I think I'm starting to give in to the negativity on here...

[amLOLdipine]

Was 100% set on anesthesia. Then I started reading these forums. I think it's finally started to get to me.

Kinda bummed about this whole situation knowing that the specialty I enjoyed most is likely a dying one that I shouldn't go into.

Starting to consider medicine subspecialties more and more by the day...

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[Consigliere]

Great idea! It would be a damn shame to go through an anesthesiology residency only to discover that you would be making someone else (AMC, hospital) $600k while you were getting paid $225k.

 

[Consigliere]

And it's not negativity, it's reality.

 

[GravelRider]

You will likely be employed as a subspecialist as well...depending on where you practice. However, you still have more opportunity to make your own way in IM or IM subspecialties. If you specialize, you will stave off midlevel encroachment a bit more.

Practicing hands-on anesthesia is satisfying. However, you will most likely end up in a supervision role running around doing pre-ops. The business of anesthesia is extraordinarily frustrating and has ruined the field. IM is a better option if you must pursue clinical medicine.

 

[rakotomazoto]

If you have doubts, no shame in choosing another path. Best of luck and no matter what you choose, work hard and have a good attitude. Residency will have its challenges regardless of where you go and what you are doing.

 

[Man o War]

Hmmmm. Just make sure you pick something you like. Everyone thinks they have an accurate crystal ball.

 

[deleted547339]

All specialties have their warts. Not saying you should do anesthesia, just be aware there is no holy grail (save for derm???).

 

[Machinery]

Was 100% set on anesthesia. Then I started reading these forums. I think it's finally started to get to me.

Kinda bummed about this whole situation knowing that the specialty I enjoyed most is likely a dying one that I shouldn't go into.

Starting to consider medicine subspecialties more and more by the day...

If you do not like it, then don't do it. As for me, I will choose anesthesiology 1000 times over any medicine subspecialty. Yes 1000 times! By the way, surveys show half the people in most specialties are satisfied, which makes SDN the atypical sample. There are many anesthesiologists going about their day having a blast who probably will never spend time posting on SDN.

 

[lobelsteve]

All specialties have their warts. Not saying you should do anesthesia, just be aware there is no holy grail (save for derm???).

Derm. Warts. Funny.

 

[amLOLdipine]

If you do not like it, then don't do it. As for me, I will choose anesthesiology 1000 times over any medicine subspecialty. Yes 1000 times! By the way, surveys show half the people in most specialties are satisfied, which makes SDN the atypical sample. There are many anesthesiologists going about their day having a blast who probably will never spend time posting on SDN.

I do like anesthesia, I really do. At least, I like it in its current form, where the usual set-up is 1:3/1:4 supervision in an ACT model, 1:2 for academics, plenty of opportunities to do your own cases especially if you subspecialize, decent compensation, and overall decent lifestyle working 50-60 hr weeks. But I'm increasingly getting the feeling that this will not be the new reality 10 - 20 years from now with the midlevel onslaught that's occurring in many fields (but especially anesthesia).

Seeing CRNAs do ASA 3-4 cases on a daily basis (with no anesthesiologist to be seen) at a certain 2-lettered hospital network was an eye-opener for me. It's not hard to start second-guessing your future career plans when you're at a certain place for a few months and only see the anesthesiologist during the pre-op evals.

 

[BLADEMDA]

I do like anesthesia, I really do. At least, I like it in its current form, where the usual set-up is 1:3/1:4 supervision in an ACT model, 1:2 for academics, plenty of opportunities to do your own cases especially if you subspecialize, decent compensation, and overall decent lifestyle working 50-60 hr weeks. But I'm increasingly getting the feeling that this will not be the new reality 10 - 20 years from now with the midlevel onslaught that's occurring in many fields (but especially anesthesia).

Seeing CRNAs do ASA 3-4 cases on a daily basis (with no anesthesiologist to be seen) at a certain 2-lettered hospital network was an eye-opener for me. It's not hard to start second-guessing your future career plans when you're at a certain place for a few months and only see the anesthesiologist during the pre-op evals.

No Fellowship= No Career safety. Midlevels will never run the ICU, do high risk peds solo or run a busy Pain Practice in a primo location. Plus, how many midlevels will really be able to do TEE with advanced level certification?

