Med student interested in anesthesiology. Still worth pursuing?

[deleted171991]

These questions are ridiculous. Anesthesia isnt going anywhere. Anesthesiologists arent just gonna start getting laid off. For one we're the most valuable specialty in the hospital if you go by objective measures. There are many things that MD's do that CRNA's cant (no offense to them). Economically speaking the supply has not met demand in the field, ever. If you need proof of that just go to gaswork.com and see for yourself. Plenty of jobs out there. Sure the days of 600-700k/year are gone. But starting out at 250-300 immediately out of residency is not bad. When put in context of doctoring, as compared to other specialties like surgery and IM, anesthesia is friggin awesome in just about ALL aspects. People have been dooming and glooming about anesthesia practice for decades.

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[GravelRider]

For one we're the most valuable specialty in the hospital if you go by objective measures.

 

[TeslaCoil]

Ok... how am I wrong?


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[deleted171991]

Ok... how am I wrong?

I should have emphasized most of your post, that's how idealistic you sound. Good for you!

 

[GravelRider]

Ok... how am I wrong?


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You said "[anesthesia is] the most valuable specialty in the hospital if you go by objective measures." What are your objective measures?

 

[DetectiveAlonzo]

Idk man.. if it was the most valuable... hospital execs wouldn't let some nurses with some bull**** degree do the same job most gas docs can do..

Also..

Primary care (FM and IM) are only 3 year tracks and you are making $250K in those as well right out of residency.

You lose out on $500K for the 2 years extra that Anesthesia residency is.

 

[anbuitachi]

Are the 1 million dollar salary international pain gigs on gaswork legit? I heard regional was more competitive than pain this yr... how can that be with pain salaries this high available with a cush life?

half of our residents applying to regional didn't match. just insane. and we are a top tier residency program..

 

[bronx43]

These questions are ridiculous. Anesthesia isnt going anywhere. Anesthesiologists arent just gonna start getting laid off. For one we're the most valuable specialty in the hospital if you go by objective measures. There are many things that MD's do that CRNA's cant (no offense to them). Economically speaking the supply has not met demand in the field, ever. If you need proof of that just go to gaswork.com and see for yourself. Plenty of jobs out there. Sure the days of 600-700k/year are gone. But starting out at 250-300 immediately out of residency is not bad. When put in context of doctoring, as compared to other specialties like surgery and IM, anesthesia is friggin awesome in just about ALL aspects. People have been dooming and glooming about anesthesia practice for decades.


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What are these objective measures that you speak of? I'm pretty sure if our administrators had the option of laying off the entire anesthesiology department or the entire surgery department, it would be an easy choice. Hell, I'm pretty sure they rather lay off anesthesia before they do the hospitalists.

 

[anbuitachi]

These questions are ridiculous. Anesthesia isnt going anywhere. Anesthesiologists arent just gonna start getting laid off. For one we're the most valuable specialty in the hospital if you go by objective measures. There are many things that MD's do that CRNA's cant (no offense to them). Economically speaking the supply has not met demand in the field, ever. If you need proof of that just go to gaswork.com and see for yourself. Plenty of jobs out there. Sure the days of 600-700k/year are gone. But starting out at 250-300 immediately out of residency is not bad. When put in context of doctoring, as compared to other specialties like surgery and IM, anesthesia is friggin awesome in just about ALL aspects. People have been dooming and glooming about anesthesia practice for decades.


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Why wouldn't anesthesiologists just start getting laid off? At some institutions they have CRNAs also do cardiac. If finances are really squeezed, you bet they'll replace the entire anesthesiology department with CRNAs,

 

[DetectiveAlonzo]

Why wouldn't anesthesiologists just start getting laid off? At some institutions they have CRNAs also do cardiac. If finances are really squeezed, you bet they'll replace the entire anesthesiology department with CRNAs,

Maybe because don't CRNAs legally need gas docs to oversee them? Once they gain independence in all 50 states... thennn we'll see that huge drop in gas salary. If you feel anesthesia is worth CRNA salary... then by all means do it!

 

[anbuitachi]

Maybe because don't CRNAs legally need gas docs to oversee them? Once they gain independence in all 50 states... thennn we'll see that huge drop in gas salary. If you feel anesthesia is worth CRNA salary... then by all means do it!

