Hi,
I'm a perfusionist for 20 years now. I'm a seriously experienced perfusionist, making what would be considered a top 10% salary, but I'm very unhappy. I'm just clinging on till I retire. I'm not bitter, because I've made a ton of money, but I think some of the mythology of perfusion needs a reality check. Why such mythology? The few remaining perfusion instructors want to remain in their jobs LOL. Of course there will be jobs in the future for perfusion all is not gloom and doom. Oh, did I say that YOU wouldn't have one of those jobs? Look on any job site, compare the number of jobs for PA with perfusionists 100 to 1 if not 500 to 1 or 1000 to 1. For the wise person, that would be enough. When I interviewed for my first job, I had 12 interviews. My last I came hat in hand and took a huge paycut.
I think if you ask most perfusionists, probably 90% or more would NOT advise their children to go into it. I advise people to become a Medical Physicist. If they are anal, I recommend NP, only because one has to finish nursing school first. I could not stand to be a nurse. Somebody with a serum K+ of 2.3 meq/l and you have to call the Dr to start a K+ drip or give pedialyte. Nursing is too robotic for me. But guess what? ER nurses in CA make far more than perfusionists! And they're union, can say whatever thay want to the MD, what I'd be fired for. If you're out for money and quality of life, become a union ER nurse in CA and work lots of overtime.
First the demographics. We're doing half the number of cases we did 20 years ago, with double the people. smaller pie, more guests, less money. Corporate dialysis companies bundle services including perfusion and get most of the business, so you're not independent. They do Quasi-statistics, and guess who collects it, in addition to the STS data? you! Try 12 hour days for less than a nurse makes. People who have made a ton of money, lost it in 2008 and wont quit or can't quit. There's a reason most of the schools closed. Angioplasties, and OPCABS, robot surgery and midcabs. Now TAVR's, every damn hospital is building a 3 million dollar TAVR room, they'll never use.
I regret choosing it as a career. Since I am near the end of my career, and I didn't lose money in 2008. I don't feel like going back to school anymore. Yes, for a few the salaries were large. But the days of starting making big money are mythology, and for the most part, is rowing the oar for a company named _ _ _ _Care or _ _ _ _Care. As a student, you basically start at what I made 20 years ago, without any adjustment for inflation. And don't expect any raises. So half what I started at. When I started, I made MORE than CRNA, and believe me, CRNA's we're coming up to me and aking how to become a perfusonist REALLY! No more. In fact, I dont make much more than I did in 1993. Those early days were great, I was in my 20's making huge money, people calling me on the phone asking me to quit and come work for more money. Dr's lounge privileges, parking paid for. Those days are over too. If you're a person of character, perfusion can be very hard, watching the affairs your Dr's have, sex in the dictation rooms, broken marriages. And even the Catholic hospitals, don't care, they just look the other way if the Dr. brings plenty of business. And the Dr. can behave any way he wants if he brings in the money. Become a Doctor.
If you do go to a perfusion school, I would recommend one of the University based schools, getting fewer and fewer. I would have recommended Ohio State, but the program is closed. Guys I worked with from there are solid. I would advise against THI. They teach one way to do things, and a guy I worked with from there, if you changed anything, he was a trembling wreck. I worked with another guy from there who was awesome, and when I asked him, he said he wasn't good because of THI, they didn't teach him much, he self taught himself. So that's someone from the school itself I respect that said don't go there. Then I would say any of the programs like Hopkins, Nebraska, South Carolina. The reason being, is the science curriculum is very tough and quite frankly overkill. But a lot of people go to the easier schools, and can barely pass their boards, with a high failure rate. The passing rate for the University programs is in the 90% range or more. Barry is private, I worked with one guy from there, and one from Washington St Louis, they were ok, but their cost was ridiculous.
