Anesthesiology After Residency

[ScarletKnights]

So there's a lot of doom and gloom surrounding anesthesiology from many people who are already in the field. I was hoping to get some info from people just finishing, or in residency on the outlook. How have the job offers been? I know I've seen people claim that they're hardly making more than hospitalist. Is the market so saturated that it is hard to find a job in the area you want? What salary are you potentially looking at and how many hours on average will you be working.

I feel like for years now people have been bad mouthing anesthesiology, but I'm still interested for some reason. I'm trying to definitively decide between EM and Anesthesia so any input would be helpful.

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[pjl]

Standard job:
Shift work, 8 or maybe 12 hour shifts. 12-16 shifts per month=full time. Shifts may be day, evening or night. Little to no "vacation," but able to group 14 days off per month. Frequent night/weekend work.

Standard job:
Variable day schedule, anywhere from 4-24 hours. End of shift is "when the work is done." Work every week day and typically 1/4 weekends. Typical work week 50-60 hours.

You pick which you like. There is a reason EM is more popular.

 

[dabillskid]

Talking to CA 3 s going to private practice for next year I'm hearing the average salary is somewhere around 290k with around 8 weeks vacation from all the interviews they went on. I personally know one who received more weeks and more vacation. This was all mainly in the northeast. Again depends a lot on private vs academic, fellowship trained ect. But if I can get paid 300 k and do the job I love I really don't understand all the doom and gloom. Most ppl have a hard time making 50k. Yes I understand we are in debt but we are talking over a quarter mil a year. I think I'm ok with that coupled with a relatively nice work schedule. Anesthesia usually offers the most in terms of vacation as well as a specialy avg around 8 wks a year. Hope this helps a little, small sample size but this is what I'm hearing from my graduating class. Cheers

 

[Baller MD]

Talking to CA 3 s going to private practice for next year I'm hearing the average salary is somewhere around 290k with around 8 weeks vacation from all the interviews they went on. I personally know one who received more weeks and more vacation. This was all mainly in the northeast. Again depends a lot on private vs academic, fellowship trained ect. But if I can get paid 300 k and do the job I love I really don't understand all the doom and gloom. Most ppl have a hard time making 50k. Yes I understand we are in debt but we are talking over a quarter mil a year. I think I'm ok with that coupled with a relatively nice work schedule. Anesthesia usually offers the most in terms of vacation as well as a specialy avg around 8 wks a year. Hope this helps a little, small sample size but this is what I'm hearing from my graduating class. Cheers

I don't understand this logic. One can always go lower. For example, the 50k person should be grateful because at least they're not living in shack somewhere in Africa.

 

[cognitus]

Standard job:
Shift work, 8 or maybe 12 hour shifts. 12-16 shifts per month=full time. Shifts may be day, evening or night. Little to no "vacation," but able to group 14 days off per month. Frequent night/weekend work.

Standard job:
Variable day schedule, anywhere from 4-24 hours. End of shift is "when the work is done." Work every week day and typically 1/4 weekends. Typical work week 50-60 hours.

You pick which you like. There is a reason EM is more popular.

EM is stressful as hell. Less hours, but they have to be like that because you'll get burned out. How much does salary increase with fellowships?

 

[kazuma]

EM is stressful as hell. Less hours, but they have to be like that because you'll get burned out. How much does salary increase with fellowships?

I didn't see any premium pay for fellowships on my interviews. Last I heard, my residency program doesn't pay more for fellowships either.


All of the pp people in my class landed great gigs, all but one leading to partnership after 1-2 years. One took an employee job in an AMC dominated big city due to geographic restrictions. Salaries range from 250-350 and 8-6 wks vacation starting out then upwards of 4-450 after partner.

All of my friends who've been out in pp for 1-2 years are loving it and think pp is the bomb. I'm looking forward to it.

 

[dabillskid]

I don't understand this logic. One can always go lower. For example, the 50k person should be grateful because at least they're not living in shack somewhere in Africa.