I mean yea if you are talking about today at this very moment, yes 100% of the anesthesiolgoist wont be fired. but i think 17 ? states already have independent practice of some sort, it wont be long before others do it, especially as we hire more and more CRNAs. When a department has like 10 anesthesiologists and 40 CRNAs, the next chair may just be a CRNA who will lobby for independent practice

 

[DetectiveAlonzo]

I mean yea if you are talking about today at this very moment, yes 100% of the anesthesiolgoist wont be fired. but i think 17 ? states already have independent practice of some sort, it wont be long before others do it, especially as we hire more and more CRNAs. When a department has like 10 anesthesiologists and 40 CRNAs, the next chair may just be a CRNA who will lobby for independent practice

If it means anything, a hospital will always hire an anesthesiologist over a CRNA for their level of pay...

If that means $200K for 36 hours a week with a bit of call and chance to pick up extra shifts.. I'll take it. I'll be working til I die anyway.

CRNAs got it sweet for now.

You'll always have a job and can take a nurse's job anytime if this stuff happens.

 

[anbuitachi]

If it means anything, a hospital will always hire an anesthesiologist over a CRNA for their level of pay...

If that means $200K for 36 hours a week with a bit of call and chance to pick up extra shifts.. I'll take it. I'll be working til I die anyway.

CRNAs got it sweet for now.

You'll always have a job and can take a nurse's job anytime if this stuff happens.

That is probably true. But it also depends on whos hiring. If the CRNA is the boss, they may only hire CRNAs and not physicians even at the same pay. Like you'd think a general surgery resident (PGY3 lets say) have the skills and knowledge to work as a Gen surg PA. but they aren't gonna hire him/her at same pay as PA cause not a PA.

 

[Man o War]

I'm curious how old you guys are...I ask
Because I've been around a long time and these same discussions were being had a couple decades ago and I have yet to see these Armageddon mass doc layoffs due to CRNAs that were being predicted back then as well. Job market is a bit different because of AMCs and other economics, but the job market is different for tons of specialties. Let's keep this in perspective- in the states where CRNAs can practice independently, there haven't been massive doc layoffs. If what you guys are saying is true, the hospitals in those states would have booted out their docs long ago; they haven't. I have plenty of friends who work in independent CRNA states and they're doing fine.
The quality of today's CRNA is also worse than in previous decades....the victim of the "mill" mentality of their modern schools.....and it shows in practice. We can certainly debate what an anesthesiologist makes per hour vs a CRNA; there's plenty of crap jobs out there, but there's always been crap jobs. That's not a new development.
Also, I've worked at a couple places with CRNAs doing cardiac, and we had them where I trained. They basically pushed the drugs we told them to and acted as a second set of hands for the docs. Hardly a threat.
The independent ones want to sit at their 30 bed hospital or outpatient surgery center and talk crap about how they don't have an anesthesiologist in an hour radius, but the fact is they would flounder and fail badly at an institution that actually does our average sick patients. The presence of anesthesiologists allows surgeons to bring these patients and have confidence it can be handled safely and properly.

 

[deleted171991]

half of our residents applying to regional didn't match. just insane. and we are a top tier residency program..

No, you're not. If you truly were, they wouldn't need a separate regional fellowship.

 

[TeslaCoil]

Ummm RVU's, QI measures, profitability. The hospital will never be in financial troubles because of anesthesia and getting rid of anesthesia or anesthesia docs would be like financial suicide for most institutions, considering that the anesthesia dept is the most profitable dept at many institutions. So no... there wont just be widespread replacement with CRNA's. Hospital administrators know anesthesia is a cash cow compared to just about every other specialty. Waging war on anesthesia would be a horrible business move at most institutions and in most situations. Sure, some hospitals in BFE have to reach for dire measures so they dont wind up like the knick. Im talking about the field as a whole.


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[Nivens]

I've been reading these threads since I was a second year medical student. I'm now a third year anesthesiology resident, and I still don't know if I have the best job in the hospital, or the worst. Sometimes I feel like these threads have led me closer to enlightenment, other times I feel like they carry me further away.

 

[Neurodelic]

I've been reading these threads since I was a second year medical student. I'm now a third year anesthesiology resident, and I still don't know if I have the best job in the hospital, or the worst. Sometimes I feel like these threads have led me closer to enlightenment, other times I feel like they carry me further away.

Seriously. I'm a 4th year medical student applying to anesthesiology this cycle. I love the type of work you all do, but the future of the practice is super unpredictable. Good to know that I'll be just as uncertain in residency.

 

[AdmiralChz]

Seriously. I'm a 4th year medical student applying to anesthesiology this cycle. I love the type of work you all do, but the future of the practice is super unpredictable. Good to know that I'll be just as uncertain in residency.

MDs have been (maybe unfairly) protected from significant change for some time given the public investment into healthcare, but it's quickly turning into an unsustainable system so things are going to have to change. What that exactly means for individual specialties remains to be see, but the future of practice is unpredictable for all specialties at the moment.

