match thoughts!?

[Silent Cool]

And the average weekly work hours are ~35 for CRNAs.

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Members don't see this ad.

 

[BLADEMDA]

And the average weekly work hours are ~35 for CRNAs.

 

[BLADEMDA]

http://thecrna.com/anesthesia-healthcare-are-changing/


CRNAs provide SAFE anesthesia. According to the Institute of Medicine, anesthesia is 50% safer today than it was in the 1980′s, and furthermore there is a 0% difference in safety between CRNAs and Anesthesiologists (Research Triangle Institute).

CRNAs are cost effective. Allowing APRN’s (Advanced Practice Registered Nurses, such as CRNAs) to practice to the full extent of their education will result in $4.2 – $8.4 billion in savings by 2020 (Rand Study In Mass Eibner 2009).

 

[BLADEMDA]

With the full assault by the AANA on this specialty the big wigs should be happy with this year's Match. The big pool of applicants seeking ANY Residency will keep the residency slots full. But, the competitiveness of the specialty is clearly on the decline.

 

[nimbus]

But in pjl's area you can make 150k by taking 10 weekends of heart call and take the rest of the year off

 

[Turtlez]

With the full assault by the AANA on this specialty the big wigs should be happy with this year's Match. The big pool of applicants seeking ANY Residency will keep the residency slots full. But, the competitiveness of the specialty is clearly on the decline.

cool, nice charts and stuff. but what do you recommend us to do? what are you personally doing about this nonsense?

 

[Nivens]

cool, nice charts and stuff. but what do you recommend us to do? what are you personally doing about this nonsense?

I

 

[Psai]

.

 

[Turtlez]

[data not yet public]

Wow.

I thought you were banned bro.

 

[pgg]

Here is what you are Missing:

1. Ortho
2. Neurosurgery
3. ENT
4. Urology
5. Heme/Onc
6. Hand Surgery
7. Optho
8. Invasive Cards


Med Students need to look at all their options before choosing GAS.

LOL

Sure didn't take long to get the obligatory "be brilliant and the world is your oyster" post.

Here's the thing Blade, a person who has the brains and drive to match into specialties like ortho, neurosurgery, ENT, and so on ... can surely be a top 10%'er in anesthesiology. While the overall job market for anesthesia isn't what it was 10 years ago, the top 10% are still doing very, very well.

80% or more of the people matching into anesthesia are not competitive for most of those specialties. Those specialties aren't options for them.


I've said this before, seems like a dozen times, when you post lists like this, you might as well be telling guys who are stuck playing minor league baseball that they simply should've chosen the NFL instead.

 

[deleted171991]

To some extent, MD anesthesiologists have become a victim of their own excellence. Deaths during the administration of anesthesia occur at a paltry rate of 1/250,00 cases nowadays. This remarkable improvement can be attributed solely to technical improvements in the monitoring of patients during a procedure. Things like continuous pulse oximetry, end tidal CO2 monitoring, and fiberoptic-based intubation equipment have almost completely eliminated major morbidity from the profession. This is a good thing. But maybe not so good for anesthesiologists. They practice in a very algorithmic, checklist-based manner.

Thus, it was relatively easy to teach their methods to CRNA’s during a period when the exponential rise in operative case loads made it necessary to incorporate “anesthesiology assistants” into a practice, thereby allowing one attending physician to cover multiple rooms. That recent studies have confirmed what everyone else in the OR already knew—that it didn’t really matter who was behind the drape while a cholecystectomy was ongoing—- is hardly a surprise. The less variability in clinical excellence one sees from certain specialists, there seems to be a commensurate decrease in perceived prestige. In other words, one’s individual reputation as a doctor can be paradoxically harmed when the overall complication rate of your chosen specialty is so low. You are seen as a mere “cog in the machine”, a cog that could easily be interchangeable with another doctor or, in this case, a CRNA.

http://www.kevinmd.com/blog/2011/01/md-anesthesiologists-victims-excellence.html

We are approaching the era of "discount" medicine, like the airlines. How much did they pay the pilots 20 years ago? How much do they pay them now, on average? How did the public look at the pilots 20 years ago, vs now?

