Is the future of anesthesiology (for MD/DO physicians) DEAD?!
Vložit
- čas přidán 9. 06. 2024
- I am frequently asked by medical students whether the specialty of anesthesiology will have a future. I am asked if CRNAs/AAs will take all of our jobs. I am asked if robots or artificial intelligence will replace us. I am asked if the job market is saturated [thus pushing salaries down]. While I do not have a crystal ball, I do have a lot of opinions on this topic.
In this video, I cover my thoughts on these 3 statements:
□ CRNAs/AAs will replace anesthesiologists.
□ AI/machines will replace anesthesiologists.
□ Salaries/demand for anesthesiologists are decreasing.
What do you think of these statements? Comment below!
Referenced in the video:
➣ Commentary on the Sedasys automatic propofol machine: journals.lww.com/anesthesia-a...
➣ Medscape 2019 Physician Salaries: www.medscape.com/slideshow/20...
➣ Medscape 2020 Physician Salaries: www.medscape.com/slideshow/20...
➣ Medscape 2021 Physician Salaries: www.medscape.com/slideshow/20...
CONNECT WITH ME:
Blog: blog.amandaxi.com
Instagram: / amandasximd
Facebook: / amandasximd
My essentials for being productive: www.amazon.com/shop/amandaeleven
Graphics created with Canva: fave.co/3oUtdgg
Music from Uppbeat (free for Creators!):
uppbeat.io/t/hey-pluto/phosph...
License code: VA9NG3QWICDJFNRI
DISCLAIMER: I never record videos during active patient care. Opinions in my videos are mine and not representative of the organizations I am part of. Videos are meant for education and are not medical advice. Links included in this description may be affiliate links. If you purchase a product or service with the links that I provide I may receive a small commission. There is no additional charge to you! Thank you for supporting my channel!
![Should you become a PA [physician assistant/associate] or MD/DO [physician, medical doctor]?](http://i.ytimg.com/vi/RV7ByW_qbwM/mqdefault.jpg)
This was very thorough...It gives some context to the rumors! I got from this video that there is a place for anesthesiologists in the future, just may not be where they are today where most have benign cases. They will be needed in the sickest populations! Wow! your career is very inspiring! It really does take a strong and very dedicated individual to be an amazing intensivist. You are appreciated for your hard work!!!
Thank you so much for watching and your comment. I really appreciate it!
I am a nurse debating crna or anesthesiologist. I am leaning towards the md route because I have always wanted to be an physician. Either way it will be a long journey for me. Thank you for your input and love your channel
Thanks for watching and following along! If you decide to become a physician, your RN background will be *so* valuable. Either way, you’ll have a gratifying career - the long road is absolutely worth the hard work. Good luck to you and feel free to reach out with questions along the way!
@@AmandaSXiMD thank you. Unfortunately I screwed up my GPA big time but I only have my associates degree so there is some hope I can still fix it. Though I am considering getting my np before I apply to either crna or med school.
Become a CRNA, you will thank me later
@@hellochildren69 why ?
Love your take on this matter! Thank you for keeping it positive Dr. Xi!
Thanks for watching!
Thank you very much for the thorough insight and words of wisdom Dr Xi !
Thanks for watching!
When computers came people thought it would replace a lot of engineers, it only made engineers better. In fact where would radiology and anasthesiology be without it. Every nurse needs to know how to use a digital record. It’s pretty asinine that people think technology will replace already established perfect human interventions. Last I checked, we are the only species that can operate on our fellow species. No supercomputer, no matter how smart will ever replace the human-human interaction and care. Technology is just a tool to make human life more advanced and better. AI will not get rid of programmers just as it will not get rid of medical specialists, medicine is archetyped by the rod of Asclepius. Without Asclepius, it’s just a rod. And without doctors and nurses, technology is useless.
Thank you so much Dr. Xi! MS1 very interested in anesthesia. I am interested in the program you mentioned at the beginning of your video!
Make sure that when you're a rising MS4 that you sign up! The link to sign up are on my blog: blog.amandaxi.com - I've had MS2s sign up, but it's really designed for a higher level student, so I suggest waiting a couple years before participating. Looking forward to seeing you on a future call!
Why don’t anesthesiologists advocate for themselves like CRNAs? CRNAs really care about their scope of practice and always stand up for themselves. Every time Med students ask anesthesiologists about this issue, they say “it’s not going to happen” but we see contrary evidence in the hospital lol Still love anesthesia as a field but I wish the senior docs cared about the issue a little for the future docs.
