Future anesthesia job market ?

[AngryBird69]

Fwiw, I do indeed apologize guys. My post was crudely composed and arrogant. FFP my apologies especially. You are a contributor to this forum whose posts I respect.

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[deleted171991]

I personally do not need any apologies, because I did not feel attacked at any point. I have my own angry moments and misjudgments.

I appreciate you trying to make amends. On this forum, we are mostly among friends, not adversaries.

 

[BLADEMDA]

With the numbers of MDs from American Medical Schools and DOs from Osteopathic schools increasing each year an IMG will have a tougher time matching into any ACGME residency program. This means that particular IMG will need BETTER grades/STEP Scores than his/her MD/DO peer attending school in the USA.
Thus, the IMG in your residency class may actually be more qualified than some of your other peers.

 

[BLADEMDA]

Despite record numbers of students applying to medical schools in 2012-2013 and enrolling this year, the United States still faces an impending physician shortage if Congress does not raise caps on residency funding, the Association of American Medical Colleges (AAMC) announced today.
Medical schools have done their part to expand enrollment, AAMC President and Chief Executive Officer Darrell Kirch, MD, said in a teleconference yesterday, and new medical schools have opened, making room for more students. Likewise, 48,014 students applied to medical school last year, with the number of first-time enrollees in US medical schools at an all-time high of 20,055.
"So the students have stepped up and done their part. The medical schools have responded quickly and with clarity, and now Congress needs to do its part and lift this 16-year-old ban on the number of training positions," Dr. Kirch said.
In 1997, as part of the Balanced Budget Act, the government limited Medicare funding of graduate medical education at 1996 levels for most teaching hospitals.
Today, teaching hospitals still face restrictions on their ability to develop or expand new programs, according to written workforce policy recommendations from the AAMC.

There are "roughly" 28,500 first-year residency positions, and graduates from US medical schools must compete for them with graduates from US osteopathic schools and foreign medical schools, many of whom are US citizens, as well as physicians from other countries.

"f things continue with the rate they are, at some point in the next 2 years it's likely that MDs will surpass the number of available [residency] slots," he said.

 

[BLADEMDA]

The most competitive specialties were Neurological Surgery, Orthopedic Surgery, Otolaryngology, Plastic Surgery, and Radiation-Oncology, specialties that offered at least 50 positions in the Match and filled at least 90 percent with U.S. seniors.
Applicants who did not match to a residency position participate in the NRMP Supplemental Offer and Acceptance Program (SOAP). During SOAP, the NRMP makes available the locations of unfilled positions so that unmatched applicants can apply for them using the AAMC Electronic Residency Application Service® (ERAS). This year, 1,075 of the 1,181 unfilled positions were offered during SOAP.

 

[aneftp]

Despite record numbers of students applying to medical schools in 2012-2013 and enrolling this year, the United States still faces an impending physician shortage if Congress does not raise caps on residency funding, the Association of American Medical Colleges (AAMC) announced today.
Medical schools have done their part to expand enrollment, AAMC President and Chief Executive Officer Darrell Kirch, MD, said in a teleconference yesterday, and new medical schools have opened, making room for more students. Likewise, 48,014 students applied to medical school last year, with the number of first-time enrollees in US medical schools at an all-time high of 20,055.
"So the students have stepped up and done their part. The medical schools have responded quickly and with clarity, and now Congress needs to do its part and lift this 16-year-old ban on the number of training positions," Dr. Kirch said.
In 1997, as part of the Balanced Budget Act, the government limited Medicare funding of graduate medical education at 1996 levels for most teaching hospitals.
Today, teaching hospitals still face restrictions on their ability to develop or expand new programs, according to written workforce policy recommendations from the AAMC.

There are "roughly" 28,500 first-year residency positions, and graduates from US medical schools must compete for them with graduates from US osteopathic schools and foreign medical schools, many of whom are US citizens, as well as physicians from other countries.

"f things continue with the rate they are, at some point in the next 2 years it's likely that MDs will surpass the number of available [residency] slots," he said.

48k apps for 20k slots?