People say money doesn't matter. It's the MAIN thing that matters. There is a reason we have the saying "put your money where your mouth is".

"Cog in the machine" is the perfect description. Never go into such a profession, if you are smart enough.

 

[deleted171991]

cool, nice charts and stuff. but what do you recommend us to do? what are you personally doing about this nonsense?

He's counting his retirement money. He's just doing all of you a favor by warning you about what's coming.

Very few people are ready to eat training crap again, after years as attending. I know how it tastes, and I was in the nicest place I could imagine. But still a trainee. And, btw, don't go into CCM, unless you love it and internal medicine (like I do); go into cardiac instead. They are still in the job explosion era, for now.

Being a trainee for life is not a solution either. The more fellowships one has, the more the employer wonders what the heck can you really do well? Not like in specialties where one can work solo. Although, to me, it makes more sense to do 3-6 months of fellowship/subspecialization every decade, than these year-long jokes of some anesthesia fellowships.

Do whatever your heart and brain tells you to do, just look well before you jump. There is no undo after.

 

[Man o War]

So some of you think midlevels wont replace EM docs but CRNAs can replace anesthesiologists? The last 3 times someone in my family ended up in the ER we saw a mid level provider until we were almost through the process and discharged. My EM buddies are more concerned than I am about being replaced. They also talk about management companies constantly. Our fields face similar threats, probably more alike than any other 2 specialties if you think about it. I'm not by any means suggesting we don't need docs in the ER. We do, as much as we need docs in the OR.

 

[BLADEMDA]

So some of you think midlevels wont replace EM docs but CRNAs can replace anesthesiologists? The last 3 times someone in my family ended up in the ER we saw a mid level provider until we were almost through the process and discharged. My EM buddies are more concerned than I am about being replaced. They also talk about management companies constantly. Our fields face similar threats, probably more alike than any other 2 specialties if you think about it. I'm not by any means suggesting we don't need docs in the ER. We do, as much as we need docs in the OR.

We agree here. I do not recommend ER to Med Students.

 

[BLADEMDA]

LOL

Sure didn't take long to get the obligatory "be brilliant and the world is your oyster" post.

Here's the thing Blade, a person who has the brains and drive to match into specialties like ortho, neurosurgery, ENT, and so on ... can surely be a top 10%'er in anesthesiology. While the overall job market for anesthesia isn't what it was 10 years ago, the top 10% are still doing very, very well.

80% or more of the people matching into anesthesia are not competitive for most of those specialties. Those specialties aren't options for them.


I've said this before, seems like a dozen times, when you post lists like this, you might as well be telling guys who are stuck playing minor league baseball that they simply should've chosen the NFL instead.

Study hard and outscore your peers on the STEP exam is hardly making the NFL roster. Top 1/3 of the med school class (M.D. USA) can still match into many great specialties.
Bottom 1/3 gets FP, Peds and soon Anesthesia.

Hence, I recommend you work your arse off in Med School so the world is oyster vs being a cog in the machine.

 

[amLOLdipine]

Study hard and outscore your peers on the STEP exam is hardly making the NFL roster. Top 1/3 of the med school class (M.D. USA) can still match into many great specialties.
Bottom 1/3 gets FP, Peds and soon Anesthesia.

Hence, I recommend you work your arse off in Med School so the world is oyster vs being a cog in the machine.

Not true at all schools. I know of some schools where many of the top applicants in the class (250+ step 1, AOA) match into fields like peds.

 

[Psai]

Not true at all schools. I know of some schools where many of the top applicants in the class (250+ step 1, AOA) match into fields like peds.

He's saying that if you are a bottom student, your options are limited. It's not a comment on what top students do or should choose

 

[Twiggidy]

Please tell me if I am missing anything. With GAS, I can expect to pull in 400K, interesting phys/pharm/pathophys, ACLS skills, fun to be facile with procedures, privacy, no pt follow up. Americans will always demand high quality anesthesia care.