This is an excellent question! I wish I could share all of my thoughts on the matter in this little text box, but it all boils down to a couple of things: 1. Power in numbers [there are not a lot of us], 2. Money, 3. Culture [doctors in GENERAL are horrible at advocacy; it's not part of our medical school curriculum and honestly, who has the energy to advocate during the 10 years of training to become an attending?]. This all being said, no specialty is protected from changes in how we practice, so make sure you have this attitude going into your career and you'll have a gratifying career!
There will always be a need for doctors. As a registered nurse I respect the CRNA and AA roles (and have looked into both of them). But the physician has final authority and much more training. Everyone is a valuable part of the team.
I have the final authority. Not anyone else. Not an MD or DO or anyone else.
@@edwardherrera846 CRNA cringe!
As a biomedical engineer by training, working in pharma, who is applying to med school this upcoming cycle and has a strong interest in anesthesiology, your channel is giving me so many things to think about. I love these videos and they've become extremely formative to how I think of my (hopefully) burgeoning career in medicine. I'm glad to know that this specialty that I find extremely interesting isn't dead and will have opportunity for me in the future, should I choose to pursue it.
Thank you for your comment! There are certainly a number of engineers that find anesthesiology to be a rewarding specialty and as I said in my video, there are plenty of ways that physician practice of anesthesiology will remain relevant for many more years to come [as long as you keep an open mind]!
There will always jobs for anesthesiologists in the foreseeable future. That said, there will always be jobs, but what will the quality of those jobs be like? For example, the future will also most likely be more and more anesthesiologists overseeing a number of CRNAs (or AAs) in a care team model or similar in contrast to sitting their own cases or rooms. Approximately 50% of all anesthesia groups in private practice are already doing this and the number only seems to be growing. Anesthesiologists overseeing CRNAs come in many different types of settings - private groups, hospital employed, anesthesia management companies, academia, etc. Not to mention an increasing number of states are allowing CRNAs to practice independently. Most other specialities likewise face mid-level encroachment, but as many anesthesiologists have said the degree of mid-level encroachment in anesthesiology is already quite severe. Then again, who knows, the tide could turn someday. The future is uncertain.
Thank you for your comment. Agreed, the future is uncertain. I think it's important that we keep an open mind about what our jobs may look like in the future since change is inevitable.
@@AmandaSXiMD With AAs, CRNAs, and MDAs in the anesthesiology field, what do you think job outlook/security is looking like for AAs and CRNAs in the future (2030-2040)?
I believe that anesthesia services will continue to be in-demand, especially with out of OR anesthesia growing. Ultimately, I believe there will be a need for all of us!
The term anesthesiologist infers that you are a doctor who went to med school and passed the boards. I wouldn't use the term "physician anesthesiologist" because of redundancy :-)
I use the term "physician anesthesiologist" because despite the fact that it is redundant, many patients/laypeople have never heard the term "anesthetist" (and even if they have heard it, may just go ahead and say "anesthesiologist" anyway, because "anesthetist" is kind of hard to say and no one explicitly explained the distinction) and may take "anesthesiologist" to be a synonym for "anesthetist" or "anaesthesia provider" (terms which do also apply to anesthesiologists).
You could continue to use the term "anesthesiologist" with no qualifiers and be potentially confusing to patients/laypeople, and when it becomes clear that you've confused them use it as a teaching opportunity to explain that "anesthesiologists are specifically physicians who have completed an MD or DO program and passed the COMLEX or USMLE (assuming US based)" - something that is true by convention only, because etymologically an anesthesiologist is one who studies anaesthesia while an anesthetist is one who anesthetizes (i.e., administers anesthesia) - and thus both are accurate descriptions of MD, DO, CRNA, and CAA anesthetists - and then go on to explain how it's like "all squares are rectangles but not all rectangles are squares".
Or, you could get out ahead of it and use the extra 3 syllables to say "physician anesthesiologist" because, while technically redundant, it imparts clarity to the uninitiated, preventing you from having to carry on an entire conversation with a person laboring under the misconception that you were using "anesthesiologist" to mean any provider of anesthesia when you meant specifically a physician, then having to go back and explain at length.