That ain't competitive. My year 1995. Entering class of 1996. Had 45-46k applications for 15k slots. 1995 was the most competitive year. Than the internet boom happen and applications nose dived to around 32k applications for 16k slots.

 

[deleted171991]

I concur. Five-10 applicants/slot... that would be competitive.

 

[BLADEMDA]

45,266 students applied to attend allopathic (MD) medical school in 2012, an increase of 3.1%. First-time applicants set another record, increasing by 3.4% in 2012, for a total of 33,772 applicants. First-time enrollment at allopathic medical schools nationwide grew 1.5% to 19,517 students, an all-time high. All major racial and ethnic groups saw increases in applicants and matriculants.

 

[deleted171991]

All of this shows that some of the really smart kids are beginning to look elsewhere. As they should.

 

[BLADEMDA]

I concur. Five-10 applicants/slot... that would be competitive.

The most competitive specialties were Neurological Surgery, Orthopedic Surgery, Otolaryngology, Plastic Surgery, and Radiation-Oncology,
And of course DERM.

Want Competition? Try to get a Residency in one of those specialties. These days it isn't getting med school as much as LANDING that coveted Residency position.

 

[Yo GabbaPentin]

Back when I applied, there were 100 Ivy League med students auditioning in American idol type interviews just to get on the waiting list! And I walked to work up hill both ways through the ghetto!

Who cares what's competitive. Do what makes you happy. As FFP mentioned... Happiness is way underrated. I'd rather smile on my way to work driving my KIA than think of ways to even find any time to kill myself driving my neurosurgeon funded Audi R8. Q3 call is ok in your 20s but becomes not cool after a while.

 

[BLADEMDA]

Back when I applied, there were 100 Ivy League med students auditioning in American idol type interviews just to get on the waiting list! And I walked to work up hill both ways through the ghetto!

Who cares what's competitive. Do what makes you happy. As FFP mentioned... Happiness is way underrated. I'd rather smile on my way to work driving my KIA than think of ways to even find any time to kill myself driving my neurosurgeon funded Audi R8. Q3 call is ok in your 20s but becomes not cool after a while.

Have you ever driven an R8? You may change your mind. FYI, I know quite a few Neurosurgeons who work LESS than Anesthesiologists per week while earning double the pay.

 

[aneftp]

Have you ever driven an R8? You may change your mind. FYI, I know quite a few Neurosurgeons who work LESS than Anesthesiologists per week while earning double the pay.

I know. My buddy anesthesia from Texas has hit some hard times recently.

He recently had to downgrade to to an Audi r8 spyder from his yellow Lamborghini.

Incomes are going down in anesthesia market. He used to make $800k. Now down to around 450-500k.

 

[Laryngophed]

Have you ever driven an R8? You may change your mind. FYI, I know quite a few Neurosurgeons who work LESS than Anesthesiologists per week while earning double the pay.

It is my understanding that a lot of spine pays so well because each level is a different procedure and may be billed as such. (If this is wrong, please correct me and fill me in with the right info.) But assuming that is true, if payors start deciding that is crap, wouldn't you expect a nosedive in those salaries*.

*I seem to remember you mentioning you had some buddies that do spine that have a great life, including pay, call schedule, owning the ASC, etc.

 

[Yo GabbaPentin]

Have you ever driven an R8? You may change your mind. FYI, I know quite a few Neurosurgeons who work LESS than Anesthesiologists per week while earning double the pay.

I understand (and agree with) your general point. Med students should do some serious research into other specialties if they ever hope to see the inside of an R8. Anesthesia likely will not get them there. There are definitely more promising specialties out there financially speaking. The real question is which specialties? In our current system, CMS can destroy a specialty with the stoke of a pen. All of a sudden colonoscopies could reimburse $30 and suddenly there is no more GI competition. Looking into my crystal ball, I foresee a two tiered system. You will have your free obamacare/hilarycare/billmaher-care and then you will have cash. IMO, the specialties who are set up to succeed are the ones that patients are willing to pay cash for. Derm, Plastics, Pain, etc.

And no, I have not been in an R8 and I don't want to. I'm good with my Honda and boglehead philosophies!