Agree with @Consigliere You have to be careful of your expectations. Today, to get that X> 400k job you're going to be working pretty hard, especially if you want to live in an urban area. If you do academics, good luck. You'll need to take everyone's call to come close. The "3Ps" statement is pretty overrated. For 90% of the job you'll treating ASA 1 and 2 patients and there's nothing interesting there. You may come across an ASA 3 that may require you to think, but unless you're at a tertiery center or doing cardiac you'll have "healthy' patients and the only pharmacology you'll be interested in is propofol and fentanyl (blocks if you're at a ortho place----still not terribly interesting or complicated). If you want weird path/pharm/phys----do peds, even better, peds cards. ACLS......pfff.....ive been private for about 5 years doing hearts in a pretty respected hospital in my area......I've pumped on the chest maybe once. Procedures....a nurse asked my once what my favorite procedure to do is....I told her, "the one where I get in the car, turn the ignition, and go home." If you like procedures, be a surgeon. As a matter of fact, ace you classes and Step 1 be a urologist. You may be called in every hour of the night for stones and stents, but that paycheck will be great, plus, if you're good, you can have pull in the hospital and OR, you wont get that "pull" factor as an anesthesiologist. In the real world it's, "I want to do my case, where's anesthesia?" Privacy....maybe, you still have to suck up to surgeons. I've tried the "mind my business and I wont cause trouble" technique, then the "he's the quiet rude who doesn't talk to me anesthesiologist" floats around. Want privacy....do radiology (although they also have a tough job market). No patient follow is true. Anesthesiology is a thankless job. I had to learn that quick. I was always thinking people didn't appreciate my work for them as the patient, surgeon, or hospital, but that's because this job is thankless. You do well because you're supposed to. Anesthesiologist are supposed to be good. It's expected. Just watch the difference in reaction when a surgeon "effs" up and when you an anesthesiologist "effs" up.

So, I think the anesthesiology match numbers are down because some (most) people do go into this field looking for some sense of glory, but more and more people are realizing the this field is not where you find it. For me, Anes, was the less of all evils (although maybe Rads would've been a lesser evil). I couldn't stand being in an office seeing patients so that was all she wrote for me. (I had good grades and good board scores so I had options) Rads probably would have suited me better, but I've even talked to those guys and they have to bow to surgeons as well and they really do have a tough job market.

So what have you missed with Anes? Well, it's the little intricacies that people do share on this forum that may sound like depressed workers, but there is truth in their statements. Not everyone shares exactly what their job is like, whether good or bad, on this forum for a a reason (even in the private forum). But if you read between the lines, you can find the positives and negatives of this field, but don't let what seems to be the "glory" overshadow the reality

 

[vector2]

He's saying that if you are a bottom student, your options are limited. It's not a comment on what top students do or should choose

I don't understand why students on the bottom aren't all just becoming hospitalists (especially if you're willing to work nights for a few years or moonlight on your off weeks). Shift work and 250-300k+ doesn't sound like a bad deal when your step 1 is <=200.

 

[Twiggidy]

Not true at all schools. I know of some schools where many of the top applicants in the class (250+ step 1, AOA) match into fields like peds.

Some people may believe or not, ACTUALLY want to work with kids or work in primary care. I knew a lot of people who graduated at the top but couldn't stand the specialties, for whatever reason. To each his/her own.

 

[amLOLdipine]

I don't understand why students on the bottom aren't all just becoming hospitalists (especially if you're willing to work nights for a few years or moonlight on your off weeks). Shift work and 250-300k+ doesn't sound like a bad deal when your step 1 is <=200.

That's not a bad option, but it's also becoming a saturated market. I suspect that will happen with EM as well 5-10 years from now, given the current boom and high interest from med students.

 

[ERRES2288]

Study hard and outscore your peers on the STEP exam is hardly making the NFL roster. Top 1/3 of the med school class (M.D. USA) can still match into many great specialties.
Bottom 1/3 gets FP, Peds and soon Anesthesia.