But as a comparison, the job market for physicians is infinitely better than JD or MBAs on the whole. My friends with those degrees frequently bemoan how readily replaceable and how minimal job security they have.

With regards to Anesthesiology, SDN tends to lean a little more towards impending doom than the general public (anecdotally). But like I always say - go check out the other forums, in particular the EM threads, and the same worries are there. Are there bad jobs? Absolutely, and some of the regular contributors here readily admit to having and hating them - that sucks, and I hate that for my colleagues. My gut tells me that the people with the worst jobs and the least job satisfaction are among the highest posting people on the forum and tend to be loud and assertive which dominates the feel of the discussion. That's to be expected I suppose with any anonymous board and it's not necessarily a bad thing - banter back and forth is healthy and productive in many instances. On the flip side, we have many contributors who are very happy and always posting about their escapades beyond the OR. But mocking idealistic/optimistic new grads and, worse, attacking anyone with any guts to post a job on the positions subform is a little much. There is a reason hardly anyone posts open positions despite so many openings (and some really good ones).

 

[TeslaCoil]

Seriously. I'm a 4th year medical student applying to anesthesiology this cycle. I love the type of work you all do, but the future of the practice is super unpredictable. Good to know that I'll be just as uncertain in residency.

What Admiral said^. Guys look, I tend to be a realist, but because of all the dooming and glooming, I'm just trying to present the other side of the coin; to be the bicarbonate to the hydrochloric acid, so to speak. Are things going to change? Of course, when do they ever not. 200 years ago doctors were the scourge of society. But look, nothing will change over night, nor will you be left out in the cold. Anesthesia suffers from the same economic trends as all the other specialties, but people tend to catastrophize. Anesthesiologists are staying put for the foreseeable future. If not, we as doctors, are qualified to work in many other fields. Just relax and focus on picking a specialty that doesn't make you hate your life every morning.


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[partydoc]

What Admiral said^. Guys look, I tend to be a realist, but because of all the dooming and glooming, I'm just trying to present the other side of the coin; to be the bicarbonate to the hydrochloric acid, so to speak. Are things going to change? Of course, when do they ever not. 200 years ago doctors were the scourge of society. But look, nothing will change over night, nor will you be left out in the cold. Anesthesia suffers from the same economic trends as all the other specialties, but people tend to catastrophize. Anesthesiologists are staying put for the foreseeable future. If not, we as doctors, are qualified to work in many other fields. Just relax and focus on picking a specialty that doesn't make you hate your life every morning.


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Jesus Christ if you're going to do that at least put up a strong acid against a strong base. SMH

 

[GravelRider]

Jesus Christ if you're going to do that at least put up a strong acid against a strong base. SMH

It's actually fits because his argument that anesthesia was the most valuable specialty in the hospital was pretty weak.

There is a saying about believing half of what you read and half of what you see...or something along those lines. That's probably applicable to the discussion in this thread. There is not a catastrophe facing anesthesia in the sense that we will never be out of a job. Many of the challenges facing anesthesia are also being faced by other specialties as well. However, putting blinders on to the problems and saying we all just need to perk up and have better attitudes is exactly the wrong solution. Many of the things we gripe about...the corporatization of medicine, the expanded role of nurses at the expense of physicians, etc...is not only bad for our profession, but bad for patients. Having the appropriate amount of cynicism and a dose of reality is the best way for future physicians to defend against these changes in the healthcare system.

The other argument that doesn't hold sway with me is the "I've been hearing about CRNA encroachment for 10 years and it hasn't happened yet" argument. That's a bogus thinking. Past performance doesn't guarantee future results. If we continue to rest on our laurels as physicians then I can guarantee you that in the future we will be seen as equals with midlevels. This kind of thinking opened up the door to midlevel encroachment in the first place.

 

[anbuitachi]

MDs have been (maybe unfairly) protected from significant change for some time given the public investment into healthcare, but it's quickly turning into an unsustainable system so things are going to have to change. What that exactly means for individual specialties remains to be see, but the future of practice is unpredictable for all specialties at the moment.

But as a comparison, the job market for physicians is infinitely better than JD or MBAs on the whole. My friends with those degrees frequently bemoan how readily replaceable and how minimal job security they have.