"The things you own end up owning you." -Tyler Durden

 

[IanMcGalt]

I understand (and agree with) your general point. Med students should do some serious research into other specialties if they ever hope to see the inside of an R8. Anesthesia likely will not get them there. There are definitely more promising specialties out there financially speaking. The real question is which specialties? In our current system, CMS can destroy a specialty with the stoke of a pen. All of a sudden colonoscopies could reimburse $30 and suddenly there is no more GI competition. Looking into my crystal ball, I foresee a two tiered system. You will have your free obamacare/hilarycare/billmaher-care and then you will have cash. IMO, the specialties who are set up to succeed are the ones that patients are willing to pay cash for. Derm, Plastics, Pain, etc.

And no, I have not been in an R8 and I don't want to. I'm good with my Honda and boglehead philosophies!

"The things you own end up owning you." -Tyler Durden

I think most derm patients could see a family practice doc and would do so if they had to pay cash.

The only viable cash specialties I can imagine working out are plastics, rich people psych, and MFM.

 

[deleted126335]

Despite record numbers of students applying to medical schools in 2012-2013 and enrolling this year, the United States still faces an impending physician shortage if Congress does not raise caps on residency funding, the Association of American Medical Colleges (AAMC) announced today.
Medical schools have done their part to expand enrollment, AAMC President and Chief Executive Officer Darrell Kirch, MD, said in a teleconference yesterday, and new medical schools have opened, making room for more students. Likewise, 48,014 students applied to medical school last year, with the number of first-time enrollees in US medical schools at an all-time high of 20,055.
"So the students have stepped up and done their part. The medical schools have responded quickly and with clarity, and now Congress needs to do its part and lift this 16-year-old ban on the number of training positions," Dr. Kirch said.
In 1997, as part of the Balanced Budget Act, the government limited Medicare funding of graduate medical education at 1996 levels for most teaching hospitals.
Today, teaching hospitals still face restrictions on their ability to develop or expand new programs, according to written workforce policy recommendations from the AAMC.

There are "roughly" 28,500 first-year residency positions, and graduates from US medical schools must compete for them with graduates from US osteopathic schools and foreign medical schools, many of whom are US citizens, as well as physicians from other countries.

"f things continue with the rate they are, at some point in the next 2 years it's likely that MDs will surpass the number of available [residency] slots," he said.

You can be sure that any increase in funding for positions will be targeted at "needed" specialties such as primary care.

 

[BLADEMDA]

I understand (and agree with) your general point. Med students should do some serious research into other specialties if they ever hope to see the inside of an R8. Anesthesia likely will not get them there. There are definitely more promising specialties out there financially speaking. The real question is which specialties? In our current system, CMS can destroy a specialty with the stoke of a pen. All of a sudden colonoscopies could reimburse $30 and suddenly there is no more GI competition. Looking into my crystal ball, I foresee a two tiered system. You will have your free obamacare/hilarycare/billmaher-care and then you will have cash. IMO, the specialties who are set up to succeed are the ones that patients are willing to pay cash for. Derm, Plastics, Pain, etc.

And no, I have not been in an R8 and I don't want to. I'm good with my Honda and boglehead philosophies!

"The things you own end up owning you." -Tyler Durden

CMS doesn't need to "destroy" any particular specialty. Instead, they announce UNIVERSAL MEDICARE COVERAGE for all on the exchanges. Thus, you either sign up for Medicaid (free), heavily discounted/subsidized Medicare or PRICEY private insurance on the exchange. Employers will begin to dump all employees into the exchanges for MEDICARE. Only the top 1-2% can afford to keep the private insurance.

CMS then freezes all Physician reimbursement at current rates while allowing Primary Care a 3% annual increase. This is the most likely scenario as health care costs rise and the GOP resists a Canadian style system. All it takes is adding MEDICARE to the exchange for my scenario to take place. A Clinton Victory in 2016 will likely see that subject on her agenda.

So, Med Students simply need to evaluate CMS reimbursement in their specialties and ask "can I live on that reimbursement from the government"? For Anesthesiologists doing their own cases this would be about $175,000 per year based on 100% Medicare at 40 hours per week. Most other specialties are cut about 15% from today's income levels.

