Talk me out of... or into anesthesia.

[deleted171991]

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I can think of many many worse ways to earn a good/great living. I think we often under appreciate what makes anesthesia cool and a good living, whether "good" means financially good, or just a good way to spend your time.

What makes any job, and especially anesthesia, good or bad are the co-workers. Also, since most of those people are hired and fired by the leadership, the fish rots from the head.

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[criticalelement]

Dude, you need to find a better job. If not for your health, for ours.

The problem is. There are no much better jobs out there, it's all the same theme. Some variation but same theme

 

[criticalelement]

.

What makes any job, and especially anesthesia, good or bad are the co-workers. Also, since most of those people are hired and fired by the leadership, the fish rots from the head.

No truer words have been spoken. Especially the part about the co workers. Thanks ffp for keeping it real.

 

[Shouldawouldacouldas]

You should not enter anesthesia.

Anesthesia is all about Risk VS Benefits....and....after 20 years, Risks outweigh Benefits. You are better off being a dentist than an anesthesiologist. If I could do it again, I would pick a specialty in which there are no mid-level providers. You are screwed in anesthesia and all the primary care specialties. Radiology is an unknown too with the remote location radiologists; eventually, computers with image intelligence will diagnosis most cases. ER is a contract/service profession like pathology. The only good thing about being a doctor of any speciality is YOU MAKE MORE MONEY THAN MOST OF THE POPULATION.

Benefit:
1. Income in the 200K - 800K
2. Usually can find "a" job; maybe not where your family wants to live
3. Don't have to "build up" a practice
4. Very low overhead or none if you are employed

Risks:
1. You are a service like electricity. No one comes to the hospital because of Dr. Anesthesia.
a. Some people don't even know anesthesiologist are doctors
b. Many CRNAs don't bother to correct people if patients think they are doctors
c. Now CRNAs can call themselves doctor, the PhD type
2. If you are an anesthesiologist of worth (knowledgable, skillful hands, great repore, and great spidey-sense), people will eventually forget you when you stood up to the admins traction/AMC and left/got fired/etc.
3. You have no location guarantee. Be prepared to move. Never buy a house you can't sell easily.
4. You have no patients (unless you are a pain doc). You can't leverage your patients like OB/GYN, ortho, primary docs, etc, can with their ancillary businesses to funnel their patients into their weight loss center, aesthetics center, lab, pharmacy, physical therapy, medical equipment shop, outpatient radiology center, etc...
5. The hospital and administration only care about the bottom line, and if you are in the way, you will lose.
6. Your income tops out and gradually drops each year. Don't marry a "Doctor's Wife." Live beneath your means and invest your money into income generating assets. Don't buy fancy cars, large houses, or expensive trips. (Hard to do after sacrificing SO SO SO much to get that brass ring "Doctor".
7. There is no business or company that you can sell to retire with millions or to pass on to your children (except for the scum bag anesthesiologists who screw over other anesthesiologists). You could have busted your butt after college for 4+4+35 with your intelligence, drive and sacrifice in some other business. If you don't have the DRIVE, then stay a doctor.
8. CRNA's do much of what you do. Now there are articles being written about starting another level of anesthesia providers below AA/CRNA. Oh...yah....the MD is a readily available consultant if something ****ty occurs as per your hospital contract. Save the hospital money and shift the risk onto the MD with no additional compensation.
9. Your ASA want you to do three jobs: Perioperative Care -- Hospitalist, Anesthesiologist, and Post Surgical Care. Are you going to get paid 3x your current salary? I bet not.
10. It's stressful physically. ON-CALL sucks and gets worse as you age.
11. It's stressful psychologically: You kiss everyone's asses. If you win, you actually have lost.
12. You can't control your time. Your kid had a 3rd grade musical in the morning and so does the surgeon's kid. The surgeon posts his cases like usual and then just doesn't show up until it is over. You just smile when he shows up as he says why is my patient not in the room already.
13. Anesthesia makes the very young and very old stupid. You'll be breathing in that stuff for 40 years. Don't be stupid. Don't go into anesthesilogy. I am too old to switch so I will continue to be vigilant, but if you are not to old then make the change.