With regards to Anesthesiology, SDN tends to lean a little more towards impending doom than the general public (anecdotally). But like I always say - go check out the other forums, in particular the EM threads, and the same worries are there. Are there bad jobs? Absolutely, and some of the regular contributors here readily admit to having and hating them - that sucks, and I hate that for my colleagues. My gut tells me that the people with the worst jobs and the least job satisfaction are among the highest posting people on the forum and tend to be loud and assertive which dominates the feel of the discussion. That's to be expected I suppose with any anonymous board and it's not necessarily a bad thing - banter back and forth is healthy and productive in many instances. On the flip side, we have many contributors who are very happy and always posting about their escapades beyond the OR. But mocking idealistic/optimistic new grads and, worse, attacking anyone with any guts to post a job on the positions subform is a little much. There is a reason hardly anyone posts open positions despite so many openings (and some really good ones).

I never liked those comparisons. For one thing, all my lawyer friends are employed w 140k+ jobs starting. It's true overall lawyers jobs are more uncertain but it's not a good comparison cause we are super regulated and we only accept the top students. Most who want to be doctors don't get to be. We should be comparing top 10 percent of lawyers or so vs medicine.

And I think it's smart to base your opinions on what's happening and basic principles.

 

[TeslaCoil]

It's actually fits because his argument that anesthesia was the most valuable specialty in the hospital was pretty weak.

There is a saying about believing half of what you read and half of what you see...or something along those lines. That's probably applicable to the discussion in this thread. There is not a catastrophe facing anesthesia in the sense that we will never be out of a job. Many of the challenges facing anesthesia are also being faced by other specialties as well. However, putting blinders on to the problems and saying we all just need to perk up and have better attitudes is exactly the wrong solution. Many of the things we gripe about...the corporatization of medicine, the expanded role of nurses at the expense of physicians, etc...is not only bad for our profession, but bad for patients. Having the appropriate amount of cynicism and a dose of reality is the best way for future physicians to defend against these changes in the healthcare system.

The other argument that doesn't hold sway with me is the "I've been hearing about CRNA encroachment for 10 years and it hasn't happened yet" argument. That's a bogus thinking. Past performance doesn't guarantee future results. If we continue to rest on our laurels as physicians then I can guarantee you that in the future we will be seen as equals with midlevels. This kind of thinking opened up the door to midlevel encroachment in the first place.

Sorry, I still think we are the most valuable specialty. We offer more services than anyone else. So I'm just not sure what you mean by "weak argument". Secondly, I never said anything about resting on our laurels. If you review some of my past posts you'll see that Im all for fighting back. I contribute to that agenda. But I'm not as worried as the doomer gloomers on this forum would have me be.


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[TeslaCoil]

I'll post this one tidbit for support.
2015 physician compensation, work RVU by specialty


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[pgg]

Given what a broken system RVUs are, and how dramatically payment for medical services is changing these days, I don't think I'd hang my hat on how many RVUs anesthesiologists have historically generated.


Here's happiness in anesthesia, and it has two parts:

1) Enjoy and take satisfaction in the day-to-day work: the patients, the cases, your role within them, the way you're treated, the hours you work.

2) "Annual income twenty pounds, annual expenditure nineteen pounds nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery."

If you can't do (1) pick another specialty.

If you can't do (2) you're going to be unhappy in any medical specialty ... or working the sour cream caulking gun at Taco Bell, for that matter.

 

[BLADEMDA]

I've been reading these threads since I was a second year medical student. I'm now a third year anesthesiology resident, and I still don't know if I have the best job in the hospital, or the worst. Sometimes I feel like these threads have led me closer to enlightenment, other times I feel like they carry me further away.

It will be okay. Really. Just suck it up and do the fellowship.

 

[BLADEMDA]

I'm curious how old you guys are...I ask
Because I've been around a long time and these same discussions were being had a couple decades ago and I have yet to see these Armageddon mass doc layoffs due to CRNAs that were being predicted back then as well. Job market is a bit different because of AMCs and other economics, but the job market is different for tons of specialties. Let's keep this in perspective- in the states where CRNAs can practice independently, there haven't been massive doc layoffs. If what you guys are saying is true, the hospitals in those states would have booted out their docs long ago; they haven't. I have plenty of friends who work in independent CRNA states and they're doing fine.
The quality of today's CRNA is also worse than in previous decades....the victim of the "mill" mentality of their modern schools.....and it shows in practice. We can certainly debate what an anesthesiologist makes per hour vs a CRNA; there's plenty of crap jobs out there, but there's always been crap jobs. That's not a new development.
Also, I've worked at a couple places with CRNAs doing cardiac, and we had them where I trained. They basically pushed the drugs we told them to and acted as a second set of hands for the docs. Hardly a threat.
The independent ones want to sit at their 30 bed hospital or outpatient surgery center and talk crap about how they don't have an anesthesiologist in an hour radius, but the fact is they would flounder and fail badly at an institution that actually does our average sick patients. The presence of anesthesiologists allows surgeons to bring these patients and have confidence it can be handled safely and properly.

