Anesthesiologists Are Like Herding Cats

I have some good news to share with my loyal blog readers. After working for over a decade in my anesthesia group, I recently received a job promotion. Now instead of just being a worker bee anesthesiologist, I have a more managerial position. Before you congratulate me on my career advancement, let me just describe to you what my new responsibilities encompass.

First of all, I get a small, small pay raise. It works out to about an extra $50 per week. Hooray! That doesn't even cover the cost of taking the family out to the movies. My new job description also doesn't include the ability to hire or fire anybody. That privilege still resides with the current Chief of our group. However what I do get to do is hear everybody's grievances about each other. And there are a lot of that.

I have to entertain complaints from anesthesiologists about nurses, surgeons, and fellow anesthesiologists. If a surgeon doesn't like the way his anesthesiologist is working, I get to hear about it. When a nurse feels one of our partners is too engrossed in his cellphone instead of on the patient, I'm the one who has to convey the message to the offender. Don't even get me started on the petty complaints our partners have against each other.

Before I got this promotion, I was totally oblivious to all this backroom drama. I came to work in the morning, shut myself in the operating room for the next eight to ten hours, then left the hospital after a job well done. Not only do I still have to keep doing those same tasks, but now I'm answering emails and text messages all day. Then there are the meetings. My work calendar has never been so full of meetings. There are conferences that meet regularly to try to resolve earth shattering disputes like how to get the janitorial services to clean the operating rooms more quickly. Or why the break room doesn't have enough shelving for everybody's lunch bags. Or how some anesthesiologists talk too much during an operation.

As any newly promoted manager will tell you, once you are not your peers' equal, you are no longer "us". You suddenly become one of "them". Which means there are no more sharing jokes about the incompetence of the group management because now I am one. The previously chummy relationships have become more formal, even a bit frosty. Edicts on proper conduct in the OR that come from above are now my responsibility to enforce to my colleagues. And that's when I realized why some surgeons dislike anesthesiologists so much.

Managing anesthesiologists can sometimes feel like herding cats. We are so used to working independently in the operating room that we don't take kindly to having somebody telling us what to do. So when I was tasked to pass along a message to a colleague that he is getting complaints about his slow inductions, causing the surgeon and the whole OR staff to wait, I not only got a frosty reception, I was nearly thrown out of the room. Since I have no powers of enforcement, like monetary penalties or job termination, my fellow partners can do that to me with impunity. In fact, some have turned the tables around and complained about me to our Chief, claiming my newly high handed and authoritarian demeanor was not tolerable.

Don't get me wrong. I love my new responsibilities. After working so long in the loneliness that can be the workday of an anesthesiologist, I suddenly feel the added tasks I do make my job interesting again. I enjoy my fellow anesthesiologists coming to me for help when they have a problem they need fixing. Or sometimes all they need is an ear for them to unload their issues. I feel I'm good at that kind of thing. And my bosses think I am too. I would take on these new duties even if I had to do it for free. But don't tell my Chief that.

What Doctors Eat On Call

You would think that doctors, with all our lecturing about healthy diets and exercise, would be paragons of nutritional correctness. But we are human just like everybody else. One of the first lessons medical students learn is that when they are on call, they should eat and drink whenever they can because the opportunity may not present itself again until hours later. So it's not uncommon for us to have the most atrocious diet while at work.

I was on call the other day and hadn't had a chance to eat anything, other than a furtive bite of a granola bar I had in my pocket. Finally, by around 9:00 PM, the operating rooms were starting to settle down. I dragged myself to the break room to get some water and what did I see when I opened the door? A bright red half eaten bag of Doritos was sitting on the table. Now anything that is sitting out in the break room is fair game. I looked around the room but it appeared I was all by myself.

I looked into the bag. There wasn't that much left, maybe a couple of servings at most. I told myself I will eat just one chip, not only because Doritos aren't exactly a health food, but because other people may want some too. I reached into the bag and brought out a perfectly triangular and unbroken chip. When I popped that in my mouth, a rush of endorphins rushed through my body. It felt like the most satisfying morsel of food I had ever eaten in my whole entire life. I didn't realize how famished I was until my tongue was coated with that delectable nacho cheese powder.

Well who can stop with just one chip? But now I wanted more. Not just more. I wanted it all. I don't care if other people working that night didn't have a chance to eat the Doritos. That bag was mine, MINE! Since there was still nobody in the break room, I quickly snatched the bag and headed to my call room. Once in the privacy of my room, I greedily reached into the package and grabbed another chip, followed by another and another. Before I knew it, I was tipping the bag upside down over my mouth to get the last crumbs of Doritos at the bottom. Then I was licking my nacho cheese covered fingers hungrily. If I could devour my cheese powder covered fingers for a snack, I think I would have that night.

Then it was over. The Doritos bag was empty. My orange colored fingertips held no more nacho cheese. And I was left suffering a deep sensation of guilt for absconding with a bag of chips from the break room. And these truly are empty calories. I felt no more fulfilled now then when I first started eating the chips. But my pager started beeping and I had to get back to work. Even if they are empty calories, they're calories just the same, enough to get me through another few hours of work.

Besides, nobody will ever know how pathetic I was when confronted with a bag of Doritos. Unless my Doritos breath gives me away. I kept that surgical mask over my face the rest of the night.

The Scariest Chart A Doctor Will See

This chart should frighten the bejeezus out of doctors. It comes from the July, 2015 issue of the ASA Newsletter. It's included in an article explaining how the new SGR fix, now known as MACRA, is supposed to work. In a nutshell, the graphic illustrates how the government takeover of American medicine is going to decimate the economic livelihood of physicians.

As you can see, during the first five years of MACRA, Medicare will entice doctors into the program with a tiny little 0.5% bonus payment each year, which doesn't even cover the cost of consumer inflation, let alone healthcare inflation. But then, in 2019, once doctors have become fat and happy with the new system, the hammer will start too fall. Medicare will start paying, or more accurately, penalizing physician reimbursement based on a set of bureaucratically selected criteria on "performance".

These factors encompass an entire bowl of alphabet soup acronyms: PQRS, VBM, MU, CPIA. I won't get into the definition of each one as that would take a lot of time and frankly, I'm not even sure of their exact meanings. You'll just have to read the article for yourself. But the bottom line is that if doctors don't measure up to these new government rules, their paychecks will start to shrink, dramatically. In ten years, which is when MACRA will sunset, physician compensation could be cut a maximum of 9% each year. For typical doctors' incomes, we're talking about $20,000 to $50,000 that will be eliminated based solely on how some faceless government workers decide how well you follow their rules. You'll also notice that this is all based on negative reinforcement. There is no bonus for doing well, only penalties for not performing as well as the feds think you should. As a matter of fact, if every single doctor doesn't do what the government wishes, Medicare may actually save more money. So you can see how if Medicare decides it needs to reduce its budget, it can easily complicate the rules anytime it wants to cut physician payments at its whim. Talk about an abusive codependent relationship.

So the American Medical Association may be crowing about how they finally rid medicine of the hated SGR. But out in the real world, working physician will only likely face more pain for years to come.