Hence, I recommend you work your arse off in Med School so the world is oyster vs being a cog in the machine.

Bottom 1/3 can match anesthesia NOW.

 

[d9sccr]

That's not a bad option, but it's also becoming a saturated market. I suspect that will happen with EM as well 5-10 years from now, given the current boom and high interest from med students.

They're also being taken over by management companies. Also, where I did my internship, the management was pushing for them to see closer to 25 patients/day if they were on non-teaching teams, which would be fine except most of our patients were ASA 3-4 type patients with the rare 1/2s

 

[Carbocation1]

Who has more pull/power in hospital politics, interventional/ep cards or surg subs?

 

[bashwell]

Study hard and outscore your peers on the STEP exam is hardly making the NFL roster. Top 1/3 of the med school class (M.D. USA) can still match into many great specialties.
Bottom 1/3 gets FP, Peds and soon Anesthesia.

Hence, I recommend you work your arse off in Med School so the world is oyster vs being a cog in the machine.

Actually, I'm not sure if top 1/3rd can match into the mostly sub-surgical specialties you listed. Maybe more like top 10-20%.

However, even if it's top 1/3rd, barring those who choose a less competitive specialty, then that still leaves out the majority (2/3rds) of med students. If so, then I think @pgg's main point stands.

 

[pgg]

Study hard and outscore your peers on the STEP exam is hardly making the NFL roster. Top 1/3 of the med school class (M.D. USA) can still match into many great specialties.

Bottom 1/3 gets FP, Peds and soon Anesthesia.

Hence, I recommend you work your arse off in Med School so the world is oyster vs being a cog in the machine.

We agree, be brilliant and work hard and things will go well for you.

My point, perhaps not clearly stated, is that the kind of top 10% med students who have the option of matching into your list of highly competitive specialties are also the kind of people who, if they choose anesthesia, are going to wind up in the top 10% of anesthesia jobs, and that ain't bad.

These people will be chief residents at top tier programs and will network into great jobs.
These people will do fellowships at top tier programs and will network into great jobs.

The problem with your advice, is that the cohort that can actually take it, doesn't need it, because they're going to excel in whatever field they choose. Even anesthesiology.

 

[amLOLdipine]

We agree, be brilliant and work hard and things will go well for you.

My point, perhaps not clearly stated, is that the kind of top 10% med students who have the option of matching into your list of highly competitive specialties are also the kind of people who, if they choose anesthesia, are going to wind up in the top 10% of anesthesia jobs, and that ain't bad.

These people will be chief residents at top tier programs and will network into great jobs.
These people will do fellowships at top tier programs and will network into great jobs.

The problem with your advice, is that the cohort that can actually take it, doesn't need it, because they're going to excel in whatever field they choose. Even anesthesiology.

What are your thoughts about going into anesthesia if an applicant is competitive enough to match into a well-ranked (e.g. top 25) major academic program in anesthesiology? (assuming he/she doesn't want to do other fields)

 

[Twiggidy]

i think 2 different discussion are being had right now.

as @pgg is stating is definitley true, if you work hard to be in top 10% of your class the more likely than not, you're going to work hard and be a top tier resident (ie chief) which will open up more opportunities. i think we all agree on that. people who work hard in any field will excel in that field, whether it's medicine, law, business, music, etc

the other topic seems to be

if you're a top 10% student is it worth it to go into anesthesiology with the way the job market is going. but i think that goes back to the point of doing whatever you LIKE. if a top 10%er loves Peds, then they should probably do peds, because the money of surgery/subspecialties may be good, but if they hate the work they may not last. i feel like a person who works hard to be the best, will stop working hard if they're doing something they hate. just my opinion. so if you're at the top of your class and you WANT to do anesthesiology, then by all means go for it, but just be aware of the positives and negatives (mainly the negatives) of the field, which can be easily found on this board. I say mainly the negatives because the positives are obvious...it's the negatives that are important.

i think people are saying to really evaluate what your motivation for doing anesthesiology really is, because when you get to work in private practice you may soon realize that motivation isn't a reality, or it will take true top 10% motivation to get to.....and you still may not achieve it

 

[Twiggidy]

What are your thoughts about going into anesthesia if an applicant is competitive enough to match into a well-ranked (e.g. top 25) major academic program in anesthesiology? (assuming he/she doesn't want to do other fields)

if you love it then do it. don't become an ENT just because you have the numbers. what if you hate it? you want to do something you hate for the next 30 yrs?