Put in a different perspective, an NP or a PA could totally stake claim to the term "intensivist" or "hospitalist", provided that is their role. It becomes necessary to specify - intensivist/CC PA, intensivist/CC NP, intensivist/CC doc; hospitalist NP/PA/DOC; physician/midlevel intensivist. Given the context of the conversation (different providers of anesthesia), and the number of "ists" that can be applied to midlevels, it feels completely appropriate to specify "physician anesthesiologist" even though technically redundant. Again, because it is more by convention than by any real, well defined factor that it feels appropriate to call a midlevel an intensivist, hospitalist, internist or nocturnist - terms which also apply to physicians - but inappropriate to call them cardiologists, nephrologists, urologists, radiologists, or pulmonologists - terms which we reserve for physicians, and instead call them by nephrology/cardiology/pulmonology/urology/radiology PA/NP. You could hardly blame someone for not knowing that "anesthesiologist" belongs to the latter group of "ist" labels rather than the former.
Might as well make the conversation - one which might include uninitiated laypeople - easy on everyone and use the most clear term, even if it is technically redundant.
The first specialty that will be replaced by AI will be general radiology.
Love your videos!!!!! I want to be an anesthesiologist and intensivist also so you really inspire me. I have a question. How come dexamethasone is pretty much only in anesthesia as an antiemetic. Why????? Thanks for all you do !!!!!
Thanks for watching!
Dexamethasone is utilized for a variety of purposes, most commonly as an antiemetic, but it also has been utilized for airway edema, for intracranial swelling (mass effect), and other purposes. Dexamethasone has been demonstrated to be a great antiemetic, but it's peak effect can be 2 hours later so patients with longer procedures benefit more from it. Hope this helps.
We are still alive and kicking filled with advancements. Thank you Dr Amanda for this share of thoughts. GOD bless you more ☺
Thanks for watching!
IF AI is going to become so advanced in the future, it might help if people who want to go into the field (like myself) sought out a degree in, or at least become acquainted with biotechnology. It might balance out the curve between artificial and human interaction with patients. Great video!
I think the formation of usable AI requires collaboration between teams that have expertise in clinical medicine AND the technology. But I agree, having a broad background will definitely be valuable! Thanks for watching and commenting!
Found this super helpful. Cool to see a bioengineer in anesthesiology!
Thanks for watching and commenting! I think that bioengineering really lends itself well to the field of anesthesiology (I am certainly not alone in my engineering background within the specialty!)
It seems the place for general anesthesiologists may be phasing out due to cost factors more than anything else. If they want to be worth their cost to the hospital systems they will need to fill the role of a super specialist with the completion of fellowships in OB, Peds, Cardiac, Neuro, etc. anesthesia subspecialities, or complete additional residencies in critical care to manage ICUs as this physician has done. Technology and training has advanced for mid-levels that allows them to safely take the regular cases, and physicians will lose their skills if all they do is supervise mid-levels and do pre/post op assessments. The fellowship specialties seem important to maintain both skills and relevance for physician anesthesiologists of the future.
I am anesthesiologist in South Korea. Medicine is not just skills or technology. The most important things are understanding human body physiology and interaction with patients. (I don’t mean CRNA doesnt understand it, I just want to say what medicine is)
I believe that final decisions of patient care always belonged to anesthesiologists even if AI would do a procedure. We should keep our responsibility on patients’ care and safety.
Thank you for sharing your opinion!
Thank you for your comment! I agree that it's so important to have an understanding of physiology and I'd say, it's even MORE important to have a good rapport with patients in order to participate in shared decision making and provide informed consent. It is absolutely our responsibility to maintain patient care and safety!
This is disappointing because as a premed interested in anesthesiology, I did have an interest outpatient surgical centers, and I also really was interested in L&D epidurals too. You think CRNAs will take over the L&D portion as well?
The partnership with interventional radiologists is a pretty interesting point!
I enjoy working with them!
As an aspiring PA, this podcast was very informative.
Thanks for watching!
I will say this... it won't die but if they continue to throw "more money, more courses" than yes it will be a lot more challenging down the road if they keep changing what's required. 😔 In general!
great video!
Thanks for watching and commenting!
Just wondering do you think pharmacy would be screwed first
Thank you! ❤
You're welcome 😊
I’m going into CRNA school (I’m currently an ICU RN) and it sucks that this is even a topic. Can we not all just work as a team? Am I really naive to think this way? I have a lot of respect for anesthesiologist and all of their knowledge and I think it’a nothing but a plus if they’re there even if all they’re doing is “supervising” my work.