 

[pgg]

Man, you need to find a better job too.

Or just recalibrate your ego and choose to be happy making gobs of money doing an interesting job.

I'm only ~7 years out of residency, still at my .mil job, but over the years I've moonlighted at 6 different places. Exactly one of them was rotten - a surgicenter where a couple of the surgeons were arrogant prima donnas, and sick insane non-ASC type patients were routinely booked for the militant shoulder chippy CRNAs to do whatever the hell they wanted while I just signed charts like a monkey in preop. I did a grand total of four days there and I didn't go back.

You don't have to be miserable. Move. That office building, clinical practice, and panel of patients you lament not owning makes you mobile. Move.

You're whining about missing your 3rd grader's school musical? What, did it get scheduled the day before? Have you zero interest or ability to plan your life? 8-12+ weeks of vacation per year not enough? Do what sane people do and scheduled the day off a month ahead of time.

You envy surgeons for their ability to schedule their lives? Come on. We're essentially shift workers. They own their patients and complications; I see surgeons do cases on Fridays that bring them back Friday night and/or Saturday for take backs for one reason or another ... but I'm not there with them. When I'm working I'm working, when I'm not I'm not. Sane people don't get pissy when they're working during times they scheduled themselves to work.

So much angst about CRNAs calling themselves Dr and patients who don't fully appreciate what an anesthesiology residency is. It must be hell being so insecure.

It's hard to live beneath your means, when those means are easily $250-300K on the low end? That's not a problem with anesthesia; that's a problem with you! Same goes for marrying some whiny materialistic demanding wife, and then putting up with her or divorcing her and marrying another. That's you, not the job.

I'll stop now.

 

[ERRES2288]

However a lot of what shoulda woulda said is valid(other than the scheduling stuff). If you think those things will bother you then don't pick anesthesia.

 

[DetectiveAlonzo]

Is this all about perspective? The old school gas docs making $800,000-1,000,000+ seem bitter and pissed because now their salary potential has gone down to $500,000 and have to work a little bit longer. They haven't downgraded their lifestyle to compensate for it. I'm interested if medicine was their first job or if they spent time before medical school in other career areas.

To a new kid on the block.... $500,000 seems AMAZING. Pay your loans off... live frugally for a bit... don't get married to some hoebag... and $tack that paper playa.

 

[BLADEMDA]

Is this all about perspective? The old school gas docs making $800,000-1,000,000+ seem bitter and pissed because now their salary potential has gone down to $500,000 and have to work a little bit longer. They haven't downgraded their lifestyle to compensate for it. I'm interested if they had jobs before medical school?

To a new kid on the block.... $500,000 seems AMAZING.

Old school docs are selling out in droves to maximize their profits now. I'm not bitter at all just the opposite: quite happy

http://sonoranweeklyreview.com/amsu...a-consultants-for-undisclosed-sum-nasdaqamsg/

 

[DetectiveAlonzo]

Old school docs are selling out in droves to maximize their profits now. I'm not bitter at all just the opposite: quite happy

http://sonoranweeklyreview.com/amsu...a-consultants-for-undisclosed-sum-nasdaqamsg/

What are your thoughts on Anesthesia?

 

[BLADEMDA]

Is this all about perspective? The old school gas docs making $800,000-1,000,000+ seem bitter and pissed because now their salary potential has gone down to $500,000 and have to work a little bit longer. They haven't downgraded their lifestyle to compensate for it. I'm interested if medicine was their first job or if they spent time before medical school in other career areas.

To a new kid on the block.... $500,000 seems AMAZING. Pay your loans off... live frugally for a bit... don't get married to some hoebag... and $tack that paper playa.

"hoebag"? If you call her that you won't be married for very long.

 

[bashwell]

What are your thoughts on Anesthesia?

