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6 total for me.How many interviews does everyone have? Seems like no more are going to get sent out, and I only have 5 so I'm a little worried.
6 total for me.How many interviews does everyone have? Seems like no more are going to get sent out, and I only have 5 so I'm a little worried.
Just interviewed ucsd today. I think they just had their second interview day. Sounded like the interview lateAnybody hear from UCSD?
I took 13 interviews. Maybe offered 15?How many interviews does everyone have? Seems like no more are going to get sent out, and I only have 5 so I'm a little worried.
I applied to 6 programs and have 4 interviews. No need for you to be worried my friend! You’ve got thisHow many interviews does everyone have? Seems like no more are going to get sent out, and I only have 5 so I'm a little worried.
I hope you are canceling some that you are not considering actually going. Professional to the programs and helps out the rest of applicants. Historically, ranking 7 programs guarantees matching, and most get their top 3. The programs are worried after last match because of the new landscape of remote interview removes the barrier to entry. On one hand, I expect more interview offers/spot by programs. However, I wonder if programs will settle by other means (i.e. exceptions).I took 13 interviews. Maybe offered 15?
I hope you are canceling some that you are not considering actually going. Professional to the programs and helps out the rest of applicants. Historically, ranking 7 programs guarantees matching, and most get their top 3. The programs are worried after last match because of the new landscape of remote interview removes the barrier to entry. On one hand, I expect more interview offers/spot by programs. However, I wonder if programs will settle by other means (i.e. exceptions).
Ya I cancelled or refused any program I knew I didn’t really want to go to after I got about 8-10. But that was only a few. How am I supposed to know if want to go there or not without interviewing? My understanding was 7 was safe before virtual interviews. Now with virtual interviews I’m not sure how it has changed. Better safe than sorry.I hope you are canceling some that you are not considering actually going. Professional to the programs and helps out the rest of applicants. Historically, ranking 7 programs guarantees matching, and most get their top 3. The programs are worried after last match because of the new landscape of remote interview removes the barrier to entry. On one hand, I expect more interview offers/spot by programs. However, I wonder if programs will settle by other means (i.e. exceptions).
Just interviewed ucsd today. I think they just had their second interview day. Sounded like the interview late
If you know you won’t go there, by all means cancel. But you are absolutely right that you don’t know what the program offers until you interview with them.Ya I cancelled or refused any program I knew I didn’t really want to go to after I got about 8-10. But that was only a few. How am I supposed to know if want to go there or not without interviewing? My understanding was 7 was safe before virtual interviews. Now with virtual interviews I’m not sure how it has changed. Better safe than sorry.
It sounds like a pretty tough year this year. I wouldn't feel great about stopping at 7.Ranking 7 programs NEARLY guarantees matching.
Yeah I mean I applied in 2020 to 12-15 programs, got invited to 8 (could only make 7 work in my schedule). Great scores. Great letters. Reasonably strong app. Reputable program. Good reputation for being a hard-worker with a positive attitude. Halfway through the interview season, COVID caused the rest of interviews to be over Zoom (4/7 for me). Whole world went crazy at that time.It sounds like a pretty tough year this year. I wouldn't feel great about stopping at 7.
Yeah, some of my CT trained classmates at academic places told me they're still heavily weighting their home applicants due in part to interviews being on zoom. However looks like there was a decent expansion of slots in 2022 plus a bunch of programs probably thought they didn't have to rank as many applicants as they should've and went unfilled, so that may help applicants this year. The flipside of that is anesthesia compensation absolutely exploded over the last year, especially for cardiac/cardiac locums, and the regular anesthesiology match was hella competitive this year so maybe the ACTA match will follow suit.Yeah I mean I applied in 2020 to 12-15 programs, got invited to 8 (could only make 7 work in my schedule). Great scores. Great letters. Reasonably strong app. Reputable program. Good reputation for being a hard-worker with a positive attitude. Halfway through the interview season, COVID caused the rest of interviews to be over Zoom (4/7 for me). Whole world went crazy at that time.
Ended up unmatched. That royally sucked to have done everything "right" and still not made it. I was wrecked. Still don't really know what happened overall. I am not under the impression that I come off as a giant D-bag in interviews. But maybe! Can't rule it out I guess.
I do know that things went crazy with COVID that year and I was told a lot of programs just kept their home people. Who knows. All that matters is that I'm in now and will finish my fellowship in 3 months!
I'm not envious of the all electronic interviews.
