Future anesthesia job market ?

[criticalelement]

"funaswc, post: 17093723, member: 444089", I will always be happy with the speciality I've chosen..

1) How can you tell the future? Do you know how many married people who say I will always be happy with my choice of spouse on their wedding day? All of 'em.
2) You are a resident so you are not the best person to speak of the current state of anesthesiology
3) You are a tool .
4) You too will be regretting you choice once you get into the thick of things.

---

Members don't see this ad.

 

[ERRES2288]

If somebody's been making 500k their entire career, then it IS their reality. They are completely in touch with reality. And you are speaking in some future projected fantasy of how you will be. If you are generating 500k/year and getting 300 of it and getting nothing else in return, it is soul-sucking to say the least. If you are getting 1mil/year but generating 2, same thing. You sound like someone who has never forked over a **** ton of $$$ to the man. It always sucks to get ripped off, no matter how much you're making. And we are all gonna get ripped off.

Agree with everything said here. My point is comparing the job of a 300k physican to a 120k middle management job is laughable.

 

[Stank811]

The majority of the doom and gloom posters in this forum work for an AMC...so they want to sell you on the fact that anesthesia is a dying field and expect to make 200-300k bc that is what they want to pay you. Crnas are taking over etc. It is all regional but the overall health of anesthesia is fine. Look at the recent RAND study in Anesthesiology....even with states opting out there has been a decrease in independent CRNA practice and only a slight uptick in supervision...with the majority of us doing our own cases. The only way we make less in the future is if we allow others to skim off the top...so that is up to each individual's situation if they want to work in that environment.

 

[TeslaCoil]

The majority of the doom and gloom posters in this forum work for an AMC...so they want to sell you on the fact that anesthesia is a dying field and expect to make 200-300k bc that is what they want to pay you. Crnas are taking over etc. It is all regional but the overall health of anesthesia is fine. Look at the recent RAND study in Anesthesiology....even with states opting out there has been a decrease in independent CRNA practice and only a slight uptick in supervision...with the majority of us doing our own cases. The only way we make less in the future is if we allow others to skim off the top...so that is up to each individual's situation if they want to work in that environment.

Sounds more credible to me...

 

[deleted171991]

1) How can you tell the future? Do you know how many married people who say I will always be happy with my choice of spouse on their wedding day? All of 'em.
2) You are a resident so you are not the best person to speak of the current state of anesthesiology
3) You are a tool .
4) You too will be regretting you choice once you get into the thick of things.

Love the part about the wedding day.

I remember how excited I was the day I matched. I also remember putting up with all the malignancies of my residency, by focusing on the future. Then, when the future arrived, and I became a body and a tool, I would have gone back in time and slapped my younger self over the head. What was I thinking, especially when I minimized the crna danger in one of my interview answers? But there is no undo button.

This is a beautiful specialty, especially if one combines with critical care. Anybody who loves physiology and pharmacology will enjoy her job. But so do many other people in other professions, or specialties. As for everything, one should look not just at the income, but also at other factors. I would rather have a guaranteed pension of 50k for the rest of my life, than die of heart attack at age 50 while making 350k. The income/stress ratio is much lower in anesthesia than in other jobs. Same goes for the income/malpractice risks ratio. Or the income/lifestyle sacrifices. Look at the big picture, pros/cons columns.

As funny as it seems, just by switching to CCM I lowered my stress level by a factor of 3-5, even if the hours are longer. Most employed anesthesiologist intensivists will rather give up anesthesia time, not CCM. Despite the fact that, even in the sicu, many surgeons treat you like their servant, not a prized consultant. It's still better than the OR. Is it better than other specialties? I would choose anesthesia for making me a very well-rounded physician, especially in the icu, but definitely not for almost anything else. I can run circles around nurse practitioners in the icu, and make a significant difference even as a fellow; as an anesthesia attending in the or, this only happens for the sick patients or complicated surgeries where I get to cover long procedures in only 2 rooms.