That 2 lettered hospital system should be the eye opener that a standard residency without a fellowship is NOT playing the long game in Anesthesia. Others on SDN may claim "there is no long game" but I disagree because CRNAs are Nurses with limited skills and education meaning fellowship can give you the edge for a good job going forward.

 

[chocomorsel]

Was 100% set on anesthesia. Then I started reading these forums. I think it's finally started to get to me.

Kinda bummed about this whole situation knowing that the specialty I enjoyed most is likely a dying one that I shouldn't go into.

Starting to consider medicine subspecialties more and more by the day...

Hell, do neurology. Apparently you can make damn good money in that with a good lifestyle.
You are being smart. Call in anesthesia sucks.

 

[Machinery]

I do like anesthesia, I really do. At least, I like it in its current form, where the usual set-up is 1:3/1:4 supervision in an ACT model, 1:2 for academics, plenty of opportunities to do your own cases especially if you subspecialize, decent compensation, and overall decent lifestyle working 50-60 hr weeks. But I'm increasingly getting the feeling that this will not be the new reality 10 - 20 years from now with the midlevel onslaught that's occurring in many fields (but especially anesthesia).

Seeing CRNAs do ASA 3-4 cases on a daily basis (with no anesthesiologist to be seen) at a certain 2-lettered hospital network was an eye-opener for me. It's not hard to start second-guessing your future career plans when you're at a certain place for a few months and only see the anesthesiologist during the pre-op evals.

I will NEVER encourage anyone hesitant about anesthesia to go into anesthesia. For one thing, that will be yet another person complaining about job dissatisfaction 10 years down the line while doing nothing to help the profession. On the flip side, I will NEVER discourage anyone excited about the field from going into it.

 

[Machinery]

Hell, do neurology. Apparently you can make damn good money in that with a good lifestyle.
You are being smart. Call in anesthesia sucks.

lol part of our problems is 'options'. Most physician gigs are actually pretty good until you start micro-comparisons. It's kinda like picking a spouse, if you fixate on your vast options, no one will ever measure up . I say you pick what you like, be content, work to contribute to the field, and quit wishing you were somewhere else. People keep throwing 'derm' around, but even among dermatologists 35% are 'dissatisfied'. What does that tell you?

 

[BLADEMDA]

lol part of our problems is 'options'. Most physician gigs are actually pretty good until you start micro-comparisons. It's kinda like picking a spouse, if you fixate on your vast options, no one will ever measure up . I say you pick what you like, be content, work to contribute to the field, and quit wishing you were somewhere else. People keep throwing 'derm' around, but even among dermatologists 35% are 'dissatisfied'. What does that tell you?

I hate Derm. If you want the dollars suck it up and do something real (IMHO). No disrespect as we all need good Dermatologists.

 

[chocomorsel]

I hate Derm. If you want the dollars suck it up and do something real (IMHO). No disrespect as we all need good Dermatologists.

What's real in your opinion blade?

 

[BLADEMDA]

What's real in your opinion blade?

No need to get hostile. I just think doing Derm is 90% acne, warts, skin cancer, botox, fillers, etc. If there ever was a field ripe to be taken over by the DNP RN it's Derm.

http://www.nadnp.net/

 

[chocomorsel]

No need to get hostile. I just think doing Derm is 90% acne, warts, skin cancer, botox, fillers, etc. If there ever was a field ripe to be taken over by the DNP RN it's Derm.

http://www.nadnp.net/

I honestly wasn't trying to be hostile. Just wanted your opinion on what you consider "real"? I don't care one way or the other about derm quite frankly.

 

[Psai]

No Fellowship= No Career safety. Midlevels will never run the ICU, do high risk peds solo or run a busy Pain Practice in a primo location. Plus, how many midlevels will really be able to do TEE with advanced level certification?

That 2 lettered hospital system should be the eye opener that a standard residency without a fellowship is NOT playing the long game in Anesthesia. Others on SDN may claim "there is no long game" but I disagree because CRNAs are Nurses with limited skills and education meaning fellowship can give you the edge for a good job going forward.

I see more of a midlevel presence in neuro ICUS than I ever expected. The neuro icu np was taking out evds, ordering consults, etc. Of course this was all with ok from neurosurg residents but the impression I got was that the np was basically making all the small day to day decisions, following the overall plan from the surgeons.