My point is the complaining and doom and gloom is pretty ridiculous when your making 300k and have 8 weeks vacation

 

[IkeBoy18]

My point is the complaining and doom and gloom is pretty ridiculous when your making 300k and have 8 weeks vacation

If I may, I believe the doom and gloom is being spoken by those who are concerned about the trajectory of the specialty. Not just regarding metrics, supervision/direction ratios or increasing liability but the intangibles such as autonomy, stress and practice environment. Not necessarily the current cross sectional representation of the salary and vacation.

 

[Wiscoblue]

Talking to CA 3 s going to private practice for next year I'm hearing the average salary is somewhere around 290k with around 8 weeks vacation from all the interviews they went on. I personally know one who received more weeks and more vacation. This was all mainly in the northeast. Again depends a lot on private vs academic, fellowship trained ect. But if I can get paid 300 k and do the job I love I really don't understand all the doom and gloom. Most ppl have a hard time making 50k. Yes I understand we are in debt but we are talking over a quarter mil a year. I think I'm ok with that coupled with a relatively nice work schedule. Anesthesia usually offers the most in terms of vacation as well as a specialy avg around 8 wks a year. Hope this helps a little, small sample size but this is what I'm hearing from my graduating class. Cheers

How would you feel if you were offered 290k and the senior partners were making 800k?

 

[criticalelement]

My point is the complaining and doom and gloom is pretty ridiculous when your making 300k and have 8 weeks vacation

Ahh, the rhetoric of someone who has not been there.

Question. Would you tightrope across the twin towers (even if you were good at it) for three hundred thousand per year? If yes than would you if you knew people who tightrope across a one story building were making two hundred thousand?

 

[Pooh & Annie]

Ahh, the rhetoric of someone who has not been there.

Question. Would you tightrope across the twin towers (even if you were good at it) for three hundred thousand per year? If yes than would you if you knew people who tightrope across a one story building were making two hundred thousand?

Wtf?

300k with 8 weeks is a great living compared to the masses, he's right about that. Concern about trajectory of the specialty is reasonable though.

It's a little pointless to argue "happy" vs "unhappy" with these situations because everyone has their own perspective. When your making well into the six figures though the lay public will feel (rightly or wrongly), that your perspective should be that you've got it pretty good.

 

[BobBarker]

Anesthesiology is extremely stressful.

 

[nimbus]

Anesthesiology is extremely stressful.

If it's extremely stressful after you've been doing it awhile, it's not a good fit. Mostly it's a pleasure.

 

[Ignatius J]

If it's extremely stressful after you've been doing it awhile, it's not a good fit. Mostly it's a pleasure.

 

[Ignatius J]

I think I could have managed a decent job in just about any city last year.

Plenty of opportunity. People will always complain. Just the way it is.

There are "traps" out there. There are also plenty of good, fulfilling positions to be had.

 

[dabillskid]

How would you feel if you were offered 290k and the senior partners were making 800k?

I would be ok with if i could move my way up. It's like any job. You shouldn't be paid more than seasoned vets. that goes for any job. My whole pojnt is I wouldn't complain if I was being paid 200 k with the schedule, vacation bc I love what I do. I don't wake up saying damn I have to work and displace my anger on everyone else "cough" surgeons. There are times I wish I got more sleep sure but if you like what you do and do it well you will be rewarded in many ways.

 

[deleted162650]

Anesthesiology is extremely stressful.

Not if you're doing it right.

Mostly it's a pleasure.

^^ This

 

[BLADEMDA]

I disagree with anyone who says my job isn't stressful; I routinely see at least 5-6 patients per day in the ASA 4 category who are extremely high risk for periop complications. Many of these patients and family members have UNREALISTIC expectations about their morbidity/mortality combined with a real lack of insight into the pre-existing medical conditions. The patients keep getting sicker and sicker while the surgeons keep booking them for elective or semi-elective surgery. These days I see 88-92 years the way I saw 75 year olds 20 years ago.

I'm past the point of saying my job is a pleasure as that simply isn't true; high acuity patients require you to bring your "A" game to every anesthetic every time.
For those who do the simple cases my statements don't apply but i suspect today's new graduate will have a job more like mine than a CRNA type gig at an ASC.

Hence, I would use the word "challenging" instead of "pleasure" for my days at work.