Gi Docs and Neurosurgeons will still be driving their Audi R8s and eating Caviar while you sit in your Honda at the Wendy's drive-thru.

That said, Med Students are an Altruistic bunch so I'm certain this won't impact their decision to choose Anesthesiology one bit. After all, why live like a Millionaire after Med School/Residency when you can be middle class.

 

[BLADEMDA]

It is my understanding that a lot of spine pays so well because each level is a different procedure and may be billed as such. (If this is wrong, please correct me and fill me in with the right info.) But assuming that is true, if payors start deciding that is crap, wouldn't you expect a nosedive in those salaries*.

*I seem to remember you mentioning you had some buddies that do spine that have a great life, including pay, call schedule, owning the ASC, etc.

Yes. As an Anesthesiologist in 2019 you have a better chance of winning the lottery than owning a share in an ASC. That isn't the case with some other specialties as they try and recruit you to bring patients to the ASC.

Gi Docs and Neurosurgeons can easily earn DOUBLE the income of an Anesthesiologist and take less call along with working fewer hours. The future of the other specialties are brighter than Anesthesiology as the USA move to a CMS for everyone system.

 

[BLADEMDA]

I agree that your career choice isn't 100% about money but income matters to a med student $280K in debt. If you are debt free, want a mommy track job and have a spouse earning $100K or more Anesthesiology is a great choice. But, if you have the idea of living the American Dream after Residency I need to caution you that Anesthesiology may not get you there.

Many seasoned Attendings on this board know that the future economic climate of Anesthesiology doesn't look very good. I doubt any new Administration will change the outlook. Instead, live modestly and pay off your debt.

 

[BLADEMDA]

http://www.daveramsey.com/show/videos/student-loans-are-stupid

Worth 5 minutes of your time.

 

[Pooh & Annie]

In my own opinion, it is at the very least distasteful, and more accurately slimy as hell to go into medicine to buy into a business and/or be a millionaire. These businesses usually have absolutely embarrassing conflicts of interest, and the millionaire attitudes are a minority, but unfortunately very visible to the lay public.

Everyone's obviously entitled to their opinion. Mine is that if your goal on life is to live like a rich king, you're shallow and don't understand what life is really about. If you go into a profession to improve other people's lives and still aren't happy unless you're a millionaire, you're not a psychosocially healthy person.

Yes I'm judgemental but god I'm sick of hearing the bitching about not making 800k.

 

[BLADEMDA]

In my own opinion, it is at the very least distasteful, and more accurately slimy as hell to go into medicine to buy into a business and/or be a millionaire. These businesses usually have absolutely embarrassing conflicts of interest, and the millionaire attitudes are a minority, but unfortunately very visible to the lay public.

Everyone's obviously entitled to their opinion. Mine is that if your goal on life is to live like a rich king, you're shallow and don't understand what life is really about. If you go into a profession to improve other people's lives and still aren't happy unless you're a millionaire, you're not a psychosocially healthy person.

Yes I'm judgemental but god I'm sick of hearing the bitching about not making 800k.

Med Students deserve to know the facts. It is about making an informed decision. Money is only one aspect of a career decision but it is an important one. Do you think it is a coincidence that the highest paying specialties are the most difficult ones to match into? I am not advocating a student choose his/her career based solely on income but ignoring the debt load from med school when deciding upon a specialty is naïve.

Med Students who choose Pediatrics, Family Medicine, General Internal Medicine do so with an understanding that they won't be getting rich. Shouldn't students entering this field be given that same speech as it regards Anesthesiology income circa 2019?

The bottom line is manage your expectations as CMS does not value anesthesia services.

 

[Yo GabbaPentin]

I'm not saying it's right to settle for middle class. But honestly what other choice do we have? Our professional societies care more about making $$ off of us (ie MOC) than they do about protecting/helping us. As we have no serious money to spend in Washington, we don't even have a fighting chance at any legislative victories. Getting upset/depressed about it doesn't help me any. I've trained myself to accept and enjoy middle class lifestyle while hoping/fighting for more.