Relatively healthy patients and/or surgeries need a lot of effort to kill the patient nowadays. If I were to practice in the or only on the sick patients (while crnas get to do the easy cases practically solo), and for the same or less income per time-unit as in the icu, I should be nuts not to almost completely switch to CCM. And the more anesthesia will be executed by crnas, and the more 1:3+ coverage we'll have (which is already the norm), the more insignificant our contributions to the outcome (and hence our status) will become. And the higher our risks and stress level, because legally the buck will still stop with us. It is (becoming) a rat race one cannot get out of, for the simple reason that the anesthesia market is getting saturated, and the patients don't get to choose their "provider". And all the knowledge to become a good anesthesiologist is almost worthless outside of the or; the main thing anesthesia offers is a great foundation for CCM or palliative medicine.

I am happy for those who still have it good on this forum, but pretty soon they will be the exception, not the rule. This is not doom and gloom, just the clear trend for the last years.

 

[deleted444089]

Fair point on #'s 1, 2, and 4 and perhaps you're right.

However, I don't see the value of your derogatory comment or appreciate being called a tool for being positive about my career choice. Having served close to a decade in the military and working in international development before that, I'm not some 20-something typical resident with limited experience in the working world.

1) How can you tell the future? Do you know how many married people who say I will always be happy with my choice of spouse on their wedding day? All of 'em.
2) You are a resident so you are not the best person to speak of the current state of anesthesiology
3) You are a tool .
4) You too will be regretting you choice once you get into the thick of things.

 

[deleted171991]

Having served close to a decade in the military and working in international development before that, I'm not some 20-something typical resident with limited experience in the working world.

That means only that it's going to be harder for you to feel disrespected, when you would expect professional courtesy.

Since you are not a rainmaker, you are a tool. In most markets, it's tougher to hire a good nurse than a good anesthesiologist. So bean counters don't really give a crap about you, or your background. As an employee, expect to be treated exactly like a tool.

 

[TeslaCoil]

Oh boy... seems nobody is ever happy in life anymore... rich or poor, established or in disarray, secure or not. Although I have little fear about the future of anesthesia... its not going anywhere peeps. When my pay falls below what the average physician makes I'll start getting really pissed. Long as I dont have to fill out soap notes, or round on patients, or get called in on off days, I'm good.

 

[deleted171991]

In some academic places, some/many docs don't make much more than crnas, on an hourly basis. How do you feel about that?

 

[deleted444089]

Why would it be 'harder' for me to feel disrespected? It's actually pretty easy to laugh at the childishness of others' unprofessional behavior and continue on.

That means only that it's going to be harder for you to feel disrespected, when you would expect professional courtesy.

 

[deleted171991]

Why would it be 'harder' for me to feel disrespected? It's actually pretty easy to laugh at the childishness of others' unprofessional behavior and continue on.

You will find it about as funny as a captain who's being treated like a sergeant, by a lieutenant or lower.

If it's rare, one can ignore it. If it's regular, and it will be, one will not find it funny at all. You did not like even just being called a tool, what will you do when they will treat you like one?

 

[deleted444089]

None taken, don't worry.

And the fact that physicians make not much more than CRNA's in some academic institutions does suck for sure. Which ones specifically?

You are naïve, no offense. You will find it about as funny as a captain who's being treated like a sergeant, by a lieutenant or lower.

 

[deleted171991]

Average CRNA 150+ k for 40 hours/week.

Average assistant professor 280 k for 60+ hours (including calls) of much more stress and liability. AMCs/private groups pay better but with more call, so not much difference.

The market is tilted against us, and it will only get worse.

 

[IlDestriero]

Ok, so far I've seen a lot of talking and circular reasoning, but not one iota of actual hard proof for all the doom and gloom. And thats all I'm gonna say for now.

Here's the reason for doom and gloom, and why you don't understand. Students making no money think 300k is awesome. It is. Here comes the but...
Anesthesiologists that were making 5-600k in good private practices can now work harder with less autonomy and less vacation for management companies that pay 300 or so. They are now increasingly working for someone else and not getting the profits.
Here's a real life example. Good group mostly partners makes 600k covering 3:1, sometimes 2:1 for challenging cases, takes average 8-10 weeks vaca. Nice private practice benefits, 52k retirement, etc.
Group votes to sell out. Nice payday for partners.
New management company changes the plan, always 3:1 coverage, some 4:1 for outpatient GI, etc. they also pay 350 instead of 600. Oh and vacation is now 6 weeks. And great benefits are now gone with 401k instead, you pay 1/2 of healthcare, etc.
Oh and if that's not enough, they flex their weight with the insurance companies and are getting 20%+ more than you did for your insurance contracts.
So they're billing more than you ever did, while working everyone harder, with less vacation, and worse benefits, and no control. And for all that, you get a 40% pay cut over what the sell outs were making for less work last year. They get a fat slice of your pie and whisper sweet nothings in your ear while they apply some astroglide.
But hey, that 375 and 401k and 1/2 medical is awesome.

