Careers in Anesthesia are Changing, with Opportunities Outside Hospitals
A popular misconception characterizes ambulatory surgery and anesthesia as the “wild west,” new, emerging fields of healthcare, driven by payers pressuring surgeons financially to move more procedures outside of the hospital, and it’s changing what careers in anesthesia can look like.
The reality, as we’ve covered previously, is entirely different. Office based surgical procedures and surgical center adoption have been a mainstay of healthcare in the United States for decades, and have a long tradition of excellent outcomes and faster patient recoveries. They’re increasingly recognized as safe, and much more affordable, efficient models of surgical care that promote quicker recovery times and increasingly represent the cutting edge of surgical and anesthesiology techniques.
While costs may be driving this transition, it’s also an overlooked boon to clinicians that are graduating already burnt out and told the only way out is through. Let’s get into why.
Per the Anesthesia Patient Safety Commission and the Mayo Clinic, anesthesia clinician burnout has seven main causes: workload and job demands, control and flexibility, work-life balance, social support / community at work, alignment of individual and organizational values, production pressures, and degree of meaning derived from work.
Like most highly demanding fields, anesthesiologists and CRNAs have been convinced that the final element of burnout, an absence of meaning derived from work, is only solvable by tolerating the prior six; that grinning and bearing a lack of control, no work-life balance, alignment of values, etc. are the only way to have a meaningful, stimulating career that connects them to the well-being of their patients.
The opposite is true. The reality is just that careers in anesthesia that allows for more direct, hands-on time with patients isn’t in the hospital, not anymore.
What follows are two testimonials from two different approaches to ambulatory anesthesiology that get right to the heart of each of those seven issues and show a clear path forward for clinicians.
First, Dr. Theresa Maicke, of Mobile Anesthesiologists in the Chicagoland area, shares her perspective: “[Transitioning to ambulatory anesthesia] was one of the best things I’ve done. I’m home every night, I have dinner with the family. Working weekends is pretty much voluntary. I work on interesting cases, meet a wide variety of people. I wish I’d known [about office-based surgery] earlier in my career.” She continued, “The people are just awesome. The administrative headaches are 100% less with ambulatory, with the right support. I don’t interact with hospital administrators. There’s no chairman, no department presidents, etc. Working ambulatory, you talk to who you’re working with, the patients, the surgeons, the nurses, and you’re done.” She adds on support while at work, “[in the hospital] we didn’t have a nurse dedicated to us. In ambulatory, I have one or two dedicated nurses that work with us day in and day out, if an anesthesiologist needs anything, they’re right there. I love it.”
She concluded, noting some concerns colleagues have had: “For people saying, ‘I just spent 12 years training, I don’t want to lose skills, if I go ambulatory, will I be able to go back?’ I have to say I’m floored by how diverse my cases are. At first, I thought I’d just be doing GI, and I am, but I’m also working in gynecology, ENT, urology, dental offices, orthopedics, pain management, plastics; the breadth and complexity of those cases with a trained, well-versed team of CRNAs and anesthesiologists keeping patients safe is just fantastic.”
In contrast, we have Dr. Thomas Kenjarski, founder of Noble Anesthesia Partners in Texas, who spoke directly to the concerns Dr. Maicke says she sometimes hears when suggesting colleagues head to ambulatory anesthesia, that it’s a “retirement plan” and not a career path.
“Shifting higher acuity procedures to the ambulatory setting is not the future, it’s the present. The past three years have seen explosive growth in the acquisition of ASCs by large health systems, as well as independent ASC organization building out larger networks of facilities. This is not just due to pressure from the payers, it’s what the patients are demanding as well.
That’s why when we recruit CRNAs and anesthesiologists, we ask them, “Are your skills good enough to do a total joint replacement with little to no opiates, and send the patient home the same day?” Those providers who make the cut are rewarded with generous compensation packages, and benefits that are tough to put a price tag on. Ambulatory centers have a much more reliable schedule than the hospital. You’re home for dinner every night. Whether that’s your social life or your family life, you get time back. You might not have any call, but if you do, it’s a later day, not in-house overnight. Noble currently does not provide Cardiac, OB or Trauma services, which require attention at all hours of the night, and we believe ambulatory services are currently the cutting edge of our specialty.”
While boastful, it’s deserved. The Noble team is known across Texas for their use of regional blocks for cases as complex as total joint replacement, even outpatient craniotomies, with extremely high patient satisfaction, strong outcomes, and lower recovery times.
Both stories address each of the seven causes of burnout via entirely different experiences in the ambulatory space, painting a much more diverse picture of an approach that benefits physicians, nurses, and patients alike. The issues of poor work life for doctors and nurses and spiraling costs for patients are not an intractable issue of healthcare itself, nor the cost of careers in anesthesia. The hospital conceived of as the absolute nucleus of care is the source of every single one of the issues outlined above.
If you’re an anesthesiologist or a CRNA, or really any healthcare professional, don’t you deserve better?
Don’t your patients?
Anesthesia and Value-Based Care: From surviving to thriving.
Portions of this piece on anesthesia and value-based care were originally published by Scope partner practice Mobile Anesthesiologists in Becker’s ASC review. It has been updated to reflect policy changes by CMS and changing landscape of non-hospital surgical care. While the backbone of value-based care is primary care and preventative medicine, inevitably surgical intervention is...
Scope Practice Spotlight: Mobile Anesthesiologists
The Competitive Advantage: The Mobile Way From the perspective of Chicago’s Mobile Anesthesiologists, the accelerating tailwinds of payers, patients, value-based care, and COVID-19 have had a positive impact on the physician office space over the past two years. In this post-COVID world, we will continue to see patients look for alternatives to hospitals and ASCs...
Data Series Part 3: Healthcare KPI Pitfalls and Measuring Useful Results
Once you have established key performance indicators (KPIs) that are measurable, influenceable, and have found that they align with a practice’s overall goals, the work really begins. After all, what good is data if you’re not going to use it? In order to determine how to actually use these healthcare KPIs that you have established,...