I would not pursue anesthesiology if I had to do it all over again. However, I'm making amends by pursuing a fellowship that will take me out of the OR and allow me to enjoy what I do and provide actual patient care by owning my patients.
Go ahead and think that your "lack of naivete" and "spunk" will help you out in your future pursuit of an anesthesia career. If you think that's gonna save the profession from the nurses, you'll be in for a rude awakening. By that point in time, nurses will continue to blur the lines when it comes to anesthesia (and likely other fields).
I'm not saying one's life goals should be a yacht and a mansion - and I don't believe that was Blade's point either (however, of course, such examples get readily eaten up by those lacking actual life/career experience). His point had more to do with considering EVERYTHING. There are now more licensing exams, harsher clinical competency requirements, and this huge hoopla on case logs. We are essentially paper pushers ensuring everything is documented appropriately as that appears to be more important than ensuring a proper residency educational experience. I don't mind working late or giving CRNAs breaks or doing a BS lap appy/chole at 5am. I really don't. I just mind the fact that mid-level services dictate the flow of cases and, quite frankly, how WE provide care. Tack on the fact that you could be watching a patient exsanguinating and the surgeon flat out tell you it's only 100cc of the blood. Of course, I don't buy it, and I do what's needed.
We are supposed to be overseeing everything in the OR and often times we don't have anyone backing us up like the surgeons have the scrub tech and OR nurse. Of course, now that I've gotten to know the OR nurses it's changed and they're present at the bedside (often per my own request) as the patient is being induced. Now imagine out in practice where you're running around signing charts to 2-4 or potentially 5-6 rooms - do you honestly think you'll be there for induction for each of those cases you are "supervising?" No. Hell no. At that point, it's a leap of faith on the CRNA. Hope you got yourself some good ones assigned else you may be putting out fires to something you may not know anything about because quite frankly you rushed on over while in the middle of preopping your next 2-6 patients and the CRNA may not have a clue either.
Of course, you're the supervising physician. You're the one responsible for the care and the patients.
250K is not enough for that. 400K pre-tax ain't enough either. Academia is funny. It provides this "blanket" that "protects" you from a real world perspective. It's nice knowing how the real world is --- and Blade is correct in his assessment of the state of anesthesia. I've had a lot of former PP attendings sell out and come here to work in academia essentially for a better lifestyle and a steady flow of income. They have told me various stories from their PP experience. The types of things you'll experience out in PP will astound you. Surgeons will dictate the care and you'll have to anesthetize the patient, else your colleagues will quickly toss you out for canceling a case. You are essentially the surgeon's bitch, and that's not just in the OR - but also in the periop setting. If there's a bad event, they'll all quickly point the finger at you. Not the surgeon, but you. Your colleagues will be the first to pull the trigger. Now soon we have to take care of these patients post-op? Better pay me twice then, as an anesthesiologist and an intensivist.
Of course, that's not gonna happen.
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Here's my top 10 career choices - in no particular order
1. EM - shift work, work 40-50 hrs, no call, decent pay for being a glorified triage nurse (i guess we're glorified CRNAs, ha!)
2. Urology
3. ENT/facial plastics
4. Plastics - go reconstruction - you get to do all the boutique stuff plus do some real good pro bono, and actually be able to do these cases
5. OMFS - of course, requires you to do dentistry - but honestly, they make bank and while their hours can be erratic, it's still a helluva lot better than what we got
6. Neurosurg/Spine
7. Orthopedics/Spine
8. Rad onc - no nurse would touch this with a 10 foot pole
9. PM&R - pay may not be great, but you have a more laid back residency experience, and being an attending is nice too. I've spoken to several. Plus, there's the backdoor route to Pain
10. Critical Care - more laid back, very sick patients - a lot of it is like a puzzle, and very rewarding when you see a patient doing so well they can be transferred out or even sometimes directly sent home. I can be a real doctor, get paid like one, and do shift work while at the same time not working almost 45-50 weeks per year.
I would not do radiology. Too saturated. Why even bother doing it for IR - it's 6 years. None of them are happy and they always end up getting suckered into doing something.
Note - I did not list IM residency. I personally felt it to be extremely painful. However, if you can bear through it, then the options are almost limitless. Go be a cardiac slave for the next 3-4 years, or scope your way to a million, or run an allergy clinic and make bank without ever seeing pts in the hospital or taking call, or go into rheumatology working derm hrs and run a little boutique option on the side to supplement. Palliative is not a bad gig either, and may be a need considering the rationed care that obamacare will bring forth. Critical care - personally felt the medical side to be more challenging than the surgical side.
Bundled payments will not be in favor of anesthesia.
I went into anesthesia without knowing all the politics that goes on. I wasn't privy to SDN until it was late for me. I went into anesthesia because, like you, "everyone seemed super chill and nice and they taught and zomg!!! the procedures!!!!!!1111" It didn't hurt that I enjoyed the OR setting, but then again, I was simply a fly on the wall (not literally) but I wasn't the one providing the anesthesia. There's a lot more to it than just pushing prop, roc/sux, fent and tube. You'll get a healthy dose or 2 of the politics starting out in residency with all that spunk you got.
The perceived lifestyle is just that. It's a perception, an illusion. Don't think for a second anesthesia is a lifestyle specialty. Is there any wonder why a good bit of anesthesia residents jump ship from the OR into pain (and now critical care?) You guys talk as if anesthesia is some perfect specialty where everyone jumps right in but never leaves. There's plenty of folks who switch out of anesthesia. One of my EM attendings in med school did that. He thought it was the best decision he ever made. Might be right.