Anesthesia Services: Bulls Get Rich, Bears Get Rich, Pigs get……
Here are some [gently edited] responses to yesterday's blog post.
Insurance
Every state requires auto insurance, but some don't want the insurance that an anesthesiologist provides for perioperative medicine. While critical events, preoperative catastrophes [or near misses] happen rarely, it is hard to believe that their diagnosis and treatment is not improved by a physician trained in the airway management and preoperative emergencies. Are we too poor to provide this margin of safety?
Gatekeepers
Who are going to be the "gatekeepers" for anesthesia care in the future?
- If anesthesia services are to be provided by predominately by non-physicians, who will have make the decisions about anesthesia care?
- Will the CRNAs/AAs become technicians directed by medical or surgical hospitalists?
- Will "go/no go" decisions be made by administrators similar to their override of scheduling decisions by anesthesia and operating room managers?
Are we ready?
There are many excellent CRNAs/AAs, but have enough of them been trained in the operation of an anesthesia service? Beyond the technical delivery of anesthesia, high performance anesthesia services require almost constant management attention. Per a CRNA's response, "I believe anesthesia professionals are becoming more prepared for the proposed [New World Order] model, but on a whole, there are still deficits in the work force that could hinder its implementation. There are many programs that are preparing their graduates for this potential, but that number must become the majority in order to accomplish this transition. Will the surgeons also ready for this, or will it simply be another healthcare mandate? "
Facts
Where are the facts?
- Are the changes in anesthesia care based on balance sheets or operations research?
- Are we simply going to slide down the slippery slope of anesthesia care until we meet a hard stop because of the body count?
Cost
"Cost has become the major factor. There is developing a huge over supply of CRNAs and you will see their salaries going down quite a bit (already happening in the deep south). This is no different than any other medical specialty. Face it- anesthesia salaries are going to drop- a lot! We are still being paid by historical numbers but look at the rates we are being reimbursed. Eventually hospitals will stop subsidizing and we will be paid at the $30-40 rate. New guys will do it, us senior guys will quit. Bottom line- patient care will suck, but that's what the government wants."
Summary
Is it true that bulls get rich, bears get rich, and pigs get slaughtered? This question reminds me of the Ironwood Pig Sanctuary near Tucson. Heard of it? This is how it works. Someone gets the bright idea that a potbelly pig would be a cute pet without doing the research to see what happens to the pig as it develops. And over time the pig grows up and gets, big, ugly, smelly and very expensive to maintain. The pig is then dumped by the side of the road with no pride of ownership. Sounds like could happen to some of the "New World Order" ideas we are being sold today. (Interesting fact, the only way to keep a potbelly pig small is to starve it. Unrelated to current healthcare planning, I think not.)
Take Home Points:
- Some ideas are like potbelly pigs; over time they get big, ugly, smelly and are very expensive to maintain.
- When that happens, no one wants to admit they bought the pig (idea) in the first place.