 

[deleted171991]

To add to @IlDestriero's excellent post, all of these come with the same malpractice liability, as in you are paying roulette with your family's future every day you work, and for what?

For you, a malpractice suit can be a career end; for your employer it's just a predicted and insured expense. It's the difference between being the driver in an accident and just owning the car.

This won't change until juries will start mostly punishing employers, not the supervising docs. When every mistake is a many million red number, the bean counters won't be as generous with the coverage ratios and patient (lack of) care.

Tl;dr Be a rainmaker, not a tool.

 

[TeslaCoil]

None taken, don't worry.

And the fact that physicians make not much more than CRNA's in some academic institutions does suck for sure. Which ones specifically?

Yes I'd like to know which ones specifically as well...

 

[TeslaCoil]

If these are legit concerns, how are they being addressed in the political arena? As a future anesthesiologist, how can I become proactive? Is there anything we can do?

 

[deleted171991]

Yes I'd like to know which ones specifically as well...

What you want to know is which ones pay better than that.

 

[IlDestriero]

What you want to know is which ones pay better than that.

Bingo.

 

[GA8314]

Almost every person I know of the baby boomer generation had/has it better than their younger contemporaries. This applies to anesthesiology as much as it does to the middle manager of a corporation, to a small business owner (of almost ANY type). While I don't like it and will fight for economic improvement (or avoidance of cuts), it is what it is.

Most of us younger folks get it. We really do. Everything the senior guys on here are saying resonates. But, wtf can we do? It's not like it's gravy train in any other sector. Indeed, I personally feel that the U.S. as a whole is entering a new economic reality. We are seeing it as well, but we are not alone.

Is this the end result of capitalism gone awry? I really don't know. Even firefighters don't have the same opportunities for security and pensions that their predecessors had. I really don't know of hardly any "industry" which is not effected to the downside, in general.

 

[BLADEMDA]

Oh boy... seems nobody is ever happy in life anymore... rich or poor, established or in disarray, secure or not. Although I have little fear about the future of anesthesia... its not going anywhere peeps. When my pay falls below what the average physician makes I'll start getting really pissed. Long as I dont have to fill out soap notes, or round on patients, or get called in on off days, I'm good.

1. I am pretty satisfied with my career choice; I've done quite well.
2. Former Partner with a group, now with an AMC- still happy with my career path as I have been well-compensated during my career.
3. Anesthesiology's pay is falling due to AMC/hospital based employment. That type of employment will be the norm.
4. Average Physician- unlikely to work as hard as an employee of the typical AMC so I hope you really do make above average pay.
5. Anesthesia providers- all of them-will be squeezed by CMS, AMCs, ACA, Bundled payments etc.
6. Try to land one of the sweet gigs in a real private practice even though they may only be 20% of the market circa 2020.

Finally, be realistic about your job vs family life. Academic gigs (which is another reason I recommend a fellowship) offer a better blend of money vs lifestyle compared to many AMC type jobs.

 

[BLADEMDA]

Almost every person I know of the baby boomer generation had/has it better than their younger contemporaries. This applies to anesthesiology as much as it does to the middle manager of a corporation, to a small business owner (of almost ANY type). While I don't like it and will fight for economic improvement (or avoidance of cuts), it is what it is.

Most of us younger folks get it. We really do. Everything the senior guys on here are saying resonates. But, wtf can we do? It's not like it's gravy train in any other sector. Indeed, I personally feel that the U.S. as a whole is entering a new economic reality. We are seeing it as well, but we are not alone.