 

[BobBarker]

It is stressful working at the only level one trauma center in a state in the top 5 for obesity, and in the bottom 5 for income and every health quality metric.

 

[BLADEMDA]

I think I could have managed a decent job in just about any city last year.

Plenty of opportunity. People will always complain. Just the way it is.

There are "traps" out there. There are also plenty of good, fulfilling positions to be had.

I'm not complaining but $250K is Family practice income for a job like I do which is WORTH double in my opinion. And yes, I earn double Family practice income because the job is harder, there is more stress, lots of nights and weekends combined with a higher skill set. Yet, the trend is for anesthesia to pay FAMILY PRACTICE income plus an extra 15-20%. I truly hope you love the field because that sentiment will be tested many nights and weekends at the hospital while the Family practice doctor is at the game with his kids.

 

[Ignatius J]

I'm not complaining but $250K is Family practice income for a job like I do which is WORTH double in my opinion. And yes, I earn double Family practice income because the job is harder, there is more stress, lots of nights and weekends combined with a higher skill set. Yet, the trend is for anesthesia to pay FAMILY PRACTICE income plus an extra 15-20%. I truly hope you love the field because that sentiment will be tested many nights and weekends at the hospital while the Family practice doctor is at the game with his kids.

I've mentioned before, but I've heard the doom and gloom for a decade now. I'm sorry, but it's just melodramatic at this point to me. I'm not saying I have any idea what's going to happen, but I do find solace in that a decade later we have the same song and dance resonating from the eeyores.

 

[Consigliere]

300k with 8 weeks is a great living compared to the masses, he's right about that.

When your making well into the six figures though the lay public will feel (rightly or wrongly), that your perspective should be that you've got it pretty good.

 

[Consigliere]

Eff the "lay public." They didn't sacrifice as much as I have, train as long as I did, or deal with the stress that I do on a daily basis. 300k with 8 weeks vacation compared to the masses sounds like anesthesiologists are getting a raw deal to me. The high school educated, minimally motivated, do just enough to not get fired garbage man gets exactly what he deserves - minimal pay and minimal vacation for minimal effort.

 

[nimbus]

It is stressful working at the only level one trauma center in a state in the top 5 for obesity, and in the bottom 5 for income and every health quality metric.

I do wonder if it is more stressful to supervise than to do your own cases. I work at a busy, often chaotic Level-1 trauma center, but I do my own cases. So I can focus on one thing at a time.

My most stressful days are when I am running the board. Juggling priorities and fielding demands and complaints from every direction. On those days the anesthesia is the easy part.

And I agree, FP income would suck. That would totally change the perceived stress level of the job.

 

[Ignatius J]

Eff the "lay public." They didn't sacrifice as much as I have, train as long as I did, or deal with the stress that I do on a daily basis. 300k with 8 weeks vacation compared to the masses sounds like anesthesiologists are getting a raw deal to me. The high school educated, minimally motivated, do just enough to not get fired garbage man gets exactly what he deserves - minimal pay and minimal vacation for minimal effort.

While I don't think the "lay public" should dictate anything about our practice, nor do I think they have an iota of a clue about our job, I do think 300K and 8 weeks vacation is a pretty good deal. Perhaps this is just a reflection of the old guard versus new guard. The old guard was around during the Golden Time of medicine when doctors killed it. The new guard has never known that. As such, I'll take 300K and 8 weeks vacation easily.

Remember, we all chose our path so "sacrifice" seems like a tough word to use there. I know that if I wasn't accepted for my "sacrifice" there were about 100 people right behind me who would have taken my spot.

 

[pjl]

EM is stressful as hell. Less hours, but they have to be like that because you'll get burned out. How much does salary increase with fellowships?

I actively disbelieve the illusion that EM jobs are so stressful you cant work more than 128 hours a month without being burned out, or that it is more stressful than a day supervising cases at a busy tertiary care hospital. There are EM guys with that schedule at urgent care centers, which is equivalent to our ASC jobs.

Edit: This is not to say EM is easy, or not stressful, just that argument for hours is silly. Just call it what it is, and say "EM hours worked are low because reimbursement is "good enough" and you like to have some time off to make up for working evenings, weekends, and nights."