1. No mass layoffs- instead FFP works for pennies on the dollar for an AMC. That's not good if you ask me. For many Anesthesiologists the AMCs are a scourge across the landscape and have raped the specialty.

2. Quality of CRNAs- definitely worse than 10 years. Younger, more inexperienced and more arrogant than the previous generation. Did I mention lazier as well?

3. Shift to 4:1- The surge in CRNA providers has led to a shift to the 4:1 model. Many practices used to be part solo MD with 3:1 Medical direction. These days more and more are going to 100% 4:1 model wherever possible. That's a lot more work and a lot less satisfying than the previous models.

4. Independent CRNAs- I readily admit this "threat" has been much slower to materialize than I predicted but I dispute the notion that the threat isn't real. CRNAs and CRNA run companies have stolen plenty of lucrative surgi-center contracts from good groups. In addition, they have moved heavily into peds dental and GI centers displacing a lot of Anesthesiologists. Those Anesthesiologists who do remain are forced to accept a lower hourly wage vs 10 years ago when they did their own billing.
The big money is at the outpatient surgi-centers and anyone who doesn't see that "cash cow" disappearing as a major problem is clearly foolish as just 3 private paying GI cases reimburses more than a Medicare CABG.

In summary, the drip, drip through the dam continues at a slow pace. What will be left once the dam breaks? (answer: The collaborative model where we do the sickest cases.)

 

[deleted171991]

1. No mass layoffs- instead FFP works for pennies on the dollar for an AMC. That's not good if you ask me. For many Anesthesiologists the AMCs are a scourge across the landscape and have raped the specialty.

I don't work for an AMC. I would rather be unemployed, or practice CCM-only, than do that. Some AMCs are just miserable places to be employed at, and the rest are industrial assembly lines that treat employed anesthesiologists like cogs. Some PP groups too (not mine). And because all the castrated docs, who are afraid to point out CRNA mistakes, upset them and lose their jobs, many CRNAs can play the perfect angelic anesthesia provider to patients, surgeons, OR staff and bean counters.

The CRNAs know the market is in their favor, not the docs', so many have become militant and egalitarian (at least deep inside). I know AMC places where CRNAs can veto the hiring of anesthesiologists, if they don't like them on the day of their interview (yes, they get to officially interview the physician anesthesiologist candidates). The younger CRNAs have been educated to be militant, and some older ones think they have enough experience to work solo. (Of course, there are many competent nice people who know their limits, appreciate physician help and are a pleasure to work with, but I would say they are less than 50%.)

The main reasons most CRNAs don't work independently are: 1. they are not allowed by their state/hospital and/or 2. they wouldn't make more money and/or 3. they couldn't keep the lifestyle and especially 4. they love the malpractice safety net provided by anesthesiologists. Can anybody imagine practicing medicine without having any malpractice concerns, while giving attitude to your supervisor? Because that's what many CRNAs get away with, on a daily basis. Btw, they don't see physicians as their supervisors, even when they sign for medical direction.

With what I know now, I wouldn't touch the specialty with a pole, as a medical student. But some people just hate "clinic", or "owning patients", which makes one wonder why they got into medicine in the first place.

The big money is at the outpatient surgi-centers and anyone who doesn't see that "cash cow" disappearing as a major problem is clearly foolish as just 3 private paying GI cases reimburses more than a Medicare CABG.

So true. And AMCs are gobbling up those contracts, cutting the lifeline of PP groups.

 

[pgg]

But some people just hate "clinic", or "owning patients", which makes one wonder why they got into medicine in the first place.

That's a little over the top ...

I hated "clinic" on the primary care side because it's generally a q15-20 minute hamster wheel. You make some incremental change or recommendation, and weeks or months later the patient comes back, plus or minus a no-show or two, and half the time they've been noncompliant with your treatment. Oh yay. There's a recipe for job satisfaction.

Having "clinic" on the surgery side would mean I'd be a surgeon, and I never wanted that.

I'm happier not "owning" patients because I'm not one who gets all warm and fuzzy about establishing long term relationships with patients and seeing a panel of 1000 people evolve over the years. I'm sort of antisocial and that kind of longitudinal view just isn't interesting to me. I like to meet a patient, do something meaningful for their care over the course of one encounter, and say goodbye. I admit this shades my very bad attitude and cynicism about the whole perisurgicaloperativeclinicalhospitalhome crap, i.e. expanding our role into some make-believe pseudo-ownership fiction.

Anesthesia's the right fit for me.

 

[bashwell]

I hated FM clinic, but some IM subspecialty clinics are pretty cool. I liked cardiology a lot better for example.