Is this the end result of capitalism gone awry? I really don't know. Even firefighters don't have the same opportunities for security and pensions that their predecessors had. I really don't know of hardly any "industry" which is not effected to the downside, in general.

Good post. What you can do is seek out expertise in a subspecialty and find a nice job in anesthesia with decent hours vs the money. This means subspecialty certification in an area which elevates you above the average job applicant.

 

[BLADEMDA]

Here's the reason for doom and gloom, and why you don't understand. Students making no money think 300k is awesome. It is. Here comes the but...
Anesthesiologists that were making 5-600k in good private practices can now work harder with less autonomy and less vacation for management companies that pay 300 or so. They are now increasingly working for someone else and not getting the profits.
Here's a real life example. Good group mostly partners makes 600k covering 3:1, sometimes 2:1 for challenging cases, takes average 8-10 weeks vaca. Nice private practice benefits, 52k retirement, etc.
Group votes to sell out. Nice payday for partners.
New management company changes the plan, always 3:1 coverage, some 4:1 for outpatient GI, etc. they also pay 350 instead of 600. Oh and vacation is now 6 weeks. And great benefits are now gone with 401k instead, you pay 1/2 of healthcare, etc.
Oh and if that's not enough, they flex their weight with the insurance companies and are getting 20%+ more than you did for your insurance contracts.
So they're billing more than you ever did, while working everyone harder, with less vacation, and worse benefits, and no control. And for all that, you get a 40% pay cut over what the sell outs were making for less work last year. They get a fat slice of your pie and whisper sweet nothings in your ear while they apply some astroglide.
But hey, that 375 and 401k and 1/2 medical is awesome.

You pretty much nailed it with your post. FYI, at my gig they don't even have the courtesy to use the astroglide. Ouch.

 

[TeslaCoil]

I'm okay with 300k etc per year on a 60 hr work week. Sure. I also have an investment plan to bolster that. Long as it doesn't dip too far below that, I think I'll be pretty happy in life. And I wish the same for all other reasonable doctors. I think if anybody went into medicine to get rich they aren't making the best use of their time anyway. Not that you cant use medicine as a springboard to wealth, but there are much more efficient ways of going about it. In the meantime, it would be nice to hear what the senior attendings think we newcomers can do to to preserve the future of anesthesia? Anybody? Instead of just doom and gloom...?

 

[IlDestriero]

Well if you're happy working for someone else who skims your profits to the tune of 200k/yr, then you have nothing to worry about. Go find the biggest AMC and sign up. But just know that others are working less and making more. That should make you think twice. It's not like working as a cog in some big corporation that you couldn't survive without. Private practices have been their own bosses and controlled their own fate since the start of modern medical practice. Management companies are a modern plague and their function is to maximize profits off the sweat of your labor. They can't work without you doing the job, but you can work just fine without their slimy hand in your pocket.
I'll keep hiding out in my gig until single payer and bundled payments hand everyone a stool sandwich.

 

[TeslaCoil]

Still not a single suggestion as to a solution to the problem... are there any takers out there?

 

[TeslaCoil]

Here... I'll start a new thread...

 

[Carbocation1]

"The practice of anesthesia has changed dramatically since the days of John Snow. The modern anesthesiologist is now both a perioperative consultant and a primary deliverer of care to patients. In general, anesthesiologists manage nearly all “noncutting” aspects of the patient’s medical care in the immediate perioperative period. The “captain of the ship” doctrine, which held the surgeon responsible for every aspect of the patient’s perioperative care (including anesthesia), is no longer a valid notion when an anesthesiologist is present. The surgeon and anesthesiologist must function together as an effective team, and both are ultimately answerable to the patient rather than to each other."

Morgan & Mikhail's Clinical Anesthesiology, 5e

 

[Man o War]

Was there ever an abundance of jobs offering 600+k/year?

There are still plenty of jobs available for 500 plus, some approaching 600 with a decent lifestyle doing cardiac with TEE advanced certification. In decent sized cities too, not BFE.

 

[pjl]

Average CRNA 150+ k for 40 hours/week.

Average assistant professor 280 k for 60+ hours (including calls) of much more stress and liability. AMCs/private groups pay better but with more call, so not much difference.

The market is tilted against us, and it will only get worse.