So why am I burned out on perfusion? So many people ask me about it, eyes glazed over, and wont hear any negative at all, I can't stop them, so I don't try. Firstly, you can't work where you want to live, anymore, AT ALL. If you do change jobs, you're moving 1000 miles or more probably. You have zero job security. You're job is as reliable as your last case. Unless you have serious connections, like your dad is the surgeon or hospital CEO or something, coming out of school, you're gonna move, and your jobs going to be unstable and probably from the dialysis guys. Second, you probably have to work for one of the two or three scuzzy companies that have dominated perfusion over the last few years. These are basically companies which have taken the "dialysis" business model, and have applied it to perfusion. They will totally lie about the conditions you'll be working under, and when you arrive, the people who you interviewed with may not even be there. They promise to the customer, that they will have 100% satisfaction or they will change personnel, and they do, frequently. I have gone to jobs, where I saw 14 names in the book in the last year, and added my name to it after 6 months. No discussion, no issues, just fired, instantly. They will lie to you on job interviews "You're going to be one of five guys, splitting call 5 ways, with great surgeons". Next you wind up one of three guys, taking call nearly 24/7, with Surgeons who scream like the late comic Sam Kineson. They'll tell you, "we'll have somebody out there soon, checks in the mail" then you're just another in a long line of suckers.
You can do a perfect job, and still lose your job. I once was called by my boss, who was late, to go to a hospital I had never been to. NEVER ORIENTED. Never walked in the front door once. I arrived late, yet found the OR, found the tubing kit, found the room, and told the MD I would be late setting up. When he wanted to work, I wasn't ready, and made him wait. He said 'You'll never work in this town again" And I didn't. My boss is like "sorry, gotta fire you". Fired for trying to help, and then your boss fights your unemployment. Still want to be a perfusionist? To be fair, I had two jobs which lasted a long time, both were University or Private, non-profit hospitals. If there's any advice I can give to you, don't work for anything other than this, unless you're a wheeler dealer and can start your own company or great at office politics. If you don't want to be Trump, and just want to pump cases and be a professional. Work for a Uni or Non Profit.
To some extent one can lose one's job in any job, but a lot in perfusion, unless you're union. Don't mistake me, I don't like unions, and some of the perfusionists I saw in NY who were union (SEIU) were some of the laziest, worst I've ever seen, because they had no fear of losing their job. But the walking on eggshells and fearing for one's job all the time gets old. So I think that's nice about being a union, but nothing else. And I think the negatives outweigh the positives. Unfortunately for those guys in NY, they got caught and all fired. They punched each others timecards, and all kinds of other untoward stuff I refused to do, so they didn't like me. The converse, if you work for a private company, they squeeze you for every dime, and usually have accounts where nobody wants to work. They'll have you do the STS database for the PA's, pacemaker for anesthesia, whatever, wash everyone's car.
Things which you are responsible for, which can kill someone, are sometimes left to be handled by others. For example, I was called to an emergency once, and the normal room was being used. The backup room, had only one oxygen port, used by anesthesia, and no power on my side of the room. The boss told me " oh yeah, you have to get a H cylinder from the basement" and a long extension cord in that room". Wow, so I have less time than normal, in a room I'm unfamiliar with, and now I have to find the basement, and find an oxygen tank! " These kinds of situations are commonplace in perfusion, and it's but for vigilance in perfusion that more are not killed. After this case, I made an incident report and insisted the oxygen lines be fixed, guess what? I'm at a new job 1000 miles away.
If you're one of the blessed few, who can BS your way out of the ghetto in a suit of $100 bills, or can sell ice to eskimo's, you'll be a good perfusionist. Because perfusion is the LAST thing you're hired for. Of course, no problems should come from perfusion, but more important than perfusion, is running your daily QC, making sure your sheets are filled out, and your JCOH checklist is completed. Perfusion is your ancillary duty, not your main one.
Now the good news. If you're a gambling man, this might be a good time to go into perfusion. In the next 5-10 years, half the Perfusionists in the US will retire. The bad thing is that half the Cardiac surgeons will retire too, at a faster pace. I have no idea what the future holds, but I'm telling my kids to do something else. What's important in life, is doing what you LIKE. And actual perfusion, I LOVE IT. Its the only reason I haven't quit.