 

[bronx43]

Sorry, I still think we are the most valuable specialty. We offer more services than anyone else. So I'm just not sure what you mean by "weak argument". Secondly, I never said anything about resting on our laurels. If you review some of my past posts you'll see that Im all for fighting back. I contribute to that agenda. But I'm not as worried as the doomer gloomers on this forum would have me be.


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It's a weak argument because you have not demonstrated any supporting evidence or even rationale why this may be true. I'm not sure how anesthesia offers "more services" than anyone else.

 

[nimbus]

Ummm RVU's, QI measures, profitability. The hospital will never be in financial troubles because of anesthesia and getting rid of anesthesia or anesthesia docs would be like financial suicide for most institutions, considering that the anesthesia dept is the most profitable dept at many institutions. So no... there wont just be widespread replacement with CRNA's. Hospital administrators know anesthesia is a cash cow compared to just about every other specialty. Waging war on anesthesia would be a horrible business move at most institutions and in most situations. Sure, some hospitals in BFE have to reach for dire measures so they dont wind up like the knick. Im talking about the field as a whole.


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I have no idea what you mean by "anesthesia is a cash cow". How so? Anesthesia is only a cash cow for the hospital if the anesthesiologists allow the hospital to steal their money which may be the case in some academic places.

It is more often the case that the hospital is subsidizing the anesthesiologists which makes them an expense for the hospital. The hospitals are willing to do this because operating rooms are profit centers for the hospital (through facility fees, associated diagnostic testing, inpatient days, etc) and they need anesthesia to run an operating room. But they're not literally "profiting" from the anesthesia itself. You don't have a clear understanding of how things work. Anesthesiologists aren't billing and collecting for their services and then handing over bags of cash or writing checks to the hospital.

 

[TeslaCoil]

Yes im mainly speaking of academics, which is one place you probably will not see a CRNA becoming a chair.
It doesnt matter how you spin it... whether we bill and then pay out or not. In the end the hospital gets the money that we make for the hospital. I understand perfectly well. We are a highly billable specialty. Every item of work we do, and we do a ton more than any other specialty if you tally it all up, is most certainly billable. And I do actually hedge my bet on RVU's for the time being, because its one of the only measures we have for value, and it speaks highly of what we do for the system. You guys are a bunch of debbie downing eeyores.

 

[TeslaCoil]

It's a weak argument because you have not demonstrated any supporting evidence or even rationale why this may be true. I'm not sure how anesthesia offers "more services" than anyone else.

Im talking about billable/reimbursable quanta. And I did, I posted the RVU article. RVU's as a metric aren't perfect, but they aren't bad either. They're standardized and to me thats what matters most. Course, the definition of "value" im using here is that pertaining to the business aspect.

 

[anbuitachi]

Im talking about billable/reimbursable quanta. And I did, I posted the RVU article. RVU's as a metric aren't perfect, but they aren't bad either. They're standardized and to me thats what matters most. Course, the definition of "value" im using here is that pertaining to the business aspect.

But we collect so much less than our rvu worth... So someone somewhere don't think we are valuable

 

[deleted171991]

But we collect so much less than our rvu worth... So someone somewhere don't think we are valuable

Someone somewhere likes to make money off our backs.

 

[anbuitachi]

Someone somewhere likes to make money on our backs.

Which is weird. You would think they d want to collect on everyone's backs

 

[deleted171991]

Which is weird. You would think they d want to collect on everyone's backs

They probably do. Except that anesthesia, and other procedure-rich specialties, are especially ripe for picking. Plus they can screw with us because the market is on their side, as in few other specialties.

 

[TeslaCoil]

Heres another nugget for thought as well, every year 1200 new medical graduates match to anesthesia. Which means there are about 4500ish anesthesia residents in training at any given time, each with an average of between $200k and $400k of debt to the government. Using the conservative estimate based on $200k this means the gov has about 1 billion dollars in loan money on the line. And thats not even figuring in attendings in practice who are also still repaying. I figure if we factored those in the US gov probably has about $2-3 billion in lent money on the line, plus interest. Thus, the Fed would be absolutely nuts to approve a rule whereby anesthesiologists would become obsolete. They might even face a lawsuit to the same tune. I know if my profession were threatened by their legislation and I still owed them money, I'd be signing that class action suit. Its a lot of money on the line, and its a headache that I don't think the federal government ever wants on their hands. Not to mention that we would also have a surplus of 1200 graduates every year to place in other specialties, where there simply are not enough spots. So, nobody can convince me that anesthesiologists will be replaced. The socio-economic ramifications would be disastrous to the medical community as well as the government.