150k/year with 6 weeks off is 81.5/hr.
Calculate that out with 1.5 pay for overtime, up to 60 hour week, same 6 weeks off.
=262k per year.

That means as an attending working 60 hours a week making 260k, you are making exactly the same per hour as your CRNA making 150k.
Think hard before you accept a substandard job in academics, if they really are paying 260k (or even 280k or whatever FFP quoted)

 

[BW15]

Well if you're happy working for someone else who skims your profits to the tune of 200k/yr, then you have nothing to worry about. Go find the biggest AMC and sign up. But just know that others are working less and making more. That should make you think twice. It's not like working as a cog in some big corporation that you couldn't survive without. Private practices have been their own bosses and controlled their own fate since the start of modern medical practice. Management companies are a modern plague and their function is to maximize profits off the sweat of your labor. They can't work without you doing the job, but you can work just fine without their slimy hand in your pocket.
I'll keep hiding out in my gig until single payer and bundled payments hand everyone a stool sandwich.

What do you recommend new grads do to avoid having someone else take some of our profits, what are the different options we have?

If we can't find a good private practice group to join, should we just work solo?

 

[deleted171991]

If we can't find a good private practice group to join, should we just work solo?

You can't. Not in this specialty.

 

[criticalelement]

What do you recommend new grads do to avoid having someone else take some of our profits, what are the different options we have?

If we can't find a good private practice group to join, should we just work solo?

1) YOU cant do anything. We can do stuff together. Boycott certain groups. If they cannot hire,.... well you get the picture
2) In this environment you wont survive solo. Maybe as a locum, but that is not truly solo.

 

[Consigliere]

No idea what you're on about... It looks pretty good from where I'm standing. People have been dooming and glooming over this subject for decades.

Look at those ads a little more closely...there may be one job which is posted by 4 or 5 agencies thereby leading the non-cognoscenti to believe there is a robust job market which is far, far from the truth. That plus everything Blade said.

 

[Consigliere]

Fair point on #'s 1, 2, and 4 and perhaps you're right.

However, I don't see the value of your derogatory comment or appreciate being called a tool for being positive about my career choice. Having served close to a decade in the military and working in international development before that, I'm not some 20-something typical resident with limited experience in the working world.

As Veteran's Day approaches, I'd like to say thank you for your service. That and lower your expectations about your career as an anesthesiologist. If you approach it recognizing that it is a joyless, soul sucking experience, you'll be fine. If you think you'll be jumping out of bed before the alarm goes off and whistling "Zip-A-Dee-Do-Dah" every day, disappointment awaits.

 

[scutdoc]

@TempleChairman has a recent post which seems to confirm a lot of what several attendings here have been saying for years (e.g. diminishing salaries, a future involving supervising CRNAs, hospital based specialties including anesthesia increasingly becoming employees, the PSH).

 

[Planktonmd]

"The practice of anesthesia has changed dramatically since the days of John Snow. The modern anesthesiologist is now both a perioperative consultant and a primary deliverer of care to patients. In general, anesthesiologists manage nearly all “noncutting” aspects of the patient’s medical care in the immediate perioperative period. The “captain of the ship” doctrine, which held the surgeon responsible for every aspect of the patient’s perioperative care (including anesthesia), is no longer a valid notion when an anesthesiologist is present. The surgeon and anesthesiologist must function together as an effective team, and both are ultimately answerable to the patient rather than to each other."

Morgan & Mikhail's Clinical Anesthesiology, 5e

They actually wrote that crap in a text book??? No wonder we have so many young people living in dream world!

 

[BLADEMDA]

@TempleChairman has a recent post which seems to confirm a lot of what several attendings here have been saying for years (e.g. diminishing salaries, a future involving supervising CRNAs, hospital based specialties including anesthesia increasingly becoming employees, the PSH).

Yes. "Employee model" of some sort is the future. Salary in the $300-$400K range after 3 years of experience plus Board Certification. Fellowship trained MDs can expect the higher end of that range ($400k) and better job opportunities (Cardiac, Peds, Pain, Critical Care).

 

[jl lin]

Wow. The current vote showing ~66% as unsure + no doesn't seem good to me.