 

[deleted50478]

My point is the complaining and doom and gloom is pretty ridiculous when your making 300k and have 8 weeks vacation

 

[Mad Jack]

Talking to CA 3 s going to private practice for next year I'm hearing the average salary is somewhere around 290k with around 8 weeks vacation from all the interviews they went on. I personally know one who received more weeks and more vacation. This was all mainly in the northeast. Again depends a lot on private vs academic, fellowship trained ect. But if I can get paid 300 k and do the job I love I really don't understand all the doom and gloom. Most ppl have a hard time making 50k. Yes I understand we are in debt but we are talking over a quarter mil a year. I think I'm ok with that coupled with a relatively nice work schedule. Anesthesia usually offers the most in terms of vacation as well as a specialy avg around 8 wks a year. Hope this helps a little, small sample size but this is what I'm hearing from my graduating class. Cheers

Rads typically offers 12 weeks with a better average salary than anesthesia.

 

[Mad Jack]

If I may, I believe the doom and gloom is being spoken by those who are concerned about the trajectory of the specialty. Not just regarding metrics, supervision/direction ratios or increasing liability but the intangibles such as autonomy, stress and practice environment. Not necessarily the current cross sectional representation of the salary and vacation.

People have been saying the same things about the trajectory of the profession since the late 90s.

 

[URMD]

Is it fair that the 'doom and gloom' is just a result of the times changing from the 'golden age' of medicine where you could make alot more doing the same thing?
Or is it more like the profession of anaethesiology just isn't good anymore?

Im interested in anaesthesiology so I'd like to know

 

[IkeBoy18]

Are there even signing bonuses for anesthesia still?

 

[scudrunner]

Are there even signing bonuses for anesthesia still?

Yes.

 

[PainDrain]

Rads typically offers 12 weeks with a better average salary than anesthesia.

Not anymore they don't unless you are a partner and your group owns the facilities. Rads guys took a beating the last few years as reimbursements got cut. I think they even did a NYT article on it.

 

[Mad Jack]

Not anymore they don't unless you are a partner and your group owns the facilities. Rads guys took a beating the last few years as reimbursements got cut. I think they even did a NYT article on it.

They're still out there. 8 weeks is the floor for rads jobs from the listings I've seen, with 10 being common and 12 being available. You will bust your ass when you're working cranking out more RVUs than in the past though.

This is all if you can get a job, of course. If you're experienced, that isn't as much an issue, but new grads are looking at 1-2 fellowships to get a desirable position nowadays, from what I hear.

 

[Ignatius J]

They're still out there. 8 weeks is the floor for rads jobs from the listings I've seen, with 10 being common and 12 being available. You will bust your ass when you're working cranking out more RVUs than in the past though.

This is all if you can get a job, of course. If you're experienced, that isn't as much an issue, but new grads are looking at 1-2 fellowships to get a desirable position nowadays, from what I hear.

Let's not forget one year extra residency training and an almost mandatory fellowship. Two years lost pay relative to anesthesia and factoring in time value of money. Combine that with a tough job search (best friend from med school is in radiology and scrounging right now) and it is tough out there. My friend is quite jealous right now. He wants to move where I found a job and even with good connections is having difficulty.

 

[Mad Jack]

Let's not forget one year extra residency training and an almost mandatory fellowship. Two years lost pay relative to anesthesia and factoring in time value of money. Combine that with a tough job search (best friend from med school is in radiology and scrounging right now) and it is tough out there. My friend is quite jealous right now. He wants to move where I found a job and even with good connections is having difficulty.

I prefer anesthesia over rads for entirely different reasons, but if you aren't that sensitive about location and are willing to move damn near anywhere, rads isn't that bad of a gig.

 

[Ignatius J]

I prefer anesthesia over rads for entirely different reasons, but if you aren't that sensitive about location and are willing to move damn near anywhere, rads isn't that bad of a gig.

Yes, keep in mind I made my decision 6 years ago. That was more directed at the "grass is greener" folks.

 

[deleted50478]

People have been saying the same things about the trajectory of the profession since the late 90s.

