In 2008 there was a movie made called ‘The Curious Case of Benjamin Button’. It was a story of a man who ages in reverse. Interesting movie.
I graduated from Osteopathic Medical School in 1972 with a debt of $20,000. Starting in 1974 I practiced as an old-fashioned general practitioner for six and a half years, including house calls, uncomplicated obstetrics, and minor surgery.
Finally, in 1979, I decided to switch to anesthesiology and, in January of 1980, began my residency at MCV. I stayed on as an assistant professor before leaving in June of 1986 for private practice. In an offshoot of Benjamin Button, I’ve often imagined, knowing what I know now, would I have chosen the same career path? Have you ever thought about it?
Let me begin by saying I have been very happy with my career decision. I really enjoy being an anesthesiologist and, to this day, still practice two to four days a week, with no weekends, no nights, no call, and no holidays. The majority of my work is as an independent practitioner and occasionally working for a large hospital system as a contract employee. So, what’s not to like?
Well….
First, let’s go back to the world of medicine in 1986. The choices for an anesthesiologist then were either academic medicine, private practice, government employee/VAH, or military.
Initially I chose academic medicine, but left after four and a half years because of the fear that, because I had no opportunity to do any research, I would not get tenure. I thought I’d explore the private practice opportunities.
I did really enjoy my time at MCV but needed to think about the future for my family and me. When I was offered a private practice job in Newport News in an all “doc” practice, and after discovering that I could live in Williamsburg, off I went.
From 1986 until 2010 I was in private practice at Riverside Regional, and we worked our butts off, but everyone was happy. Initially in our group, we were paid whatever was collected from the insurance company and patient for the work we did, minus expenses.
With the growth of ASC’s, we morphed into a modified care team model. If I could pin it to one kind of case, I’d say it was the new technology for cataract surgery. Instead of a 45-minute case, it was a 10-minute case to be done in an ASC.
Instead of a surgeon doing eight cases in a day, an opthamologist could do up to 30 cases in a day. Eventually we morphed into a practice with CRNA’s from 7:00 am to 3:00 pm, with 50% of our cases being done by anesthesiologists, including all cardiac, craniotomies, and obstetrics. Our pay was 80% of what you generated and 20% evenly distributed, after practice expenses.
Fast forward to 2010, the beginning of the big changes in how healthcare was going to be provided. Our main hospital decided they would evolve into one that wanted more control over the medical providers. We chose not to do it, and the group stopped covering there.
About 50% of the providers left the group and found work elsewhere. Just thinking about our specialty, we have seen the takeover of practices by national companies and healthcare systems in full force. Yes, there are still some private practices, but as the years move along, we have fewer and fewer.
What has this evolution brought to us? First and foremost, a loss of control over our professional life. We used to be independent service providers with five customers in every case. We had the patient, their family, the surgeon, the staff, and the administrators.
Now the patient remains at the top, but it seems that moving up to second place is the administration and nursing staff, ahead of the surgeon and family. When one becomes an employee, whether of the hospital or a big national company, the game changes.
Instead of being in control of your money, your schedule, and who you must make happy, you are now the middleman between the patient and those making a living off of you.
Think about that for a minute. While they say many things, the bottom line for them is profit. It is well known that there is plenty of money to be made when one does the right thing, but when money comes first, one will do wrong things just to make money.
That 28-year-old MBA, who sometimes walks around with a clipboard and doesn’t know anything about real healthcare, is making sure the room runs on time and that you are not holding things up, even though your patient has multiple medical problems that got through the pre-anesthesia office.
They will occasionally justify making money before doing the right thing. You went to school for a minimum of 12 years after high school, and this MBA with far less education, is effectively your boss.
The next big change happening is the gradual takeover of anesthesiology in the United States by CRNA’s. Unfortunately, the national companies and hospitals now run medical groups, are moving to a more CRNA dominated model, often times billing with medical supervision instead of medical direction. Where I live in Williamsburg, the main hospital in 2020 disposed of their mostly physician provided anesthesia model, terminating the only group that ever provided anesthesia services there, and now has a national company, instituting a medical supervision model.
The anesthesiologists are supervising, filling out the electronic medical record and rarely providing anesthesia. What message does that send to the surgeons and staff about anesthesiologists? We went to medical school, did a four-year residency, and is this what we want to do? Really? What happens to our skill set?
Finally, is there really job satisfaction in that system? Is there satisfaction when you don’t have control? When I began the practice of medicine, the term burnout was used for drug users whose life was burned out. Now we have physicians of all specialties talking about burnout.
Just looking at the percentages of physicians who say they are suffering from burnout, why would I go $300,000 in debt? Why have physicians lost control over the real practice of medicine? There are many reasons, but that is beyond the scope of this essay.
So, would I do it again? Probably not. A lifelong career after all that schooling, just to work for someone with less education than I have, who controls my schedule, controls my income, controls my behavior.
I don’t think so. I will continue to do what I do, occasionally in the hospital, but mainly in plastic surgery and GI offices where I can be an independent practitioner, controlling my time and still being a real anesthesiologist.
Sad it has come to this, but true.