 

[Man o War]

I don't even know if top 10% means much when it comes to landing a high paying anesthesia job. I think it's almost always who you know. If you look at gas work and cold call, you will think the job market sucks. One of the most competitive groups where I did my fellowship hired one of the residents from my program and he was terrible but he knew somebody over there. One of my co fellows applied and didn't even get an interview and he was really strong, good personality, good scores.

 

[BLADEMDA]

I don't even know if top 10% means much when it comes to landing a high paying anesthesia job. I think it's almost always who you know. If you look at gas work and cold call, you will think the job market sucks. One of the most competitive groups where I did my fellowship hired one of the residents from my program and he was terrible but he knew somebody over there. One of my co fellows applied and didn't even get an interview and he was really strong, good personality, good scores.

That's my point. Anesthesia is a "roll of the dice" when it comes to landing a top 10% type of job. It comes down to "who you know" rather than "what you know" to get one of these jobs.
This is the reason I would recommend a bottom 10 ORTHO Residency over a top 10 Anesthesiology Residency. The odds heavily favor the fact the Ortho graduate will be able to secure a very nice gig after training since the Median salary is so much higher than GAS.

Of course, a med student needs to pick the specialty which he/she can see doing for the next 30 years. Those with options really need to choose wisely.

 

[donkeykong1]

So only derm, surg subs, gen surg, and a ballooning bull market EM had more US Grads matching than Anesthesia. But you all still say its on decline? Anesthesia is still moderately competitive. Just has been recently overtaken by EM which has much more spots. Wouldn't be surprised to see that bubble burst in 5 yrs or so.

 

[Man o War]

That's my point. Anesthesia is a "roll of the dice" when it comes to landing a top 10% type of job. It comes down to "who you know" rather than "what you know" to get one of these jobs.
This is the reason I would recommend a bottom 10 ORTHO Residency over a top 10 Anesthesiology Residency. The odds heavily favor the fact the Ortho graduate will be able to secure a very nice gig after training since the Median salary is so much higher than GAS.

Of course, a med student needs to pick the specialty which he/she can see doing for the next 30 years. Those with options really need to choose wisely.

I would agree with this, unfortunately. I do think some of the fellowships negate that go an extent though.

 

[Man o War]

So only derm, surg subs, gen surg, and a ballooning bull market EM had more US Grads matching than Anesthesia. But you all still say its on decline? Anesthesia is still moderately competitive. Just has been recently overtaken by EM which has much more spots. Wouldn't be surprised to see that bubble burst in 5 yrs or so.

That's an odd result IMO, they are really low hanging fruit for midlevels.

 

[BLADEMDA]

So only derm, surg subs, gen surg, and a ballooning bull market EM had more US Grads matching than Anesthesia. But you all still say its on decline? Anesthesia is still moderately competitive. Just has been recently overtaken by EM which has much more spots. Wouldn't be surprised to see that bubble burst in 5 yrs or so.

Anesthesiology is a necessary specialty (although the AANA may disagree) but that doesn't mean it isn't on the decline: It clearly is. That said, the vast numbers of graduating Medical Students (MD-USA, DO and MD-IMG) will take every spot available because a Residency in Anesthesiology is better than the alternatives: No residency or one in Primary Care

 

[donkeykong1]

That's an odd result IMO, they are really low hanging fruit for midlevels.

I agree. EM has become so protocol based. PA's and NP's can work the room easily. Plus insurance companies are doing everything possible to reduce annual ER visits and re-route patients to PCP. While the revers is true for surgery. This bodes well for anesthesia

 

[BLADEMDA]

I agree. EM has become so protocol based. PA's and NP's can work the room easily. Plus insurance companies are doing everything possible to reduce annual ER visits and re-route patients to PCP. While the revers is true for surgery. This bodes well for anesthesia

"This bodes well for the AANA."