 

[Green Grass]

Just do what makes you happy. Or better yet, do the specialty you can stand being in the hospital for the longest. The second option will get you through residency.

 

[deleted697127]

Going to a nurse for botox is like drinking wine from Ohio.

 

[Doctor4Life1769]

The big time rich folks with primo insurance don't go to nurses for their skin care...

 

[Doctor4Life1769]

It's a sad state of affairs if you have to do a fellowship to distinguish yourself from a bunch of nurses.

 

[bronx43]

No need to get hostile. I just think doing Derm is 90% acne, warts, skin cancer, botox, fillers, etc. If there ever was a field ripe to be taken over by the DNP RN it's Derm.

http://www.nadnp.net/

No. The client base that can afford botox, fillers, etc are exactly the type to want EVERYTHING done by not only an MD, but a board certified dermatologist.

 

[GravelRider]

No. The client base that can afford botox, fillers, etc are exactly the type to want EVERYTHING done by not only an MD, but a board certified dermatologist.

Not quite true. They go to people who market themselves well. Those successful derms use the board certification as part of their marketing. Anesthesiologists are atrocious at marketing. Why wouldn't those same people who need a dermatologist to do their Botox demand an anesthesiologist to administer their anesthetic.

 

[Planktonmd]

Actually people don't mind getting their plastic surgery done in someone's garage as long as it costs less money!
If your plan for the future depends on people becoming smarter and asking for better health care providers then you need a better plan!

 

[bronx43]

Not quite true. They go to people who market themselves well. Those successful derms use the board certification as part of their marketing. Anesthesiologists are atrocious at marketing. Why wouldn't those same people who need a dermatologist to do their Botox demand an anesthesiologist to administer their anesthetic.

I think those same people WOULD be the ones who demand an anesthesiologist administer their anesthetic. You guys would be set if you just limit your numbers like dermatology did and find a way for this clientele to pay out of pocket.

 

[WholeLottaGame7]

Was 100% set on anesthesia. Then I started reading these forums. I think it's finally started to get to me.

Kinda bummed about this whole situation knowing that the specialty I enjoyed most is likely a dying one that I shouldn't go into.

Starting to consider medicine subspecialties more and more by the day...

A couple things:

1) It's not anesthesia that is "dying," it's medicine as a whole. There are very few specialties that are immune to midlevel encroachment, and the ones that are are for a reason (competitive, litigation, ****ty lifestyle, etc).

B) Midlevel encroachment has been going on for >30+ years. Someone posted a headline about MD-CRNA wars from back in the '80s. It does seem to be spreading/accelerating, but maybe it just feels that way. Who knows.

#) Choose the specialty you enjoy the most. Don't pick something based on what you think the field will be like in 20 years, because we're all pretty ****ty at predicting the future. Would suck to go into GI just because you think it is lucrative and safe, only to have some DNP group publish a study showing they can drive a scope as well as you. Now you're competing against people with half your training, your salary is dropping, and to top it off, you're stuck in a field where you're elbow-deep in some 300lb dude's a$$ all day.

 

[ERRES2288]

A couple things:

1) It's not anesthesia that is "dying," it's medicine as a whole. There are very few specialties that are immune to midlevel encroachment, and the ones that are are for a reason (competitive, litigation, ****ty lifestyle, etc).

B) Midlevel encroachment has been going on for >30+ years. Someone posted a headline about MD-CRNA wars from back in the '80s. It does seem to be spreading/accelerating, but maybe it just feels that way. Who knows.

#) Choose the specialty you enjoy the most. Don't pick something based on what you think the field will be like in 20 years, because we're all pretty ****ty at predicting the future. Would suck to go into GI just because you think it is lucrative and safe, only to have some DNP group publish a study showing they can drive a scope as well as you. Now you're competing against people with half your training, your salary is dropping, and to top it off, you're stuck in a field where you're elbow-deep in some 300lb dude's a$$ all day.

Even if there was such a study it would take years before they would encroach to a level that would matter. Yes most fields are subject to mid level encroachment, but anesthesia encroachment is 15-20 years ahead of everyone else.

 

[Doctor4Life1769]

I think those same people WOULD be the ones who demand an anesthesiologist administer their anesthetic. You guys would be set if you just limit your numbers like dermatology did and find a way for this clientele to pay out of pocket.

