Why does Anesthesiology pay so much?

Pre-Med & Medical School Pre-Med Topics
1

<p>Why does Anesthesiology pay so much? I’ve seen quite a few surgeries, and it doesn’t seem like they do that much during the surgery, even if they do prepare the drugs beforehand. However, oftentimes they make more than the surgeon. Why?</p>

2

<p>I have the exact same question…it seems like the easiest specialty.</p>

3

<p>I hear they have to be extremely precise as the patient’s life is in their hands. The same could be said for the surgeon though, so…</p>

4

<p>Anesthesiologists must be incredibly precise and extremely meticulous in their methods. They are essentially responsible for keeping the patient alive during and at the end of surgery. I think a lot of people have the misconception that anesthesiologists are only responsible for putting people to sleep, but they are also responsible for maintaining all sorts of physiological homeostasis during an operation. This includes being able to react quickly under pressure when/if something goes wrong in the OR. Doesn’t sound that “easy” to me…</p>

5

<p>they are in charge of the patient’s vitals</p>

<p>So while it may not seem like they do that much in most surgeries, they become critical when something is going wrong with the patient.</p>

<p>That being said, i have no idea whether this has anything to do with pay or not.</p>

6

<p>well yeah, but there’s also Physicians Assistants to help, and the Pulminologist essentially takes over when the chest is open (at least in a few i’ve seen)</p>

7

<p>As one anesthesiologist put it to me: “I don’t get paid the big bucks to put patients to sleep. I get paid the big bucks to wake them up again!”</p>

8

<p>i’ve been in a surgery before (neurological, shadowing), and the anesth. explained to me what all the equipment was for. the machinery is very complex, and they have to know every single detail about it. they also have to control oxygen, and nitrogen levels, while keeping an eye on hb levels and such. they really have to beable to multi task. also, IMO, the surgeon is really just a human hacker, however, it is the anesth that really keeps the patient alive.</p>

<p>aspiring neurosurgeon.</p>

9

<p>In any case, compensation in medicine is not rational or market-based. It does not depend on skills, what you do, or the value of the services you provide. It is determined largely by what the government thinks you are worth, which sets its Medicare rates, which sets other insurance rates, which determine your compensation.</p>

10

<p>I shadowed a gas man and while it seems pretty interesting, I don’t know if I want to go into it. The people my family know who are doctors keep mentioning CRNAs taking over their work. But I’m talking out of my ass, bluedevilmike or someone with experience in the field would know more about this</p>

11

<p>Surgical mistakes, in general, do not result in patient deaths. Anesthesia errors, particularly airway mishaps, can cause serious and sometimes fatal trouble.</p>

<p>By and large, the patient’s physical condition has little bearing on the difficulty of the procedure for the surgeon. By contrast, systemic disease, particularly cardiopulmonary disease, can make anesthetizing a patient challenging. Administering anesthesia can be stressful since the surgeon’s actions frequently perturb physiologic equilibria.</p>

<p>That all being said, third party anesthesiologist compensation per case is typically one third of the surgeon’s compensation for the same case.</p>

12

<p>Anesthesiologist get paid a lot because they have more billable procedures. Same goes for dermatologist and pathologist. For ever drug they put in and the time they put in to monitor patients, they get paid for it. Plus if they want more money they could hire and supervise more CRNA so they can cover more OR’s at a time. If anesthesiologist want to make more money they usually do a pain management fellowship which have a salary of $370,000-620,000 compared to an general gasdoc who gets $275,000-450,000.</p>

13

<p>Anesthesiology is indeed a procedure based practice. </p>

<p>Don’t, however, get the idea that an anesthesiologist bills for each injection given during the conduct of an anesthetic. Compensation for anesthesia for surgery has a fixed component, based on the complexity of the surgical procedure, and a time based component. (Other modifying circumstances may apply and have bearing on fees).</p>

<p>Anesthesiologists practicing pain medicine bill very much like surgeons performing minor surgery in the office: there are billing codes and fees for evaluation (varying according to complexity), other codes for follow up visits, and still more codes for procedures.</p>

<p>Third party compensation in medicine is neither rational nor the result of coherent planning: the current scheme reflects historical facts, quirks, biases and the relative effectiveness of various physician lobbies.</p>

<p>You can see the Medicare fee schedule at the CMS site: <a href=“http://www.cms.hhs.gov/PhysicianFeeSched/downloads/rvu07a2.zip[/url]”>http://www.cms.hhs.gov/PhysicianFeeSched/downloads/rvu07a2.zip&lt;/a&gt;
(word file rvupuf07 explains the file format)
(text file pprrvu07 lists the relative value units of each procedure)
Medicare professional fees are calculated as RVU<em>Conversion factor</em>geographic adjustment factor.</p>

14

<p>Thanks for the corrections.</p>

15

<p>well wouldn’t hiring a bunch of CRNA’s and one or 2 anesthesiologists be cheaper for the hospitals? what kind of job security do you think they have?</p>

16

<p>Hospitals do not pay the anesthesiologists. These physicians bill insurance or Medicare for their service. So replacing anesthesiologists with CRNA’s would not have financial implications for the hospital. The CRNA’s need anesthesiologists in order to work. Depending on the case, it may be necessary for the anesthesiologist to be there throughout.</p>

<p>Pulmonologists do not do anything with an open chest. They are not surgeons. Perhaps you meant thoracic surgeons? But they do not manage the anesthesia.</p>

17

<p>Risk versus reward plays into the equation also. It’s a fertile area for medical malpractice.</p>

18

<p>Most anesthesiologists work in groups and most CRNA’s are employed by anesthesia groups. Few anesthesiologists are directly employed by the hospital, but many groups receive subsidies from the hospital.</p>

<p>

<a href=“http://www.asahq.org/Newsletters/2004/09_04/pracMgmt09_04.html[/url]”>http://www.asahq.org/Newsletters/2004/09_04/pracMgmt09_04.html&lt;/a&gt;&lt;/p&gt;

<p>Using CRNA’s could affect the total cost of anesthesia for a hospital in at least two scenarios: First, if the hospital is paying a contracted amount to a group for anesthesia services, using salaried CRNA’s under anesthesiologist supervision in a large OR suite could reduce the bid amount. Second, in those states where physician supervision of CRNA’s is not required, hospital employment of CRNA’s could reduce cost to the hospital as long as the surgeons were willing to accept the increased liability due to the captain of the ship doctrine. (For a list of the states see: <a href=“http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1790[/url]”>http://www.aana.com/Advocacy.aspx?ucNavMenu_TSMenuTargetID=49&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1790&lt;/a&gt;)</p>

<p>Where anesthesia work is strictly fee for service, presence or absence of CRNA’s should not affect the cost of anesthesia to the hospital.</p>