Anesthesiology

[MD 81]

Hello, I want to be a cardiac anesthologist and does anyone know the real salary since the internet is giving all sorts of crazy numbers.Which one involves more working hours, employed or private practice.
Thank You

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[sevoflurane]

.:troll:

 

[periopdoc]

I am a cardiac anesthesiologist.

I usually get up between 4AM and 5AM and I am usually home by 6PM unless I am on call in which case I can be at work all night and I still have to do my cases the next day. It is M-F except one week a month when I am on call for the whole weekend. Vacations are available, but there is no such thing as paid time off so the less you work, the less you make. I prefer to make more money with less time off.

Not sure what you mean by private practice vs employed. Employed positions can be private practice. Do you mean employed vs. partnership or private practice vs academic? There isn't any significant income difference, but there is a difference in autonomy.

The money is good enough, but isn't enough to make up for the years of life wasted getting here. Income varies widely by region and practice makeup so it is an impossible question to answer.

- pod

sometimes i like feeding trolls

 

[panetrain]

I am a cardiac anesthesiologist.

I usually get up between 4AM and 5AM and I am usually home by 6PM unless I am on call in which case I can be at work all night and I still have to do my cases the next day. It is M-F except one week a month when I am on call for the whole weekend. Vacations are available, but there is no such thing as paid time off so the less you work, the less you make. I prefer to make more money with less time off.

Not sure what you mean by private practice vs employed. Employed positions can be private practice. Do you mean employed vs. partnership or private practice vs academic? There isn't any significant income difference, but there is a difference in autonomy.

The money is good enough, but isn't enough to make up for the years of life wasted getting here. Income varies widely by region and practice makeup so it is an impossible question to answer.

- pod

sometimes i like feeding trolls

I agree!

 

[PistolPete]

The above 2 comments are somewhat worrisome for me, as I'm considering applying to anesthesia in the fall.

Care to elaborate?

Sounds like if you guys could go back and do things differently, you would.

 

[pgg]

The above 2 comments are somewhat worrisome for me, as I'm considering applying to anesthesia in the fall.

Care to elaborate?

Sounds like if you guys could go back and do things differently, you would.

Lots of doctors wouldn't choose medicine again. There's no anesthesia-specific story here.

You're a med student, so you've already bought your ticket. Yeah, a lot of the journey sucks, but you're almost halfway through it.

periopdoc works hard, so do I; he still thinks anesthesia is the bomb, so do I.

 

[midazme]

i would demand...

one MILLION dollars.

 

[MD 81]

Is there any time for spending time with family?

 

[periopdoc]

Don't you think we should ask for *more* than a million dollars? A million dollars isn't exactly a lot of money these days. Virtucon alone makes over 9 billion dollars a year!

 

[amyl]

Is there any time for spending time with family?

No, not really. I suppose in general anesthesia you can find "mommy tracks." some of our attendings work M-W 7-3 and make much less money. Another girl I know got a nice mommy track with similar hours in TX.
I think you can find these jobs in a little bit less desirable location or for way less money in general anesthesia.... i don't think the nature and environment of cardiac really allows for this kind of stuff too often.

if you are looking for a lifestyle specialty, do not pick anesthesia

 

[periopdoc]

To spend a solid 9+ years training for a career that will likely be non-existent in the next 5-10 years does not make sense. The return on investment is simply not good enough.

There are a lot of other possibilities than the above scenario, but you have to come to terms with that cold hard possibility before you go into this job.

If your goal in life is family time, find something that gives you family time right now and don't waste 9+ years of family time trying to get a job that will give you family time.

If your goal in life is money, find a job that makes you money now while there is still money to be made. It is very likely that there won't be money there at the end of nine years.

If you love cardiac anesthesia and that is your goal in life, go for it. It sounds like you have other priorities and the sacrifice will not be worth it.

With student loans equal to or greater than the median mortgage, you will be in debt for a long time as our incomes drop.

Yes I make reasonably good money right now and I have a great lifestyle. It is likely that in the near future I will have to sacrifice a significant amount of both. If my situation stays like it is for the next 20 years, it will have been worth it.

Success is a gamble so pick your path and the attendant level of risk.

If I wanted a safer bet, I would go with an interventional career. Good pay, can ply your trade anywhere from BFE to the Ivory Tower, good time off, reasonable call, pretty much unlimited future with minimal competition for the foreseeable future. You have to survive a medicine or a radiology residency first though. The latter would probably be the lesser of two evils.