If I enjoyed sitting in a cold room wearing pajamas all day while staring at monitors and listening for blips and bloops then I might've liked working in IT. Just kidding.

Personally I think anesthesia as a medical field is very cool, love the science, physiology, pathophysiology, pharm, etc.

But the "business" side of practicing anesthesia in the US... Suffice to say you can probably read through lots and lots of threads here on SDN to see pros and cons.

 

[DetectiveAlonzo]

"hoebag"? If you call her that you won't be married for very long.

Alternative term for "money hungry".

 

[DetectiveAlonzo]

If I enjoyed sitting in a cold room wearing pajamas all day while staring at monitors and listening for blips and bloops then I might've liked working in IT. Just kidding.

Personally I think anesthesia as a medical field is very cool, love the science, physiology, pathophysiology, pharm, etc.

But the "business" side of practicing anesthesia in the US... you can probably read through lots and lots of threads here on SDN to see pros and cons.

What is your take on the business side? Do you feel fairly compensated in your position? are you private practice or do you work for a hospital under contract?

 

[bashwell]

What is your take on the business side? Do you feel fairly compensated in your position? are you private practice or do you work for a hospital under contract?

Sorry, I'm merely a M4 down under in Australia, best to ask these guys here and or as I said read through the literally tons of threads in the recent past about all this. I think there was a good one titled "anesthesia vs IM" recently if I remember right.

Edit: here it is

http://forums.studentdoctor.net/threads/anesthesia-vs-im.1056994/

 

[Chloroform4Life]

Doing anesthesia....everyday is a battle. You're battling patient's comorbidities, the clock (everyone is rushing you), greed from administrators, incompetent surgeons, etc.

Most days these battles are easy. Some days they can be very difficult. But if you go into battle with high spirit, expecting the difficulties, it can be fun. For those who dread these battles, doing anesthesia will be full of misery.

I would choose anesthesia again, but cannot recommend it for everyone. The pay is still good, but not worth it imo if you dont enjoy the job.

 

[DetectiveAlonzo]

Doing anesthesia....everyday is a battle. You're battling patient's comorbidities, the clock (everyone is rushing you), greed from administrators, incompetent surgeons, etc.

Most days these battles are easy. Some days they can be very difficult. But if you go into battle with high spirit, expecting the difficulties, it can be fun. For those who dread these battles, doing anesthesia will be full of misery.

I would choose anesthesia again, but cannot recommend it for everyone. The pay is still good, but not worth it imo if you dont enjoy the job.

So just like anything in life... if you truly don't enjoy it... then it will drain ya. Thanks for your input!

 

[criticalelement]

Doing anesthesia....everyday is a battle. You're battling patient's comorbidities, the clock (everyone is rushing you), greed from administrators, incompetent surgeons, etc. I

Most days these battles are easy. Some days they can be very difficult. But if you go into battle with high spirit, expecting the difficulties, it can be fun. For those who dread these battles, doing anesthesia will be full of misery.

I would choose anesthesia again, but cannot recommend it for everyone. The pay is still good, but not worth it imo if you dont enjoy the job.

Very well put!!!
I dont mind battling the patients co morbidities and the clock, but the other challenges I can do without. And its daily and it comes out of nowhere sometimes. I, too, cannot recommend it. Its not for everyone. Can be very brutal even those with strong stomachs

 

[Wiscoblue]

Not true. Every single spot in every single anesthesiology residency program can be filled by a warm body who passed USMLE or its equivalence. Whether or not this med student decides to go into Anesthesiology won't alter the fact that there are more qualified applicants for these positions than there are openings.

The quality of the applicant is what is at stake for this specialty going forward not the quantity.

Blade, I personally know some FMGs who are doing IM or Peds residency with USMLE step one scores in 255 range. You have to keep in mind that the cream of the cream from Medical Schools in India are coming to the US. I know there are many anesthesiology departments (Oklahoma, Duke, MCV, Michigan) who are very happy to get anesthesiologists from Britain and South Africa. A salary of 300k would be awesome compared to what they would be making in IM and Peds. So if you're talking about the Caribbean FMGs, you might have a point. Those are the ones that didn't get into a US medical school.