 

[Mman]

Wow. The current vote showing ~66% as unsure + no doesn't seem good to me.

if you are using the poll results, I think it's crystal clear that nobody has any idea. Equal numbers say yes and no with a large group in the middle admitting they don't know.

You'll likely get the same results for all of medicine or just going to medical school in general. It isn't what it once was, but will still probably be OK in the end.

 

[deleted444089]

I don't expect to jump out of bed whistling a tune, but to ME (maybe not to you, and that's fine), it should be less of a soul sucking experience than primary care in the military. I'm sorry that you find the specialty 'joyless' and 'soul-sucking.' You know what's soul-sucking? Not seeing your kids for 6 months on deployment.

As Veteran's Day approaches, I'd like to say thank you for your service. That and lower your expectations about your career as an anesthesiologist. If you approach it recognizing that it is a joyless, soul sucking experience, you'll be fine. If you think you'll be jumping out of bed before the alarm goes off and whistling "Zip-A-Dee-Do-Dah" every day, disappointment awaits.

 

[Baller MD]

I don't expect to jump out of bed whistling a tune, but to ME (maybe not to you, and that's fine), it should be less of a soul sucking experience than primary care in the military. I'm sorry that you find the specialty 'joyless' and 'soul-sucking.' You know what's soul-sucking? Not seeing your kids for 6 months on deployment.

Different people have different thresholds for bull****.

 

[kazuma]

If you think you'll be jumping out of bed before the alarm goes off and whistling "Zip-A-Dee-Do-Dah" every day, disappointment awaits.

Maybe the newness will wear off, but for now I'm still whistling on the way to work most mornings. But then again, I do work in a magical place as stated previously by an SDN member.


Edit:sp

 

[pgg]

If you think you'll be jumping out of bed before the alarm goes off and whistling "Zip-A-Dee-Do-Dah" every day, disappointment awaits.

Nobody likes a whistler, particularly not the divinity that shapes our ends.


My day job is mostly enjoyable. It's still a job but I get satisfaction out of it, and I like almost all of the people I work with, surgeons included.

I moonlight a bit at a surgicenter where I'm a chart-signing preop monkey. The days drag on, forever. I'm often anxious about what the CRNAs might be doing in the OR while I'm on the consent assembly line. The money is good but it feels like work and I look at the clock about 75 times each day. I think I'm going to stop working there. I think if I worked there every day, I'd hate the world as much as you.

 

[Consigliere]

I'd hate the world as much as you.

I don't hate the world, just the fatal error in judgement in choosing anesthesiology as a career.

 

[Mman]

I don't hate the world, just the fatal error in judgement in choosing anesthesiology as a career.

There are things that are life and death (ask UTSouthwestern if he was still with us), choosing anesthesiology was not one.

 

[TeslaCoil]

I don't hate the world, just the fatal error in judgement in choosing anesthesiology as a career.

If you had to go back right now... What would you have done differently?

 

[IlDestriero]

If you had to go back right now... What would you have done differently?

I would have done Ortho.

 

[partydoc]

What's the deal with ortho? Why are they such a cash cow?

 

[pgg]

I would have done Ortho.

Again illustrating the difficulty of the what-if scenarios and advice that come up in these threads ...

We get a skewed view on SDN of applicants with 250 Step 1 scores, but the truth is that at least 80-90% of anesthesia residents in the country wouldn't have been competitive for an orthopedics or ENT spot, the two surgical specialties that get pointed to most often in these "best future" threads.


To any undecided med students reading this thread, if you're a brilliant top-10%-er, you have some great options.

If you're not a brilliant top-10%-er, and you can't do ortho or ENT, what then? You could do internal medicine, and THEN become brilliant and excel, and land a GI or cardiology fellowship. But we're back to the same basic advice: "be brilliant" and the world is your oyster.


I would humbly suggest that anyone who has the option of doing ortho probably also has the brains and drive to make a great career out of anesthesiology, even in this climate. The top 10% of anesthesiologists are going to do well for themselves, even in a gloomy world where 75% of anesthesiologists are hospital or AMC employees.

Telling the bottom 80% of would-be anesthesiologists that they should pick ortho instead is like telling a minor league baseball player that he should just go play football for the New England Patriots instead.