 

[bashwell]

Heres another nugget for thought as well, every year 1200 new medical graduates match to anesthesia. Which means there are about 4500ish anesthesia residents in training at any given time, each with an average of between $200k and $400k of debt to the government. Using the conservative estimate based on $200k this means the gov has about 1 billion dollars in loan money on the line. And thats not even figuring in attendings in practice who are also still repaying. I figure if we factored those in the US gov probably has about $2-3 billion in lent money on the line, plus interest. Thus, the Fed would be absolutely nuts to approve a rule whereby anesthesiologists would become obsolete. They might even face a lawsuit to the same tune. I know if my profession were threatened by their legislation and I still owed them money, I'd be signing that class action suit. Its a lot of money on the line, and its a headache that I don't think the federal government ever wants on their hands. Not to mention that we would also have a surplus of 1200 graduates every year to place in other specialties, where there simply are not enough spots. So, nobody can convince me that anesthesiologists will be replaced. The socio-economic ramifications would be disastrous to the medical community as well as the government.

I don't think the federal government would ever try to make anesthesiologists obsolete in one go. I think the issue is more of a gradual chipping away at anesthesiology as a specialty until the cost/benefit of becoming an anesthesiologist is no longer favourable to med students who want to become anesthesiologists. Some of the attendings on this forum believe the costs already outweigh the benefits of becoming an anesthesiologist at this very moment, while others disagree. But I have no dog in this fight, just my observation.

 

[738177]

I don't think the federal government would ever try to make anesthesiologists obsolete in one go. I think the issue is more of a gradual chipping away at anesthesiology as a specialty until the cost/benefit of becoming an anesthesiologist is no longer favourable to med students who want to become anesthesiologists. Some of the attendings on this forum believe the costs already outweigh the benefits of becoming an anesthesiologist at this very moment, while others disagree. But I have no dog in this fight, just my observation.

I'm curious, are midlevels a concern in Australia like it is in the states? It doesn't really seem like a big factor up here in Canada.

 

[nimbus]

Heres another nugget for thought as well, every year 1200 new medical graduates match to anesthesia. Which means there are about 4500ish anesthesia residents in training at any given time, each with an average of between $200k and $400k of debt to the government. Using the conservative estimate based on $200k this means the gov has about 1 billion dollars in loan money on the line. And thats not even figuring in attendings in practice who are also still repaying. I figure if we factored those in the US gov probably has about $2-3 billion in lent money on the line, plus interest. Thus, the Fed would be absolutely nuts to approve a rule whereby anesthesiologists would become obsolete. They might even face a lawsuit to the same tune. I know if my profession were threatened by their legislation and I still owed them money, I'd be signing that class action suit. Its a lot of money on the line, and its a headache that I don't think the federal government ever wants on their hands. Not to mention that we would also have a surplus of 1200 graduates every year to place in other specialties, where there simply are not enough spots. So, nobody can convince me that anesthesiologists will be replaced. The socio-economic ramifications would be disastrous to the medical community as well as the government.

Health care policy makers don't give a rats ass about the student loans of a small group of people. $2-3bil is a drop in $4tril budget and they'll expect you to pay it back even at CRNA wages. Student loans of doctors is not even on the list of factors to be considered.

 

[bashwell]

I'm curious, are midlevels a concern in Australia like it is in the states? It doesn't really seem like a big factor up here in Canada.

Thanks, good question. There are midlevels (e.g., NPs), but they're not like midlevels in the States (at least not yet). There are no PAs or at least none that I've ever seen or met. There are "anaesthetic nurses" who help anaesthetists or anesthesiologists in theatre (OR), but they are definitely nothing like CRNAs, and none are "independent" like CRNAs in some US states. I think Australia is much more like Canada where midlevels aren't as big a factor.

Sure, conceivably things could change in the future where midlevels gain more ground in Australia, but Australia is such a different society and culture (e.g., in my opinion patients seem far more grateful and still really respect physicians and would not likely tolerate midlevels acting as anything more than a midlevel), and a different medical education and healthcare system, that it's really hard for me to envision how things could ever become like how they are in the US. Again, doesn't mean it can't happen someday, but I just don't see it happening any time soon. And I believe most Australian anaesthetists or anesthesiologists are very much aware of the CRNA issue in the States and make it a point not to have things ever become like that. Just my opinion.

 

[TeslaCoil]

I don't think the federal government would ever try to make anesthesiologists obsolete in one go. I think the issue is more of a gradual chipping away at anesthesiology as a specialty until the cost/benefit of becoming an anesthesiologist is no longer favourable to med students who want to become anesthesiologists. Some of the attendings on this forum believe the costs already outweigh the benefits of becoming an anesthesiologist at this very moment, while others disagree. But I have no dog in this fight, just my observation.