A response is reassuring, especially if it’s a program you really like. That’s why I was wondering if others got many responses. I have on some but not others,I sent thank u email. But no all the program answered back. like 40% of the emails I sent. I wish we could have like a discord or excel where we can post post-interviews communication.
There was, and for the score i just put "pass"Was there a field for "ABA Basic Exam" in Licenses/Examinations when everyone submitted their supplemental form? I don't remember one being there, but I see one now (blank and unable to change) looking over my application again.
Any II’s lately? Seems like it’s getting to be end of season for invites and interviews themselves.
The Evolving Importance of Cardiovascular Anesthesia |
Summary |
Heart cases involve lots of base units and lots of time units, but how much value do they really bring to an anesthesia practice? Today’s article examines the current volume and relative value of cardiac anesthesia cases. |
April 10, 2023 There was a time, not too long ago, when cardiovascular anesthesiologists were the most respected members of anesthesia practices. Their specialized training and complexity of cases distinguished them both in terms of clinical skills and compensation. It was not uncommon for the cardiovascular surgeons to only allow certain members of the anesthesia practice into the heart room. Although these anesthesiologists rarely performed the greatest number of cases, the acuity of care inherent within their casework was often intense as most patients had advanced stages of coronary artery disease. One of the hallmarks of these cases was the introduction of invasive monitoring, such as arterial lines, CVPs, Swan-Ganz catheters and, more recently, transesophageal echocardiography (TEE). As so often happens, though, the significance of the cardiovascular anesthesia team, while still a necessity, has diminished significantly. A Review of Volume A review of surgical activity for a sample of large anesthesia practices indicates that cardiac cases (ASA codes 00560 to 00580) now represent only about one percent of all surgical cases, and this has been fairly constant for the past five years. Because of the nature of cardiovascular disease, the number of heart cases—typically CABGs and valves—was not significantly impacted by the pandemic. Coronary artery disease was not a condition for which treatment could be deferred, especially if the patient had experienced a heart attack. |
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The Relative Value While cardiac care involves high acuity patients with compromised cardiac function, the cases are not only long (often lasting more than four hours) but complex. A typical CABG would result in about 40 base and time units, as well as separate charges for the invasive monitoring. (The arterial line, the CVP, the Swan-Ganz catheter and TEE are paid from a surgical fee schedule, not ASA units.) The problem, of course, was that, because these patients are often covered by Medicare, the effective net yield per billed unit is well below the group average. In other words, a practice that generates an average $40 per unit might only generate $30 or less for the cardiovascular cases. Paradoxically, then, while it may look as though hearts should provide an above-average yield per case, the net yield per hour is not significant once you divide the total payment by the length of the case. The chart below shows the changes in the yield per cardiac case over the last five years. |
|
As a result of the relative undervaluing of cardiac cases, cardiovascular anesthesia has come to epitomize the challenge of today’s medicine: providers who are being asked to assume cases of greater complexity in an era of an aging population for less compensation per hour of work. As most hospitals continue to invest in their cath labs, the cardiovascular anesthesia time continues to be critical; it has simply become somewhat of a loss leader. For most practices, cardiovascular anesthesia is now the least profitable line of business. Continuing Challenges Coverage and call requirements for cardiac anesthesia can be especially problematic. Typically, only cardiac certified anesthesiologists can cover this call, which means that a cardiac specialist must be available every night when cardiac cases are performed. Historically, this has required an additional stipend from the facility. Another problem that continues to challenge many practices is the need for cardiovascular specialists for unproductive heart programs. A group may go to great lengths to hire a cardiovascular anesthesiologist only to learn that the heart program is being phased out due to a lack of sufficient volume of cases. This can have a very disruptive impact on a practice. If you have any questions, please reach out to your account executive. With best wishes, Rita Astani, President, Anesthesia |
Email from anesthesiallc
The Evolving Importance of Cardiovascular Anesthesia
Summary Heart cases involve lots of base units and lots of time units, but how much value do they really bring to an anesthesia practice? Today’s article examines the current volume and relative value of cardiac anesthesia cases.
April 10, 2023
There was a time, not too long ago, when cardiovascular anesthesiologists were the most respected members of anesthesia practices. Their specialized training and complexity of cases distinguished them both in terms of clinical skills and compensation. It was not uncommon for the cardiovascular surgeons to only allow certain members of the anesthesia practice into the heart room. Although these anesthesiologists rarely performed the greatest number of cases, the acuity of care inherent within their casework was often intense as most patients had advanced stages of coronary artery disease.
