Gonna start looking more intently around August. I have had initial convos with private practices. No specifics, just friendly hellos. There was one small group, 10 anesthesiologists. I asked how long of a partnership track. He scoffed at the question and said he couldn’t imagine being a partner right out of training and would need at least 2 years. Honestly was a little off putting.

Another group had a 4 year partnership track. Partners making 650, track making 400. Can you imagine losing out on a million dollars and your “coworkers” pocketing it. They just decreased it to 3 years but they still have a ton of posts looking for people.

And then someone here will post something dumb like “all these greedy locums people are killing private practices.”

 

[LowWafer8]

That is a very optimistic view of the future.
I agree that you will need 2-3 of the new guys to replace one of the old guys since they will all want to work as little as possible. The downside to that is if they do a third of the work they will likely get paid a third of the money by pure market dynamics and they will compete with CRNAs as equals.
Also the future of health care in the U.S. will be some sort of single payer system which will likely result in across the board drop in pay.
So, the good news : You will all have jobs, the bad news you will take a big pay cut.

when will this future single payor system occur? seems to me that's been the promise for at least the past 20 years.

 

[finalpsychyear]

when will this future single payor system occur? seems to me that's been the promise for at least the past 20 years.

Big pharma and private insurance have too much to lose thus will control lobbyists and keep the votes to not allow this. My guess is at least 10 years minimum likely longer.

 

[LowWafer8]

Big pharma and private insurance have too much to lose thus will control lobbyists and keep the votes to not allow this. My guess is at least 10 years minimum likely longer.

yes, that's what i was implying. the illumanti control all.

 

[sbmed100]

14 months (ie two more graduating classes) and the tide will turn. Will NEVER be as short as 2022. The issue like I said before is that salaries (compensation) are high due to the manpower shortage -but in real terms revenue (the money being brought in from collections) keeps falling. So when the tide turns lots of folks gonna be caught with their pants down wondering what the hell happened.

 

[Dr. Rude]

yes, that's what i was implying. the illumanti control all.

They are coming for you for outing them.

 

[pgg]

14 months (ie two more graduating classes) and the tide will turn. Will NEVER be as short as 2022. The issue like I said before is that salaries (compensation) are high due to the manpower shortage -but in real terms revenue (the money being brought in from collections) keeps falling. So when the tide turns lots of folks gonna be caught with their pants down wondering what the hell happened.

The point is that (professional fee) revenue is becoming less relevant than labor supply/demand.

Surgery isn't going to stop. It isn't going to slow. The trend is in the other direction.

There aren't enough of us. This trend isn't improving.

Hospitals will subsidize groups, or subsidize AMCs, or subsidize directly by employing anesthesia services themselves, or their ORs will close. We know the ORs won't close.

Salaries are driven by supply and demand. Do CRNAs deserve the salaries they earn? Do traveling circ RNs? Do we? It's an irrelevant question. As the man said, deserve ain't got nothing to do with it.

 

[pgg]

Big pharma and private insurance have too much to lose thus will control lobbyists and keep the votes to not allow this. My guess is at least 10 years minimum likely longer.

Before or after fusion is a commercially viable energy source?

 

[sbmed100]

I agree with almost all your points, esp supply and demand…but I do see the trend of manpower shortage improving within two years with all the new grads (both MD and AA/CRNA.)

 

[dizzy21]

And then someone here will post something dumb like “all these greedy locums people are killing private practices.”

Cardiac locums are making more than the partners at that group currently. Population is aging and americas diet has not improved so I think the supply-demand side of cardiac anesthesia market won’t get better for the group unless you get replaced by either a robot, a CRNA or a robot CRNA.

But who knows. Everyone thought that cardiac surgery was a doomed specialty due to stents and TAVRs and yet people continue to need surgery.

 

[Status Sciaticus]

And then someone here will post something dumb like “all these greedy locums people are killing private practices.”

 

[ambiturner]

Cardiac locums are making more than the partners at that group currently. Population is aging and americas diet has not improved so I think the supply-demand side of cardiac anesthesia market won’t get better for the group unless you get replaced by either a robot, a CRNA or a robot CRNA.

But who knows. Everyone thought that cardiac surgery was a doomed specialty due to stents and TAVRs and yet people continue to need surgery.

At least locally, we’re expecting a big shortage of fellowship trained anesthesiologists for at least 2-3 extra years since seemingly none of our residents want to do cardiac or peds (pain people seem to still want to do pain) and would rather get out and get paid now. Who knows if they’ll go back to fellowship when the boom is over.

 

[drdan4]

If he thinks that unreasonable, it seems like he is out of touch with the current market. Most groups/hospitals nowadays will gladly pay new grads their market value and immediate financial equity right off the bat (or after 1 yr max), why the hell would anyone bend over backward for some "25 year legacy partner" to skim 30% off the top of your billable earnings for years and pad their own pockets on the back of your labor, then decide "you aren't quite a good fit" and move on to the next chump or they sell out before you make partner? In the current job market new grads have zero reason to waste their time playing these stupid games.

Just focus on learning the trade for the sake of your patients. As a new grad you don't have the knowledge, speed or skill to demand the same pay as a 20 year vet. The last few new grads we hired were the perfect combination of lazy, incompetent and entitled. Almost makes you want to burn down the whole thing down rather than hand them the keys.

Anyway, with rising Medicare, the No Surprises Act and astronomical labor costs it's almost better to be employed or do locums now. Perfect timing for me to slow down. Probably will be closing shop sooner than later.

 

[UscGhost]

The point is that (professional fee) revenue is becoming less relevant than labor supply/demand.

Surgery isn't going to stop. It isn't going to slow. The trend is in the other direction.

There aren't enough of us. This trend isn't improving.

Hospitals will subsidize groups, or subsidize AMCs, or subsidize directly by employing anesthesia services themselves, or their ORs will close. We know the ORs won't close.

Salaries are driven by supply and demand. Do CRNAs deserve the salaries they earn? Do traveling circ RNs? Do we? It's an irrelevant question. As the man said, deserve ain't got nothing to do with it.

Yup.

And as salaries improve, they need to work less to make the same salary, so then you see an increased labor shortage.

Just focus on learning the trade for the sake of your patients. As a new grad you don't have the knowledge, speed or skill to demand the same pay as a 20 year vet. The last few new grads we hired were the perfect combination of lazy, incompetent and entitled. Almost makes you want to burn down the whole thing down rather than hand them the keys.

Anyway, with rising Medicare, the No Surprises Act and astronomical labor costs it's almost better to be employed or do locums now. Perfect timing for me to slow down. Probably will be closing shop sooner than later.

Often the new grads are faster, more personable and better at regional than the 20 year vets. You just have to hire the right ones.

And once you get from about year 3 to year 15, they are generally more productive than the 20 year vet.