- pod

 

[btbam]

To spend a solid 9+ years training for a career that will likely be non-existent in the next 5-10 years does not make sense. The return on investment is simply not good enough.

Just curious why you say it will be non-existent in the next 5-10 years, can you elaborate?

 

[CrazyJake]

What he means is that in 5-10 years with Obamacare no one will be allowed to have surgery anymore. Zip, Zilch, nobody.

All Anesthesiologist will be forced to do lawn care, drive trucks, construction careers, teach school b/c of the no surgery rule. Surgeons are going to be out of luck too...it's so depressing.

The interventional guys (Radiology and Cardiology) are VERY happy right now too b/c they realize their salaries are about to triple in the next 5-10 yrs - I wish I had choosen wiser!

I hope this gets posted before the sky drops!
CJ

 

[Doctor4Life1769]

Why no surgeries?? I'm kinda confused.. there's evidence showing that interventional procedures aren't exactly gold standard options as was thought before...

 

[RT2MD]

Why no surgeries?? I'm kinda confused.. there's evidence showing that interventional procedures aren't exactly gold standard options as was thought before...

Correct me if I'm wrong, but I believe that his post was intended to be facetious.

 

[Doctor4Life1769]

Correct me if I'm wrong, but I believe that his post was intended to be facetious.

You're probably right..

 

[periopdoc]

There are a lot of other possibilities than the above scenario, but you have to come to terms with that cold hard possibility before you go into this job.

Nice how you conveniently ignore this second paragraph of my post. There are a lot of threats to our career and if you cannot accept the very real possibility that you will not be doing intraoperative cardiac anesthesia in 5-10 years, I think you need to reconsider. The OP specifically asked about a career in cardiac anesthesia, and it sounds like he hasn't even started down the anesthesia path yet. My advice in this thread is mostly to those who are in his situation.

No I don't think Obamacare is the death knell of anesthesia or of surgical careers. In fact, there was a good chance that surgery numbers would have gone up while reimbursement went down keeping our incomes somewhat buoyed at a lower level under his full plan. The plan that ultimately went through will, IMHO, set in motion the most painful possible path to a single payer system. Ultimately everyone gets sick of paying the insurance companies for minimal coverage, has to pay out of pocket for real care, and realizes how much of their health care dollar is increasingly going to insurance administrative costs, then they will scream for a single payer system. In the meantime, the majority of the fiscal pain will be carried by physicians and patients, not hospital admins, insurance folks or politicians.

Political thoughts aside, lets look at the real threats to cardiac anesthesia careers.

1 - Percutaneous procedures. Despite the data supporting superior longevity of CABG in certain circumstances, it is hard to talk a patient into getting a full anesthetic with their chest opened several days hence when they can be stented right now with some sedation and can be out of the ICU in short fashion. Surgeons have, in large part, compensated for this by taking older and sicker patients to the OR. I believe we have pretty much hit our max for older sicker patients. Valves have been the (almost) exclusive domain of the surgeon, but perc valves are coming of age. As tissue modeling, stem cell research, etc improves the valves that can be placed percutaneously, we will see a large segment of cardiac surgical procedures eliminated. Smaller VADs are on the near horizon. These will be placed/ exchanged in the cath lab, and will be attached to the subclavian vessels reducing the need for open chest VAD procedures and transplants. There will be a reduced need for cardiac anesthesia.

2 - Economic reality. The biggest threat. Right now we still live in a country with tremendous economic unreality. Insurance has divorced us from reality to the point that the cost of healthcare is not tangible for the patient or the physician. There is little hope that the overall economy will recover to a point that will allow us to continue spending at current levels for more than a few years. At some point, utilization of health care resources is likely to decrease. This will either come at the behest of government mandate or by individual choice.

Further, these patients are mostly covered by medicare with reimbursement values that are terrible for anesthesiologists. We have artificially propped up salaries through stipends, redistribution of group incomes, supplementing with non-cardiac cases etc, but that can only go so far. In this era of huge budget cuts, it would be surprising if we did not see a significant reduction in the salary of those who practice cardiac anesthesia full-time.


3 - CRNA's

Susan Parry McMullan, CRNA, MSN, chief nurse anesthetist at Hinsdale Anesthesia Associates, Hinsdale, Illinois, uses trans esophageal echocardiography to evaluate pre*operative heart function in a patient scheduled for coronary artery bypass graft surgery.

I think that image/ quote pretty much says all that needs to be said about this threat.

I am sure that there are other threats.