AMCs weren't monopolizing the field in the 90s.

 

[nimbus]

AMCs weren't monopolizing the field in the 90s.

At that time there was an outfit called Premier Anesthesia and a couple of others that were trying. People were fretting about them then.

 

[cognitus]

I didn't see any premium pay for fellowships on my interviews. Last I heard, my residency program doesn't pay more for fellowships either.


All of the pp people in my class landed great gigs, all but one leading to partnership after 1-2 years. One took an employee job in an AMC dominated big city due to geographic restrictions. Salaries range from 250-350 and 8-6 wks vacation starting out then upwards of 4-450 after partner.

All of my friends who've been out in pp for 1-2 years are loving it and think pp is the bomb. I'm looking forward to it.

I want PP so bad. I meant how much would attending salary increase with certain fellowships? (Cardio, regional)

 

[pjl]

I want PP so bad. I meant how much would attending salary increase with certain fellowships? (Cardio, regional)

Not at all in my group.
Actually, we do give 10k if you pass advanced echo boards, but otherwise, none.

 

[Ignatius J]

I want PP so bad. I meant how much would attending salary increase with certain fellowships? (Cardio, regional)

Dirty little secret- most of the time, you don't make jack **** billing cardiac cases in private practice.

 

[kazuma]

I want PP so bad. I meant how much would attending salary increase with certain fellowships? (Cardio, regional)

Like I said, nothing. None of the pp groups I looked at paid any extra for having a fellowship. Especially not for things like OB and Regional. OB, regional and the ability to do healthy neonates/kids are skills you are expected to have straight out of residency.

Why would a pp group pay you extra for spending an extra year doing something you should have mastered during 3 years of residency?

 

[Wiscoblue]

Dirty little secret- most of the time, you don't make jack **** billing cardiac cases in private practice.

In a group where you are being paid on a blended unit, the cardiac guy could do quite well. Every heart case generates 60-70 units. You'd have to do 7 lap choles to generate that many units. Depending on the payer mix, cardiac could hold its own or be subsidized by Ortho and general cases. Cardiac guys in my group make at least 100k more than the general guys. Possibly more.


Sent from my iPad using Tapatalk

 

[BLADEMDA]

In a group where you are being paid on a blended unit, the cardiac guy could do quite well. Every heart case generates 60-70 units. You'd have to do 7 lap choles to generate that many units. Depending on the payer mix, cardiac could hold its own or be subsidized by Ortho and general cases. Cardiac guys in my group make at least 100k more than the general guys. Possibly more.


Sent from my iPad using Tapatalk

Which is why some groups pay a flat base salary then incentives based on time at work instead of blended units. I do both Cardiac and General so the concept of the person in the heart room earning more money for doing 1 case while I slave away doing 7 cases doesn't sit well with me or seem fair. But, an incentive based on time spent at the hospital (assuming you can control that nobody stays around doing nothing) may be a fairer approach.

 

[BLADEMDA]

Is it fair that the 'doom and gloom' is just a result of the times changing from the 'golden age' of medicine where you could make alot more doing the same thing?
Or is it more like the profession of anaethesiology just isn't good anymore?

Im interested in anaesthesiology so I'd like to know

Yes. You are correct that the "doom and gloom" refers to the fact that AMCs are taking over the field day by day. The result is Anesthesiology income is decreasing significantly and the practice model of being your own boss is fading away. Anesthesiology is still an excellent profession but IMHO, not a great career choice due to the change in practice model.

The Midwest and West are still holding out against the employment model for now. A new graduate has the best chance for success in those regions.

 

[BLADEMDA]

I've mentioned before, but I've heard the doom and gloom for a decade now. I'm sorry, but it's just melodramatic at this point to me. I'm not saying I have any idea what's going to happen, but I do find solace in that a decade later we have the same song and dance resonating from the eeyores.

Totally false statement. In my region AMCs have taken over the vast majority of practices and that trend is accelerating; this means one can expect to be an employee forever if he/she wants to reside in my region.

 

[aneftp]

Everything is perspective here guys and gals.

My brother got out in 1996 cardiac anesthesia trained. Starting salary fulltime $110k in major top 5-6 population east coast city.