From what i’ve seen they are worried because our rates and pay are going up because we are in demand and they don’t like it. They are still paid more than us and yes they should stop worrying about our pay and work on their abilities to collaborate and adjust to the changing healthcare system because most likely it’s not going to get better or change to where crnas and AAs are not needed because everywhere is short staffed.
The fact is that CRNAs are being utilized more due to being paid 150 to 200k plus less than an anesthesiologist and able to practice on their own.
It is naive to say can't we all just work together? Because eventually with the current model of profits over patients hospitals will in my opinion kill off anesthesiologists completely 10 years from now.
CRNA'S have been coming out saying oh I've done better work or know more than the MD anesthesiologist so it shouldn't matter. It's a sad reality, but when lawsuits start piling up due to malpractice for using CRNAs over MDs it might just be too late at that point.
There are so many possible ethical dilemmas with having medical AI taking over. Even if AI takes over medicine within the next 300 years I would still be hesitant about it. It just wouldn’t feel right at all, keep that shit in movies only, for example have you ever seen the move transcendence? It’s a really good Sci fi film where AI took over the society and it getting abused. Johny depp is the main character in that film by the way:)
It is definitely interesting to bring up the ethical dilemmas in AI. We have a long way to go in this realm!
300 years it’s already happening. Go talk to radiologists
as someone not from the USA, like many others, used to look up to the american educational systems…after i have entered into the medical field, im pretty happy where i am right now….too many shortcuts in the medical field in the USA…and assistants want to be doctors without going the hardships and training that we physicians go through…for the sake of cutting cost many new post have been introduced…This is getting quite dangerous, during the pandemic one american crna youtuber said lots of crna went to help out in the ICU….getting more dangerous out there in the USA….I hope safety can be put before money!
Really enjoyed ur video and found u really brave to discuss an issue considered a taboo nowadays in the USA!
Liked ur video and subscribed 😀 looking forward for more videos!
Thanks for watching!
I don't think it's as simple as taking "too many shortcuts" here in the U.S. - I am proud of the care we provide here and love the support we have from various team members. However, there are administrative and systems issues that are really inefficient and sometimes enacted to optimize the revenue stream rather than to optimize patient care. These inefficiencies make it hard for clinicians at any level to want to stay in medicine.
@@AmandaSXiMD thanks for ur reply. Looking forward for ur new videos!
I love your perspective, especially when it comes to AI. It does not only apply to medicine, but to nursing as well. I am a nursing student in the Philippines and I'm planning to study medicine after my undergrad and I'm keen on doing anesthesiology or ENT.
New subbie here!
I feel like this was the same debate when PAs and NPs started to become into fruition. And look, physicians are still around and they work well as a team with their APPs in all other facets of medicine. Why can’t this be the same in anesthesia? Sounds very waah waah waah to me
I don’t see this as a competition with crnas. There is a physician shortage all around. If a lot of anesthesia can be delegated to crnas. Then more students can fill the other specialties that don’t have alternatives. It’s about the patient and access to care!
why do you even need to be a nurse...be careful what you wish for....CRNA's will be replaced by technicians.
If we LET it to end, it will end!
Nurses are cheap and doctors are not. I see cost as the driver. I imagine an MD with several CRNAs working under them. Just like I'm seeing doctors with several ARNPs under them. It's the same pattern up and down the west coast with nurse practitioners performing jobs that were historically performed by physicians.
There are not nearly enough MD anesthesiologists to provide Anesthesia for everyone who needs it. There will ALWAYS be a need for MD anesthesiologists. Mid level providers such as CRNAs and AAs simply bridge the gap for care. In summary, no one’s jobs are getting taken away. If anything, there is MORE work than there are providers. If CRNAs and AAs didn’t exist, half of the people who needed anesthesia care would be delayed care or not recieve it at all. In the same token, NPs and PAs are the bridge to care gaps in outpatient and inpatient care settings.
Thanks for providing a thorough explanation and non biased opinion.