Regarding the "safest" specialties, this is where I just don't think GI, Neurosurg, etc are safe. You can't base it on current CMS reimbursement because they continue to cut that year after year. For example cardiology and pain. They cut epidural steroid injections by 60% and obliterated spinal cord stim reimbursement this year. Just because they can. Who is to say that next year they don't go after ortho or neuro surg? There is no money in the system and physicians are easy targets. They will nail one of these "safe" specialties in the near future because the "safe" specialties are where the money currently is. I'm actually one of very few who is bullish on FP. They have a very good thing going with the cash based membership programs and a quality physician will do well with that. Not only that but they can actually get to be a physician without government and insurance company interference.

My main point was to pick the specialty you enjoy and hope that the rest pans out. Picking a specialty based on future income is like trying to time the market. You might get lucky but you may not and then end up hating life.

 

[BLADEMDA]

In my own opinion, it is at the very least distasteful, and more accurately slimy as hell to go into medicine to buy into a business and/or be a millionaire. These businesses usually have absolutely embarrassing conflicts of interest, and the millionaire attitudes are a minority, but unfortunately very visible to the lay public.

Everyone's obviously entitled to their opinion. Mine is that if your goal on life is to live like a rich king, you're shallow and don't understand what life is really about. If you go into a profession to improve other people's lives and still aren't happy unless you're a millionaire, you're not a psychosocially healthy person.

Yes I'm judgemental but god I'm sick of hearing the bitching about not making 800k.

The majority of surgeons in my area (80 percent plus) bring their best paying patients to the ASC which they own. By your definition they are "slimy as hell." But, by my definition they are good business people and multi-millionaires.

 

[Yo GabbaPentin]

Blade you are right. Med students need to understand that CMS places little to no value on anesthesia services. With the scenario you describe, anesthesia will quickly be sent back to the dark ages (1990s). Even if the third party insurance just decides to place their rates similar to medicare, there would be drastic pay cuts. Hopefully the pendulum would swing back around though.

 

[BLADEMDA]

I'm not saying it's right to settle for middle class. But honestly what other choice do we have? Our professional societies care more about making $$ off of us (ie MOC) than they do about protecting/helping us. As we have no serious money to spend in Washington, we don't even have a fighting chance at any legislative victories. Getting upset/depressed about it doesn't help me any. I've trained myself to accept and enjoy middle class lifestyle while hoping/fighting for more.

Regarding the "safest" specialties, this is where I just don't think GI, Neurosurg, etc are safe. You can't base it on current CMS reimbursement because they continue to cut that year after year. For example cardiology and pain. They cut epidural steroid injections by 60% and obliterated spinal cord stim reimbursement this year. Just because they can. Who is to say that next year they don't go after ortho or neuro surg? There is no money in the system and physicians are easy targets. They will nail one of these "safe" specialties in the near future because the "safe" specialties are where the money currently is. I'm actually one of very few who is bullish on FP. They have a very good thing going with the cash based membership programs and a quality physician will do well with that. Not only that but they can actually get to be a physician without government and insurance company interference.

My main point was to pick the specialty you enjoy and hope that the rest pans out. Picking a specialty based on future income is like trying to time the market. You might get lucky but you may not and then end up hating life.

If you think CMS will cut Neurosurgery and Ortho to FP levels you are sadly mistaken. There are specialties which will weather the CMS storm much better than others.
Anesthesia is not one of them. Of course, you shouldn't choose a specialty based solely on income but the fact remains Anesthesia is already DEVALUED by CMS and no further cuts are necessary or even sustainable.

 

[msmith83]

Is there currently a rush to Pain Management? Or a foreseeable one? Just from clerkships I have noticed many people having to pay cash (and willing to do so) to go to their pain doc.

 

[BLADEMDA]

Is there currently a rush to Pain Management? Or a foreseeable one? Just from clerkships I have noticed many people having to pay cash (and willing to do so) to go to their pain doc.

Pain Management is an excellent career choice if you like the field. As a Physician you have the right to control the amount of CMS which you see in your office. This means you can work a bit less and see fewer CMS patients unwilling to pay cash (you opt out of medicare).