One of the hallmarks of these cases was the introduction of invasive monitoring, such as arterial lines, CVPs, Swan-Ganz catheters and, more recently, transesophageal echocardiography (TEE). As so often happens, though, the significance of the cardiovascular anesthesia team, while still a necessity, has diminished significantly.
A Review of Volume
A review of surgical activity for a sample of large anesthesia practices indicates that cardiac cases (ASA codes 00560 to 00580) now represent only about one percent of all surgical cases, and this has been fairly constant for the past five years. Because of the nature of cardiovascular disease, the number of heart cases—typically CABGs and valves—was not significantly impacted by the pandemic. Coronary artery disease was not a condition for which treatment could be deferred, especially if the patient had experienced a heart attack.
The Relative Value
While cardiac care involves high acuity patients with compromised cardiac function, the cases are not only long (often lasting more than four hours) but complex. A typical CABG would result in about 40 base and time units, as well as separate charges for the invasive monitoring. (The arterial line, the CVP, the Swan-Ganz catheter and TEE are paid from a surgical fee schedule, not ASA units.) The problem, of course, was that, because these patients are often covered by Medicare, the effective net yield per billed unit is well below the group average. In other words, a practice that generates an average $40 per unit might only generate $30 or less for the cardiovascular cases.
Paradoxically, then, while it may look as though hearts should provide an above-average yield per case, the net yield per hour is not significant once you divide the total payment by the length of the case. The chart below shows the changes in the yield per cardiac case over the last five years.
As a result of the relative undervaluing of cardiac cases, cardiovascular anesthesia has come to epitomize the challenge of today’s medicine: providers who are being asked to assume cases of greater complexity in an era of an aging population for less compensation per hour of work. As most hospitals continue to invest in their cath labs, the cardiovascular anesthesia time continues to be critical; it has simply become somewhat of a loss leader. For most practices, cardiovascular anesthesia is now the least profitable line of business.
Continuing Challenges
Coverage and call requirements for cardiac anesthesia can be especially problematic. Typically, only cardiac certified anesthesiologists can cover this call, which means that a cardiac specialist must be available every night when cardiac cases are performed. Historically, this has required an additional stipend from the facility.
Another problem that continues to challenge many practices is the need for cardiovascular specialists for unproductive heart programs. A group may go to great lengths to hire a cardiovascular anesthesiologist only to learn that the heart program is being phased out due to a lack of sufficient volume of cases. This can have a very disruptive impact on a practice.
If you have any questions, please reach out to your account executive.
With best wishes,
Rita Astani,
President, Anesthesia
Spot on. The narrative needs to change so that a subsidy for cardiac anesthesia from the massive hospital charges / facility fee brought in by cardiac surgery is a given. Problem is that AMCs couldn't care less and will gladly staff up a pump case with an anesthesiologist and then give him two or three other rooms anyway to supervise. And by supervise I mean let the CRNA do the case by themselves (including inducing / emerging solo many places).
So they are on a “payment plan”.
Thought there was no such thinggood lord
Don’t worry because the demand exceeds the supply. The actual anesthesia collections (Medicare) from cases are low,even structural heart cases, but the hospitals need you. That means large stipends for those that can do TEE for Mitral clips and other complicated cases. The hourly rate for cardiac as a locums is higher as well.Good summary Nimbus, not something I understood during any point in training. Some silver linings are that our presence in EP lab and to a much larger degree in structural heart cases like TAVRs are sought after. Also interesting in your chart that 2022 represents a significant rise in reimbursement, hopefully a start of a trend.
Just upmc. But they shipped it to everyoneHave you guys gotten any thank you/gift packages before or after interviews? I heard it may be a thing
Duke and OSU sent gifts tooHave you guys gotten any thank you/gift packages before or after interviews? I heard it may be a thing
No such thing as far as I know.Same here, I checked previous post and they said BWH >MGH> BI
Can someone post the list of the top 10 ACTA fellowship? I am not asking personal ranking list i am asking national wise!! Thank you
There is no such thing because a fellowship rank list depends on what you want to get out of it. Different people will value different things.Same here, I checked previous post and they said BWH >MGH> BI
Can someone post the list of the top 10 ACTA fellowship? I am not asking personal ranking list i am asking national wise!! Thank you
I know my program has had a decreasing applicant pool each of the last 2 years. I suspect for that exact reason.Why do you say it is a competitive year? The job market is booming so more people not applying to fellowship, programs are expanding fellowship, so more number of spots. This year should be less competitive than the previous years.
Which program are you at ?I know my program has had a decreasing applicant pool each of the last 2 years. I suspect for that exact reason.