My view of the future of anesthesia is somewhat different. I see CRNAs taking the most challenging cases in equal measure to the MDAs. In both cases, these assignments will be made based on experience and training, and will of course require a collaborative care team, not merely an individual. I see MDAs consulting with CRNAs in a relationship of mutual respect, with parity in salaries and authority. CRNAs entering the profession are now required to have doctoral degrees, and their training is rigorous. To qualify for the National Certification Examination, they must have completed at least 2,000 hours (600 cases) of clinical anesthesia experience. This is in addition to their extensive previous training and experience as a critical care RN. In fact, on average, brand new CRNAs come into the profession with and average of 7,000 hours of clinical nursing and anesthesia experience. CRNAs do not want to take jobs away from MDAs, but they do want to be respected for their hard work and dedication to the profession, their years of training and experience, their commitment to patient care, and their record for delivering anesthesia with no measurable differences in safety or quality compared to MDAs. CRNAs already administer the largest share of anesthetics in the US, and they have been doing so for over 150 years.
I disagree. Using the false history to justify your present claim is deceptive. Nurses who held a bag in their hands back in the day is not comparable to what people in the anesthesia field do today. And to say that CRNA and anesthesiologists have the same knowledge. Disrespectful. If CRNAs wanted understand the body and handle the "most difficult cases," they should go to medical school. Remember you are the minority who wants their ego stroked and you're in a echo chamber. If you want the prestige and actual knowledge, GO TO MEDICAL SCHOOL since you're smart enough.
@@anarchistonsunsetdrive7813boohoo you sound very mad.
What exactly do you want? Can you even articulate it without screaming “go to medical school“?? If they wanted to they would, and they’d do well there.
Try being a doctor without other health care staff and see how that works for you.
The need to massage your ego is bigger for you than the care your patients need. Do better
@@j.jellis7770by month 2 of medical school you’ll be learning things that none of my friends who are NPs or PAs were taught. I would imagine that it would be a similar situation when comparing CRNAs and Anesthesiologists.
It’s not an ego thing for everyone who thinks it’s laughable CRNAs will be taking more challenging cases. Some of us know and have seen the difference of depth in education.
Its a mess and most importantly jeopardizing pt care to be taken care by nurses ans aa. Its a mess there in the US
Advancement in both medicine and nursing is only a win for the patients we serve. Advance practice nurses provide safe and high quality care. ❤️
It's all a team effort!
Let the CRNAs take the physician exams. They will "shine," future anesthesiologists, you don't need to worry. You are going to be in medical school, you're the cream of the crop, you will have so much knowledge and no CRNA could come close. Stay positive and organize and lobby for anesthesiologists. You are the only experts in this field, remember that!
100%. This comment is important.
Every CRNA spends at least a couple years in the ICU managing those “sickest” patients for 12 hours a day before going to school and passing boards with the same exact USME style questions as the MDs.. same books too 🤷♂️ who knew.. fun fact, nurses pioneered the anesthesia profession and a lot of early methodologies.. CRNAs are not new.. been there since day 1
Honestly, mid level health care is a bunch of shit but nobody wants to say it.
Ask Lindsay Clancy about her psych NP...
Anesthesiologists replaced with C.R.N.A with A.I.
In practice, this hasn't happened. Either way, a lot of places that can use anesthesiologists/CRNAs/AAs!
This is virtually only an issue in the USA where private hospitals employ nurses to do the job of physician anesthesiologists because of 💰💰💰... no such thing as a CRNA in most countries
It’s like driving a Tesla while sleeping..A small mistake and life of patients will get destroyed
Yes, it's so important for anesthesiologists to remain vigilant at all times!
I don't worry about CRnas replacing anesthesiologists. To put it bluntly, CRnas learn from anesthesiologists, who not only provide medical services, but also have a large number of scientific tasks. A crna is more of a technician and operator, while an anesthesiologist is closer to a medical scientist.
hmm ortho went up even though they were hit super hard by pandemic too... i think there are too many DO's going into GAS while also too many mid levels. ur right about waxing and wayning but i think unfortunately competition of a specialty will always predict the compensations rate of change 4 years in the future
It's not dead but it looks to be going downhill. Even the government predicts that there's not that much job growth.
Where is a source for any of this? Because it is not true.
a solid no. the future is geriatrics, obesity, failed kidneys, regional anesthesia, pain, suicide and litigations. ive rarely seen any asa 1 or 2 patients in my practice. and people shouldnt be doctors if they only think about money. where most parts of the world where money is scarce, most of us anaesthesiologists are also critical care specialists. a reducing number of us is an ominous sign that healthcare is failing, not improving. The surgeons should be worried if that day actually comes.