 

[Yo GabbaPentin]

If you think CMS will cut Neurosurgery and Ortho to FP levels you are sadly mistaken. There are specialties which will weather the CMS storm much better than others.
Anesthesia is not one of them. Of course, you shouldn't choose a specialty based solely on income but the fact remains Anesthesia is already DEVALUED by CMS and no further cuts are necessary or even sustainable.

I didn't say to FP levels. I just said that they aren't safe. Would being a neurosurgeon with tons of call be worth 300k per yr after a decade of residency? Hell no. But if CMS/insurance sets the bar there then what can they do? The best options IMO are to find ways to avoid CMS/insurance completely in the future. Obviously that is not possible with a lot of specialties, including anesthesia.

 

[Yo GabbaPentin]

Pain Management is an excellent career choice if you like the field. As a Physician you have the right to control the amount of CMS which you see in your office. This means you can work a bit less and see fewer CMS patients unwilling to pay cash (you opt out of medicare).

THAT is exactly where I was going. For strictly financial reasons, I think that those who are able to opt out will be in the best position. That doesn't mean it's viable now, but in the future that may be where it goes.

 

[Yo GabbaPentin]

Is there currently a rush to Pain Management? Or a foreseeable one? Just from clerkships I have noticed many people having to pay cash (and willing to do so) to go to their pain doc.

It's not there yet but with CMS cuts it could get there.

 

[BLADEMDA]

Please take a look at these figures:

Average cost of a Medical School Education in 2013:

Public: $218,898
Private: $286,806


These numbers are still going up by about 2-5% per year. In a few years the average cost will exceed $300K for 4 years of med school. But, these young graduates are supposed to seek jobs paying $175K per year? When you factor in College costs ($100K) a student could have $400K in debt to become a Physician. If money doesn't matter how is he/she supposed to pay that debt back and have a nice lifestyle?

 

[Yo GabbaPentin]

My med school was $120k. With living expenses and interest, my loan total was about $300k. I'd venture to guess that with 300k in tuition alone that the total would be half a million by the time someone would get the bill.

 

[Postictal Raiden]

My med school was $120k. With living expenses and interest, my loan total was about $300k. I'd venture to guess that with 300k in tuition alone that the total would be half a million by the time someone would get the bill.

This will be me, but that also includes my and my wife's undergrad cost. However this is the amount I will owe after med school not after residency because the amount will grow by 30k every year I'm in residency.

I'm hoping for governmental income based repayment options to remain an option. I also hope that the average starting salaries to keep up with inflation.

 

[sleepallday]

I think most derm patients could see a family practice doc and would do so if they had to pay cash.

The only viable cash specialties I can imagine working out are plastics, rich people psych, and MFM.

+1 on the psych. I know from personal experience, that if you make a name for yourself, you can set up a very lucrative cash only practice. (even if you're an IMG) No coding, billing, or insurance companies to deal with.

 

[Baller MD]

In my own opinion, it is at the very least distasteful, and more accurately slimy as hell to go into medicine to buy into a business and/or be a millionaire. These businesses usually have absolutely embarrassing conflicts of interest, and the millionaire attitudes are a minority, but unfortunately very visible to the lay public.

Everyone's obviously entitled to their opinion. Mine is that if your goal on life is to live like a rich king, you're shallow and don't understand what life is really about. If you go into a profession to improve other people's lives and still aren't happy unless you're a millionaire, you're not a psychosocially healthy person.

Yes I'm judgemental but god I'm sick of hearing the bitching about not making 800k.

Most current students like myself care about the future earnings in medicine because they'll have 300k-400k in student loans when it is all said and done, likely more if you consider interest.

If wanting to pay off my student loans and start a family, buy a home, or what have you (you know, the "middle-class" American dream), makes me greedy then so be it.

Also, I don't think any anesthesiologist on this board is expecting to make 800k per year. It seems that most are fine with the current 400k/year and are just hoping it doesn't continue to get cuts.