My sister got out anesthesiology residency in 1998. $120k. Again major city east coast.

Me personally started out at $185K in 2004 fresh new grad again major top 5-6 population city on east coast full time with calls (government job) with 40 -45 hour work weeks.

My friend who finished at same time as me in 2004, in a top 20 population city in the Southeast started out at 220K a year full-time with calls working 60 hours a week. He was on partnership track where partners made $500K and up.

The "golden area" of anesthesia (with this current generation) was probably between 2000-2010 when supply (number of graduating anesthesia residents (especially those USA citizens who could actually stay in the USA was low). The real golden area of anesthesiology was the 1980s obviously. But I am talking about this generation.

Anyways the current generation (which I prefer to call, generation me) those born around 1982 and later (aka generation NOW). They feel entitled to a lot of things, including a prime job in a prime location. And in anesthesia, " generation me" wants a non board certified new grad to command a $300K salary PLUS benefits PLUS 8 weeks vacation.

Those jobs are few and far in between these days.

Most new grads are looking at 250K W2 in a major city but with more reasonable work hours. There is a lot of give and take.

Agree Rads market is tough in major areas. Friend of mine works 9pm-7AM shifts 14-16 days out of the month. He's been doing for 4 plus years in the southeast. Its an employed position also. They don't have any regular day hours open.

My other rads friend in midwest in big city makes a killing around 600K a year. But his group has hired 2 new grads in the past 3 years as well. Its just a tough job market in bigger city.

Don't think the grass is greener on the other side.

They're still out there. 8 weeks is the floor for rads jobs from the listings I've seen, with 10 being common and 12 being available. You will bust your ass when you're working cranking out more RVUs than in the past though.

This is all if you can get a job, of course. If you're experienced, that isn't as much an issue, but new grads are looking at 1-2 fellowships to get a desirable position nowadays, from what I hear.

 

[Ignatius J]

Totally false statement. In my region AMCs have taken over the vast majority of practices and that trend is accelerating; this means one can expect to be an employee forever if he/she wants to reside in my region.

What's totally false about my statement?

I have mentioned that I am in private practice and I love it. It's not like I don't have the data points to say "Yeah, the histrionics are a little overblown."

 

[Ignatius J]

Everything is perspective here guys and gals.

My brother got out in 1996 cardiac anesthesia trained. Starting salary fulltime $110k in major top 5-6 population east coast city.

My sister got out anesthesiology residency in 1998. $120k. Again major city east coast.

Me personally started out at $185K in 2004 fresh new grad again major top 5-6 population city on east coast full time with calls (government job) with 40 -45 hour work weeks.

My friend who finished at same time as me in 2004, in a top 20 population city in the Southeast started out at 220K a year full-time with calls working 60 hours a week. He was on partnership track where partners made $500K and up.

The "golden area" of anesthesia (with this current generation) was probably between 2000-2010 when supply (number of graduating anesthesia residents (especially those USA citizens who could actually stay in the USA was low). The real golden area of anesthesiology was the 1980s obviously. But I am talking about this generation.

Anyways the current generation (which I prefer to call, generation me) those born around 1982 and later (aka generation NOW). They feel entitled to a lot of things, including a prime job in a prime location. And in anesthesia, " generation me" wants a non board certified new grad to command a $300K salary PLUS benefits PLUS 8 weeks vacation.

Those jobs are few and far in between these days.

Most new grads are looking at 250K W2 in a major city but with more reasonable work hours. There is a lot of give and take.

Agree Rads market is tough in major areas. Friend of mine works 9pm-7AM shifts 14-16 days out of the month. He's been doing for 4 plus years in the southeast. Its an employed position also. They don't have any regular day hours open.

My other rads friend in midwest in big city makes a killing around 600K a year. But his group has hired 2 new grads in the past 3 years as well. Its just a tough job market in bigger city.

Don't think the grass is greener on the other side.

To be fair, this "Generation Me" are guys like me who are very content with their gigs and not the guys who have been painting the doom and gloom for a decade. A lot of guys don't want to work for an AMC. We'll see how that continues. I pray it doesn't happen to my practice.