 

[bashwell]

Blade, I personally know some FMGs who are doing IM or Peds residency with USMLE step one scores in 255 range. You have to keep in mind that the cream of the cream from Medical Schools in India are coming to the US. I know there are many anesthesiology departments (Oklahoma, Duke, MCV, Michigan) who are very happy to get anesthesiologists from Britain and South Africa. A salary of 300k would be awesome compared to what they would be making in IM and Peds. So if you're talking about the Caribbean FMGs, you might have a point. Those are the ones that didn't get into a US medical school.

I completely agree. There are different types of IMGs, some better, some worse than others. Not all IMGs just passed the USMLE, but some have scored very high. There's a Sydney Uni alum currently a CA1 at (a great school) UCSD for example. I've heard of other Aussie IMGs getting interviews at some other solid places too.

By the way a salary of $300k is a big improvement for many UK anaesthetists, especially with all the strikes right now:

http://www.blog.greatzs.com/2016/04/what-happens-to-doctors-when-government.html

 

[Doctor4Life1769]

Blade, I personally know some FMGs who are doing IM or Peds residency with USMLE step one scores in 255 range. You have to keep in mind that the cream of the cream from Medical Schools in India are coming to the US. I know there are many anesthesiology departments (Oklahoma, Duke, MCV, Michigan) who are very happy to get anesthesiologists from Britain and South Africa. A salary of 300k would be awesome compared to what they would be making in IM and Peds. So if you're talking about the Caribbean FMGs, you might have a point. Those are the ones that didn't get into a US medical school.

Sure.
One would need to compare the stats - Carib FMGs, traditional IMGs vs. seasoned anesthesiologists coming from their native country and wishing to re-train in the USA. I could be wrong, but I don't think there are as many seasoned anesthesiologists/physicians from native countries coming here relative to those other two groups. I could be wrong and I'm willing to accept that.

 

[bashwell]

I think that could be true. There are also some (a 4th IMG group?) who are somewhere in between fresh grad or intern and resident too. For eg, I know in the UK and some Commonwealth nations, it's normal for junior doctors (PGY1-2 or so) to have a couple or now even a few years of experience working in the hospital including doing elective rotations or even a full single year in various things like ICU, surgery, etc. before applying to a specialty. They would have more knowledge and experience going in than a fresh grad yet not be a resident (registrar) yet. Many specialties including anesthesia require studying for a year prior to applying and passing the entrance exam too before getting in, so many read various physio and pharm texts, some Miller, etc.

 

[Doctor4Life1769]

I think that could be true. There are also some (a 4th IMG group?) who are somewhere in between fresh grad or intern and resident too. For eg, I know in the UK and some Commonwealth nations, it's normal for junior doctors (PGY1-2 or so) to have a couple or now even a few years of experience working in the hospital including doing elective rotations or even a full single year in various things like ICU, surgery, etc. before applying to a specialty. They would have more knowledge and experience going in than a fresh grad yet not be a resident (registrar) yet.

Good to know. I'm not too familiar with European style training.

 

[Brahnold Bloodaxe]

Blade, I personally know some FMGs who are doing IM or Peds residency with USMLE step one scores in 255 range. You have to keep in mind that the cream of the cream from Medical Schools in India are coming to the US. I know there are many anesthesiology departments (Oklahoma, Duke, MCV, Michigan) who are very happy to get anesthesiologists from Britain and South Africa. A salary of 300k would be awesome compared to what they would be making in IM and Peds. So if you're talking about the Caribbean FMGs, you might have a point. Those are the ones that didn't get into a US medical school.

I'd like to see what that 255 USMLE score would look like adjusted for not being able to study for it at leisure until one is completely ready to take the test. US MD/DO and even IMG don't have that luxury, FMGs who already graduated med school and don't need to squeeze USMLE prep into a few shorts weeks do.