 

[Baller MD]

My med school was $120k. With living expenses and interest, my loan total was about $300k. I'd venture to guess that with 300k in tuition alone that the total would be half a million by the time someone would get the bill.

My student loans by the time I graduate will be at least 350k. I wouldn't be surprised if it'll reach 500k by the time I'm done with residency, depending on the specialty I choose.

 

[bronx43]

If you think CMS will cut Neurosurgery and Ortho to FP levels you are sadly mistaken. There are specialties which will weather the CMS storm much better than others.
Anesthesia is not one of them. Of course, you shouldn't choose a specialty based solely on income but the fact remains Anesthesia is already DEVALUED by CMS and no further cuts are necessary or even sustainable.

You keep saying that about neurosurgery, ortho, etc, but you never support your position. There's no reason these surgical sub-specialties are going to be untouched going forward. Keep in mind general surgeons were king just a few decades ago. Now, they get shat on by the likes of ENT, uro, plastics, etc. NO ONE is safe - no one. They may not make FM money, but they don't work 9-5 either. Even pain medicine or other pay-out-of-pocket fields will feel the pain, because there aren't enough people out there able to pay handsomely out of pocket for everyone to get theirs. There may be a select few who have made a name for themselves in a wealthy community that will fare well, but everyone else will be scrapping for the leftovers.

 

[mja75]

With a 31.6% increase in residency positions since 2009, I dont care what shortages the govt is projecting now, we're going to run into a wall of unemployed anesthesiologists.

"Other fields that are highly sought after have kept the number of residency positions level or even decreased despite the clamoring for spots. Dermatology went from 31 in 2010 to just 20 this year, making it even more desirable like a rare commodity. Neurosurgery went from 191 five years ago to 206 today, a barely perceptible increase of 7.9%. Orthopedics stayed fairly stable from 656 to 695, or 5.9%. What did anesthesiology department heads do? They increased the number of positions available by 31.6% in five years. That rate of growth is clearly not sustainable and will take time to absorb." - http://www.blog.greatzs.com/

Credit to FFP for posting about anesthesiology blogs. I like this Great Z's one.

 

[deleted171991]

That's my favorite, too.

 

[Baller MD]

You keep saying that about neurosurgery, ortho, etc, but you never support your position. There's no reason these surgical sub-specialties are going to be untouched going forward. Keep in mind general surgeons were king just a few decades ago. Now, they get shat on by the likes of ENT, uro, plastics, etc. NO ONE is safe - no one. They may not make FM money, but they don't work 9-5 either. Even pain medicine or other pay-out-of-pocket fields will feel the pain, because there aren't enough people out there able to pay handsomely out of pocket for everyone to get theirs. There may be a select few who have made a name for themselves in a wealthy community that will fare well, but everyone else will be scrapping for the leftovers.

Have you looked at the supply of surgical sub-specialties vs anesthesia? Yeah...

 

[bronx43]

Have you looked at the supply of surgical sub-specialties vs anesthesia? Yeah...

This isn't about anesthesia vs [blank]. It's about payment models and rates.

 

[BLADEMDA]

"Other fields that are highly sought after have kept the number of residency positions level or even decreased despite the clamoring for spots. Dermatology went from 31 in 2010 to just 20 this year, making it even more desirable like a rare commodity. Neurosurgery went from 191 five years ago to 206 today, a barely perceptible increase of 7.9%. Orthopedics stayed fairly stable from 656 to 695, or 5.9%. What did anesthesiology department heads do? They increased the number of positions available by 31.6% in five years. That rate of growth is clearly not sustainable and will take time to absorb." - http://www.blog.greatzs.com/

These new graduates will drive starting salaries down even further. AMCs will exploit the newly inflated numbers by offering lower salaries. Fellowship positions will become sought after in even greater numbers.

The biggest threat facing Anesthesiology in the near future is our own organization. Leadership needs to curtail residency slots by 50% and transfer these ACGME positions to Family practice or Internal Medicine. Instead, open AA programs and staff the O.R.s using the same 4:1 model (or 3:1 for academics) like AMCS use in the real world.

If our leadership cut positions by 50% I would highly recommend this field to med students.