That would require them to know what an anesthesiologist vs CRNA is. CRNA vs anesthesiologist, all thought to be anesthesiologist.

 

[Doctor4Life1769]

Actually people don't mind getting their plastic surgery done in someone's garage as long as it costs less money!
If your plan for the future depends on people becoming smarter and asking for better health care providers then you need a better plan!

Works in Miami.

 

[nonick123]

bump

 

[epidural man]

If you are still in med school - quit now and become an dentist - then ortho or endo. It will take you about the same amount of time (surprisingly) and you will be happy and rich.

 

[amLOLdipine]

If you are still in med school - quit now and become an dentist - then ortho or endo. It will take you about the same amount of time (surprisingly) and you will be happy and rich.

I'm committed to medicine. Don't get me wrong, I like anesthesiology and I have not ruled it out completely just yet. The only thing stopping me from going into the field right now is the uncertain future and the mass invasion of CRNAs into a formerly physician-dominated specialty. Anesthesiology seems to be at least 10 years ahead of every other field in that aspect. I don't want to graduate from residency only to end up doing pre-op checks all day.

 

[amLOLdipine]

No Fellowship= No Career safety. Midlevels will never run the ICU, do high risk peds solo or run a busy Pain Practice in a primo location. Plus, how many midlevels will really be able to do TEE with advanced level certification?

That 2 lettered hospital system should be the eye opener that a standard residency without a fellowship is NOT playing the long game in Anesthesia. Others on SDN may claim "there is no long game" but I disagree because CRNAs are Nurses with limited skills and education meaning fellowship can give you the edge for a good job going forward.

How safe do you think fellowship-trained anesthesiologists will be from midlevel invasion 10-20 years from now?

Another issue is that 1500+ anesthesiologists are graduating from residency per year. According to the most recent available data, there were 183 cardiac, 305 pain, 190 peds, and 167 critical care fellowship spots available. If 1 or even 2 fellowships becomes the new norm in anesthesia, when will we get to the point when it becomes almost impossible to get a decent fellowship after anesthesia residency?

 

[GravelRider]

How safe do you think fellowship-trained anesthesiologists will be from midlevel invasion 10-20 years from now?

Another issue is that 1500+ anesthesiologists are graduating from residency per year. Are there enough fellowship spots to cover even half that many grads? If 1 or even 2 fellowships becomes the new norm in anesthesia, when will we get to the point when it becomes almost impossible to get a decent fellowship after anesthesia residency?

You have to do a fellowship now to get a job, but it is by no means safe. With these companies and hospitals taking over practices and looking to cut costs and increase profits, they will be looking for the cheapest way to get things done.

Apple has it's products built in China. Is it because the Chinese build things better compared to American factories? Or is it because they are the cheapest? The American healthcare system is a business and is going down the same path. These hospitals are finding the cheapest way to accomplish things so they can profit. None of this is driven by patient care or truly improving the health of American citizens. This is all about profit and greed.

 

[Green Grass]

How safe do you think fellowship-trained anesthesiologists will be from midlevel invasion 10-20 years from now?

Another issue is that 1500+ anesthesiologists are graduating from residency per year. According to the most recent available data, there were 183 cardiac, 305 pain, 190 peds, and 167 critical care fellowship spots available. If 1 or even 2 fellowships becomes the new norm in anesthesia, when will we get to the point when it becomes almost impossible to get a decent fellowship after anesthesia residency?

If they continue to bite the hand that feeds, we will simply stop training the SRNAs. Then it will be nurses training nurses which will end the problem. Fellowships aren't the norm. Check www.gaswork.com. The sky is always falling around here, just don't look up and you don't have to worry about it.


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[ProwlerturnGas]

Bite the hand that feeds? Man, they have bitten it, swallowed it, digested it and pooped it out...and yet we continue to train SRNAs. Anesthesiology has been flushed down the sh**ter and the ASA just wants to play nice.

 

[Green Grass]

Bite the hand that feeds? Man, they have bitten it, swallowed it, digested it and pooped it out...and yet we continue to train SRNAs. Anesthesiology has been flushed down the sh**ter and the ASA just wants to play nice.

Where I'm at there's angst from the SRNA/CRNAs bc they know if this VA thing happens, we're gonna stop training them.