 

[deleted171991]

I agree. EM has become so protocol based. PA's and NP's can work the room easily. Plus insurance companies are doing everything possible to reduce annual ER visits and re-route patients to PCP. While the revers is true for surgery. This bodes well for anesthesia

You mean it bodes well for CRNAs.

 

[Man o War]

Who has more pull/power in hospital politics, interventional/ep cards or surg subs?

Where I've worked, 1) cardiac surgeons 2) fast, busy ortho surgeons (the slow ones didn't have much pull) 3) neurosurgeons.

 

[donkeykong1]

You mean it bodes well for CRNAs.

They'll certainly get a share of the pie just as any other MidLevel. Probably more so in rural areas. Call me optimistic but as someone who matched Anesthesia yesterday, I'm more than satisfied with my specialty choice even if it means tacking on an extra 12 months doing a fellowship to gain more job opps

 

[BLADEMDA]

 

[donkeykong1]

Who has more pull/power in hospital politics, interventional/ep cards or surg subs?

intervenional/ep cards gets the leftovers while the ct surgeon is doing his lucrative CABG

 

[BLADEMDA]

 

[ERRES2288]

So only derm, surg subs, gen surg, and a ballooning bull market EM had more US Grads matching than Anesthesia. But you all still say its on decline? Anesthesia is still moderately competitive. Just has been recently overtaken by EM which has much more spots. Wouldn't be surprised to see that bubble burst in 5 yrs or so.

How is anesthesia moderately competitive? I consider EM and gen surg as moderately competitive. Anesthesia is the hardly above family or internal.

 

[donkeykong1]

Nurses are their own worst enemy. The more they churn out. The less in demand they become, the sooner those inflated salaries nosedive. While our numbers are bottlenecked by residency slots, so the demand is more or less constant with minor cyclical ups and downs.

 

[donkeykong1]

How is anesthesia moderately competitive? I consider EM and gen surg as moderately competitive. Anesthesia is the hardly above family or internal.

You can easliy get into FM/IM with just a passing Step 1, not the case with Anesthesia

 

[Twiggidy]

They'll certainly get a share of the pie just as any other MidLevel. Probably more so in rural areas. Call me optimistic but as someone who matched Anesthesia yesterday, I'm more than satisfied with my specialty choice even if it means tacking on an extra 12 months doing a fellowship to gain more job opps

Congrats on your match. You're still very early in the game. PGY 1 is nothing like residency which is nothing like being an attending. Take what you read on here with a grain of salt, but at the same time, read closely to what people who have been in the game long are saying. They could give you some good advice.

 

[donkeykong1]

Congrats on your match. You're still very early in the game. PGY 1 is nothing like residency which is nothing like being an attending. Take what you read on here with a grain of salt, but at the same time, read closely to what people who have been in the game long are saying. They could give you some good advice.

Thanks! I've had the chance to get to know some AMC leaders and great PP attendings over the years. For all the doom and gloom, SDN certainly gives great advice i think. Wonderful platform. Shout out to @BLADEMDA!

 

[Man o War]

They'll certainly get a share of the pie just as any other MidLevel. Probably more so in rural areas. Call me optimistic but as someone who matched Anesthesia yesterday, I'm more than satisfied with my specialty choice even if it means tacking on an extra 12 months doing a fellowship to gain more job opps

If you like pain, do that fellowship and buy into a surgery center. I seriously considered this and love the procedures but just can't tolerate the patient population. I'd have been a miserable SOB for the rest of my career.

 

[donkeykong1]

If you like pain, do that fellowship and buy into a surgery center. I seriously considered this and love the procedures but just can't tolerate the patient population. I'd have been a miserable SOB for the rest of my career.

Pain or Regional are what im considering. But I agree after having done a Pain rotation as a med student the pt population is difficult and procedure reimbursement is on decline, though doing the interventions can be rewarding.