Maybe but I doubt it. California might secede from the US, and there is a petition in effect to that end. I doubt that will happen either. In a lot of ways the hysteria over CRNA's/the impending doom of anesthesiology and the secession of California are alike.

With regard to your comment on cost/benefit, it boggles my mind that some attendings think this. I think perhaps this is because they're used to the cushy ways of the past. But those trends have impacted every field of medicine in the US from what I understand. Even at the current state of affairs I would never choose a different specialty. I would literally rather leave medicine altogether. Lets keep things in perspective here, we make WAY more than doctors everywhere else in the world. In many countries in Europe, anesthesiologists and doctors in general are taking home the equivalent of $500/month.


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[GravelRider]

Maybe but I doubt it. California might secede from the US, and there is a petition in effect to that end. I doubt that will happen either. In a lot of ways the hysteria over CRNA's/the impending doom of anesthesiology and the secession of California are alike.

With regard to your comment on cost/benefit, it boggles my mind that some attendings think this. I think perhaps this is because they're used to the cushy ways of the past. But those trends have impacted every field of medicine in the US from what I understand. Even at the current state of affairs I would never choose a different specialty. I would literally rather leave medicine altogether. Lets keep things in perspective here, we make WAY more than doctors everywhere else in the world. In many countries in Europe, anesthesiologists and doctors in general are taking home the equivalent of $500/month.


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What in the world are you talking about? Doctors in Europe make $500/month? That's $6,000 a year.

 

[TeslaCoil]

What in the world are you talking about? Doctors in Europe make $500/month? That's $6,000 a year.

Yep. Im talking about the less developed countries. In countries like germany, italy, england they earn more of course, but still maybe half of what doctors earn here. In other countries, for instance, in the balkans, they earn shamefully little... and probably complain half as much as we do.


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[bashwell]

Maybe but I doubt it. California might secede from the US, and there is a petition in effect to that end. I doubt that will happen either. In a lot of ways the hysteria over CRNA's/the impending doom of anesthesiology and the secession of California are alike.

With regard to your comment on cost/benefit, it boggles my mind that some attendings think this. I think perhaps this is because they're used to the cushy ways of the past. But those trends have impacted every field of medicine in the US from what I understand. Even at the current state of affairs I would never choose a different specialty. I would literally rather leave medicine altogether. Lets keep things in perspective here, we make WAY more than doctors everywhere else in the world. In many countries in Europe, anesthesiologists and doctors in general are taking home the equivalent of $500/month.


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I can't speak for Europe or other parts of the world, but I know in Australia anesthesiologists (anaesthetists) do really well. Range is from about $300-$400k for 40-45 hours per week if you work in a public hospital, but you get paid more if you work more (and I'm not even counting benefits etc which you'd also get). However if you work in private, then you will make a lot more (the general rule of thumb is 1 day's work in private is equivalent to 3 days of work in public). I've seen a mid-career cardiac anaesthetist or anesthesiologist who makes nearly $1 million per year. Maybe these numbers are low compared to the US, but I don't think they're significantly lower, are they? And in general the pace of work probably isn't as intense in Australia as it is in the US. No supervision of CRNAs, sit your own cases. At least from what I've seen, generally speaking, surgeons and anesthesiologists completely respect one another as colleagues too.

 

[deleted162650]

I can't speak for Europe or other parts of the world, but I know in Australia anesthesiologists (anaesthetists) do really well. Range is from about $300-$400k for 40-45 hours per week if you work in a public hospital, but you get paid more if you work more (and I'm not even counting benefits etc which you'd also get). However if you work in private, then you will make a lot more (the general rule of thumb is 1 day's work in private is equivalent to 3 days of work in public). I've seen a mid-career cardiac anaesthetist or anesthesiologist who makes nearly $1 million per year. Maybe these numbers are low compared to the US, but I don't think they're significantly lower, are they? And in general the pace of work probably isn't as intense in Australia as it is in the US. No supervision of CRNAs, sit your own cases. At least from what I've seen, generally speaking, surgeons and anesthesiologists completely respect one another as colleagues too.

Time to start working on getting my visa.

 

[pgg]

Yep. Im talking about the less developed countries. In countries like germany, italy, england they earn more of course, but still maybe half of what doctors earn here. In other countries, for instance, in the balkans, they earn shamefully little... and probably complain half as much as we do.

Well by that logic the poorest Americans should be taxed at 39.6% since compared to the other 6 or 7 billion people on earth they're 1%'ers.