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[Ignatius J]

I wouldn't change my choice for anything. You will find chicken littles in every specialty.

 

[GravelRider]

Where I'm at there's angst from the SRNA/CRNAs bc they know if this VA thing happens, we're gonna stop training them.


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Nope. It won't happen. SRNA training is an income stream for most places.

Why not stop training them now?

 

[amLOLdipine]

Where I'm at there's angst from the SRNA/CRNAs bc they know if this VA thing happens, we're gonna stop training them.


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I think that would be a great thing if it actually happened.

I've never understood why anesthesiologists help to train SRNAs, when their ultimate goal is to replace us and not to work in a physician-supervised model. If they want to be trained, they should be trained by CRNAs.

 

[minutemen11]

if you read into any of the posts on SDN, the consensus is anesthesia was great, now its terrible (thanks Obama?). Oh the consensus is also that medicine as a whole is going down the drain so you should probably do something else (dentistry-- lol-- FULL of mid-levels). Dont go to med school unless you have the skills/scores/desires to be an orthopod. This is just ridiculous, if at the end of the day you like the field, DO IT. there is not a single specialty that has mid-level encroachment. Anesthesia in the future= running around with your head cut off while the CRNA secretly second guesses your practices during the case and is bitter that you make 2x (or 1.5x....) more than them. However, most are nice to work with on the surface, which is all I care about. Nurses, NPs and PA's also feel the same to some degree in the other specialties. Do pain or critical care if you want to feel like the boss of the patient and do a mix in the OR if you like it. What more can you ask for? The CRNA threat is real, but the speciality is a long way from dead. if you dont like the field though, please dont apply, let me get into the competitive programs hehe

 

[pgg]

You have to do a fellowship now to get a job, but it is by no means safe.

Come on, even the most pessimistic among us would surely admit that is a gross overstatement. The number of baggage-free* unemployed anesthesiologists in North America has got to number in the single digits.



* ie, non-felons, multiple malpractice losses, etc

 

[GravelRider]

Come on, even the most pessimistic among us would surely admit that is a gross overstatement. The number of baggage-free* unemployed anesthesiologists in North America has got to number in the single digits.



* ie, non-felons, multiple malpractice losses, etc

And when unemployment was at its peak a few years ago there were still plenty of jobs to go around...people were just unwilling to do those jobs (low pay, labor type jobs). It's the same thing in anesthesia, yeah sure, you can get a job anywhere, but in just the two years that I've been looking at the market average salaries have decreased and workload has increased. There is a point where the hours worked, stress level, and liability is not worth it and we are approaching that.

 

[GravelRider]

Two years ago, as a CA2 who is also boarded in internal medicine, I thought doing a fellowship was kind of a waste unless you truly loved that field. I thought that if you were likeable in residency (which I was), worked hard (which I do), know your $hit (which I do), get very proficient at regional (yup), be comfortable in big cases like trauma, liver transplant, dissections, hearts, etc... (yup that's me) then you could get a good job. Now that I am out in the real world, I have changed my mind on that. It is true that some markets are tighter than others. However, the trend is that you have to do a fellowship nowadays. That is the best advice I can give to any med student thinking about anesthesia. Maybe you are lucky and have some family connection or want to live in an area where there is a huge need for anesthesiologists and can get a decent general gig out of residency, but the vast majority of people do not fit that description.

If you love anesthesia, figure out early which of the fellowships suits you the most: pain, ccm, cardiac, peds. Regional is a waste, do pain instead. The acute pain service is run by the chronic pain guys at my institution. OB is silly unless you want to be at Brigham and Women's doing the highest risk OB cases.

That's my advice.

 

[criticalelement]

Two years ago, as a CA2 who is also boarded in internal medicine, I thought doing a fellowship was kind of a waste unless you truly loved that field. I thought that if you were likeable in residency (which I was), worked hard (which I do), know your $hit (which I do), get very proficient at regional (yup), be comfortable in big cases like trauma, liver transplant, dissections, hearts, etc... (yup that's me) then you could get a good job. Now that I am out in the real world, I have changed my mind on that. It is true that some markets are tighter than others. However, the trend is that you have to do a fellowship nowadays. That is the best advice I can give to any med student thinking about anesthesia. Maybe you are lucky and have some family connection or want to live in an area where there is a huge need for anesthesiologists and can get a decent general gig out of residency, but the vast majority of people do not fit that description.