 

[BLADEMDA]

This isn't about anesthesia vs [blank]. It's about payment models and rates.

We are the lowest reimbursed specialty in the USA when comparing CMS vs Private Insurance.

 

[BLADEMDA]

You keep saying that about neurosurgery, ortho, etc, but you never support your position. There's no reason these surgical sub-specialties are going to be untouched going forward. Keep in mind general surgeons were king just a few decades ago. Now, they get shat on by the likes of ENT, uro, plastics, etc. NO ONE is safe - no one. They may not make FM money, but they don't work 9-5 either. Even pain medicine or other pay-out-of-pocket fields will feel the pain, because there aren't enough people out there able to pay handsomely out of pocket for everyone to get theirs. There may be a select few who have made a name for themselves in a wealthy community that will fare well, but everyone else will be scrapping for the leftovers.

Everyone gets cut. Everyone. The problem is Anesthesiology will get cut on an already ridiculously low number unlike Gi or Neurosurgery. The cut may result in only a CRNA being able to do CMS cases solo. A subsidy would be required by employers or AMCs in order to pay an Anesthesiologist's salary for supervision of 4:1 if CMS was the sole payer in the USA. In fact, the subsidy would amount to the salaries and benefits of all the Anesthesiologists on staff as the CMS payment would only cover CRNA costs.

There is real risk to the field becoming extinct if CMS becomes the only payer in the USA.

 

[Doctorbob1485]

"Other fields that are highly sought after have kept the number of residency positions level or even decreased despite the clamoring for spots. Dermatology went from 31 in 2010 to just 20 this year, making it even more desirable like a rare commodity. Neurosurgery went from 191 five years ago to 206 today, a barely perceptible increase of 7.9%. Orthopedics stayed fairly stable from 656 to 695, or 5.9%. What did anesthesiology department heads do? They increased the number of positions available by 31.6% in five years. That rate of growth is clearly not sustainable and will take time to absorb." - http://www.blog.greatzs.com/

These new graduates will drive starting salaries down even further. AMCs will exploit the newly inflated numbers by offering lower salaries. Fellowship positions will become sought after in even greater numbers.

The biggest threat facing Anesthesiology in the near future is our own organization. Leadership needs to curtail residency slots by 50% and transfer these ACGME positions to Family practice or Internal Medicine. Instead, open AA programs and staff the O.R.s using the same 4:1 model (or 3:1 for academics) like AMCS use in the real world.

If our leadership cut positions by 50% I would highly recommend this field to med students.

Aren't some of these inflated numbers due to the requirement that all residency slots had to be filled through the NRMP Match rather then filling positions after the match? Would that make it seem as though positions are increasing every year even though they really are not?

 

[BLADEMDA]

http://residency.wustl.edu/CHOOSING/SPECDESC/Pages/Anesthesiology.aspx

 

[BLADEMDA]

Aren't some of these inflated numbers due to the requirement that all residency slots had to be filled through the NRMP Match rather then filling positions after the match? Would that make it seem as though positions are increasing every year even though they really are not?

The numbers are increasing from 2010. This year the total is very similar to 2013. There has been a huge increase though over the past 4 years.

2014 1662 positions
2013- 1653 positions
2012- 1476
2011-1404
2010-1355

______
2009 1394
2008 1364
2007 1338
2006 1311
2005 1283

2005-2009 data may not include another group of Residents who switched into anesthesiology. However, that number has usually been around 50-80 per year.


http://www.nrmp.org/2014-nrmp-main-residency-match-results/

 

[BLADEMDA]

The numbers are increasing from 2009. This year the total is very similar to 2013. There has been a huge increase though over the past 5 years.

2014 1662 positions
2013- 1653 positions
2012- 1476
2011-1404
2010-1355

______
2009 1394
2008 1364
2007 1338
2006 1311
2005 1283

2005-2009 data may not include another group of Residents who switched into anesthesiology. However, that number has usually been around 50-80 per year.


http://www.nrmp.org/2014-nrmp-main-residency-match-results/

What we need is decrease to a total of 1,000 per year from 1662. You will thank me later for your better job as a result.