I believe the market will contract from both ends (fewer cases being done with more of them done without anesthesiologist involvement) while incomes will drop with the result being that many of us will not be doing a significant amount of cardiac anesthesia. How dramatic an effect we will see is yet to be determined. As it currently is, how many anesthesiologists are doing strictly cardiac anesthesia? I would guess only slightly more than the number of CRNA's who currently do hearts part-time.

There are, of course, other possibilities. The Supreme Court could declare the bill unconstitutional, congress could stop deficit spending, housing prices could return to 2008 levels, and the AANA could decide that they actually were wrong all along and echocardiography and cardiac anesthesia are really the practice of medicine and should thus be left to fellowship-trained anesthesiologists. Which scenario do you think is more likely.

Our skill set will still be valuable and hopefully we can adapt it to other areas of medicine. Certainly, we can be valuable for non-cardiac surgery in patients with cardiac disease (especially structural cardiac disease), but I doubt that cardiac anesthesia will look the same 5-10 years hence.

Of course the proceduralists are going to see a drop in income, but it is likely that 10 years hence their business will have picked up dramatically as more and more surgical repair is done in a transcatheter fashion. If you are looking for income stability get a job in primary care, the only field who's income is pretty much guaranteed to not go down. If you want to make more money, you have to take more risk of losing that income down the road.



- pod

 

[CrazyJake]

The post was meant to be more sarcastic than anything, but facetious is accurate also. If I believed everything I read on this darn SDN, I'd jumped from a bridge by now!

I mean come'on - where is Anesthesia going to go - vacation, deported, kidnapped? Are all Anesthesiologist going to be displaced in 5-10 years, extinct like the dinosaur? So every hospital in the U.S. is going to say we don't need our Anesthesiologist anymore, thanks. NO WAY. After that will the ACGME come by every Anesthesia program and board up the dept? Doubt it.

for the last 20 yrs they've been saying that automated pharmacies were going to take over Pharmacy, dental hygienist would replace dentist and optometrist will replace Optho MD's/DO's - That hasn't and isn't going to happen either in the next 30 yrs! As long as they're are scum bag lawyers (which Obama boi didn't do a thing about), Anesthesia and especially Anesthesiologist are going to be fine - maybe less $$, but that's everyone in healthcare...I'm betting we still make at least 250K (probably >300K) just for the liability alone.

Also, the Radiology and Cards guys in my area aren't getting reimbursed jack for reading images or Cath's anymore...sit in a dark room and not make anything, work ALL THE TIME and not get paid for it - now that sounds awesome!

To answer the OP's questions (which rarely happens also on sdn) - the Cardiac guys in my area are making 400-500K. They're on call q 3 -5 depending on the week, called in when there are emergencies, take backs from earlier surgeries, usually a wknd a month and none 'appear' to be worried about losing their jobs in 5-10!

CJ

 

[xbulletin]

The demand for anestheisologists goes up every year, as does the amount of residency spots..

Also, cardiac anesthesiologists can still practice main OR anesthesia of their specialty goes under..

 

[nlfru]

The demand for anestheisologists goes up every year, as does the amount of residency spots..

Also, cardiac anesthesiologists can still practice main OR anesthesia of their specialty goes under..

Keep telling yourself that. I can give you evidence based on experience and evidence based on numbers. As a CA1 I watched CA3's get hounded to take multiple 350-400K jobs with immediate partnership in August of their CA3 year. As a CA3, most of us are doing fellowships and the rest still can't even find an employed position.

As for numbers, when I was a CA1 there were 2500+ jobs on gaswork. Now there are less than 800.

These two things make me doubt that the demand for anesthesiogists goes up each year. It tends to swing back and forth. Coming our way in the next several years will be the panic phase of the swing we saw in the 90's. The sky is falling, CRNAs will rule the world, Obamacare, etc.... then the supply will go waaay down, demand will go waaay up and the swing will go the other way. Just my opinion.

 

[pgg]

As for numbers, when I was a CA1 there were 2500+ jobs on gaswork. Now there are less than 800.

A lot of older anesthesiologists have chosen to delay retirement since the financial SHTF in late 2008. I bet a large part of the reason there are fewer jobs being advertised today is that vacancies haven't and aren't opening up the way they used to.

But those guys won't work forever. Even the ones who sold off their portfolios at 6500 and shorted everything all the way back up are going to retire eventually.

Of course the wild cards here are what flavor of national healthcare we actually end up getting, and when/where the overall national debt spiral ends. I'm personally more worried about the latter.