If you love anesthesia, figure out early which of the fellowships suits you the most: pain, ccm, cardiac, peds. Regional is a waste, do pain instead. The acute pain service is run by the chronic pain guys at my institution. OB is silly unless you want to be at Brigham and Women's doing the highest risk OB cases.

That's my advice.

It is really who you know and how easy you are to work with.

Write letters to your senators and representatives on a daily basis.

It is the ASA that is selling the specialty out and continues to do so.
COncentrating on moca is out of place right now.

This fight is about patient education and public education. Nurses are not suited to make medical decisions about medical issues. period.

 

[risnwb]

Two years ago, as a CA2 who is also boarded in internal medicine, I thought doing a fellowship was kind of a waste unless you truly loved that field. I thought that if you were likeable in residency (which I was), worked hard (which I do), know your $hit (which I do), get very proficient at regional (yup), be comfortable in big cases like trauma, liver transplant, dissections, hearts, etc... (yup that's me) then you could get a good job. Now that I am out in the real world, I have changed my mind on that. It is true that some markets are tighter than others. However, the trend is that you have to do a fellowship nowadays. That is the best advice I can give to any med student thinking about anesthesia. Maybe you are lucky and have some family connection or want to live in an area where there is a huge need for anesthesiologists and can get a decent general gig out of residency, but the vast majority of people do not fit that description.

If you love anesthesia, figure out early which of the fellowships suits you the most: pain, ccm, cardiac, peds. Regional is a waste, do pain instead. The acute pain service is run by the chronic pain guys at my institution. OB is silly unless you want to be at Brigham and Women's doing the highest risk OB cases.

That's my advice.

I don't disagree with you in terms of needing a fellowship if you want to work at a tertiary care center. However in the world of the community hospital, fellowship training is a waste. There just aren't cases done in many community hospitals that require skills that one can't obtain at any reasonable residency program. At both small ~200 bed community hospitals I've worked at so far I do healthy peds, thoracic, ob, and lots of regional. Now, as far as whether there is any future in a small practice at a community hospital, that I can not say. Bigger cases will continue to be transferred away to large medical center, but the bread and butter will likely continue at community hospitals. And as for whether the anesthetics will be delivered by an anesthesiologist or a Solo CRNA, only time will tell. But as of now, no fellowship is gonna save my job if I want to stay in the community hospital setting and the hospitals move to predominantly CRNA care.


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[OneFellSwoop]

I'm at the end of my 2nd year of a 3 year partnership track in a community hospital and ASC. What I've seen is CRNAs that feel they can do everything on their own, but also regularly ask me questions regarding management (and yes Ive bailed them out on several occasions but I've also learned from them as well). They can do nearly all of my cases that I supervise without resulting in death. It is hard to kill an otherwise healthy homo-sapien, even with potent anesthetics as long as there is some training combined with the monitoring we have these days. In addition, we simply wouldn't have evolved if it was easy to kill us. Our value lies in improving patient experience and possibly outcomes outside of mortality. Whether that is earlier discharge, decreased ponv, improved pain control, reduced ICU admission, optimizing ventilation/cardiovascular parameters for ICU admissions or determining medication choices relative to comorbidities. Most studies focus on differences in mortality. The fact is intraoperative mortality is extremely low and attributing post op mortality, even 24h after surgery, to anesthesia is extraordinarily difficult. This results in very mixed results in large retrospective studies whether endorsed by aana or Asa, despite bias. This seems to be the focus of the PSH whether for better or worse, it's trying to show we can improve other outcome metrics, and claim a larger piece of the pie. My experience seems to be that our perioperative staff (including surgeons) intuitively knows which questions need to come to me vs which ones they ask the CRNAs. I get the more complex, perioperative, medication related questions and they get very basic management questions about the OR. I get a sense that trying to prove differences through studies is virtually impossible, but we have significant value. It reminds me of the definition of porn, you know it when you see it, and staff know which questions to direct to me and which can be directed to a CRNA. In the end, if the sky completely falls, I am competing for jobs with CRNAs. I can simply offer more than they can both preop, intraoperative and postop. A half decent anesthesiologist will always have a job. And bottom line is I'd rather do anesthesia for 200k than FP for 200k. Perspective is extremely important.


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