The doom and gloom worked at my school

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2012: 1,585 anesthesia grads
2007: 1,479 anesthesia grads

source: https://www.acgme.org/acgmeweb/tabi...GraduateMedicalEducationDataResourceBook.aspx
The increase in the number of residency spots happened after 2009, so your statistics are old. Plus you forgot all the new CRNA schools and the massive change in the solo/ACT practice ratio.

In order to have a similar market to 5 years ago, as more and more groups switched to an ACT model, the number of anesthesia spots should have gone down.

What the ABA and the residency programs are doing is a massacre of the specialty, by creating an incredible inflation of anesthesiologists. Our leaders have a Louis XV-type of thinking: "After me, the flood". All they care about is having enough slave residents and fellows, who will be happy to get any job they are thrown at graduation.

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In the late 1990s the number of grads plummeted from ~1100 to ~600. That needs to happen again for the market to turn. Even that may not be enough. Churning out 1600 grads a year is just stupid.
 
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Seems to me like you are in need of an SSRI and/or a good therapist, my man.

Nah, I think it's just you that needs a good dose of reality.
 
The example of the low 200's that I mentioned above was the worst scenario that I found in my investigations prior to pulling the trigger on my ERAS app. I brought it up, not necessarily because I think it defines the future, but because I think it is one dismal possibility that applicants and graduates should be aware of. This is one large organization that shall remain nameless in a larger western city. Inevitably they will grow, and others will likely adopt their practice model, since it has been successful from a management perspective.

I am sure that there is plenty of money to be made in anesthesia, and in medicine in general. The question is, who is going to be making it? As employees, or junior partners, we are likely only going to make what we are allowed to make. I appreciate reading the perspectives in this forum, since they are really helpful in understanding situations to be wary of in the future.

My plan is to aggressively pay down debt during residency (not as difficult as I had previously thought, at least from my budget currently), so as not to be desperate at graduation.
 
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It seems like the leaders of anesthesia has learned nothing from Pathology and Radiology. Maybe they have - except they just want more free labor.

A saturated anesthesiology market + CRNA market = lulz you want to negotiate your contract? You wish.
 
Out of curiosity- are we including anesthesia sub- and supersub- specialties in this conversation? Or is all of this restricted to the private practice, general anesthesia arena?
 
Specialization will only help. If you bring more to the table, you have more choices. Market forces affect everyone, but how many CRNAs can, or want to, solo hearts or sick kids? How about peds hearts? Pain has other problems, but I'm not sure how much CRNA creep can affect their market. If you're a private pain group you can market yourself as board certified physician subspecialists, I'm not sure what "pain nurses" can do to drink your milkshake. Maybe the can out care you.
 
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Out of curiosity- are we including anesthesia sub- and supersub- specialties in this conversation? Or is all of this restricted to the private practice, general anesthesia arena?
Short-term the latter, long-term the former. After they finish playing the DNP game, they will start playing the "fellowship" game. I can see OB, regional and pain becoming very threatened by that, in the future. Whatever needs more technical skill than medical knowledge is in danger, not only in anesthesia (yes, surgeons, I am talking about you). We are dealing with people who are less book smart than us, on average, but equally if not more skillful with their hands, and definitely more street smart. Plus they have the support of their brethren in management, and of bean counters everywhere.

They won't stop until they reach their maximal level of incompetence, at which point, maybe, maybe, the public will do something about them. But they will keep hiding behind our skirts until they feel secure they can take over.

The only way to stop them is to stop working with any of them, period. Whenever you supervise them, you teach them, passively. This entire PC pacifist movement towards embracing them should stop. 80+% have militant psychology, just not in our face.

Again, our leaders could not care less. All they care about is making their usual amounts of money and surviving till retirement, grunts be damned.

We need to unionize nationally and get them out of our shops, even take lower salaries if needed, whatever it takes. They need to become unemployed in large numbers, and hence discourage new generations from wasting money on CRNA school.

STOP TEACHING THEM AND ALLOWING THEM TO LOOK OVER YOUR SHOULDERS! Their schools are so weak that 90% of what they know is stolen from us, after graduation. Nobody has it as good as them: it's like we are keeping them in a supervised "residency" cocoon for decades. No surprise that, after a while, they feel they could do whatever we do (our CA-3's live with the same illusion after only 2.5 years).
 
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Short-term the latter, long-term the former. After they finish playing the DNP game, they will start playing the "fellowship" game. I can see OB, regional and pain becoming very threatened by that, in the future. Whatever needs more technical skill than medical knowledge is in danger, not only in anesthesia (yes, surgeons, I am talking about you). We are dealing with people who are less book smart than us, on average, but equally if not more skillful with their hands, and definitely more street smart. Plus they have the support of their brethren in management, and of bean counters everywhere.

They won't stop until they reach their maximal level of incompetence, at which point, maybe, maybe, the public will do something about them. But they will keep hiding behind our skirts until they feel secure they can take over.

The only way to stop them is to stop working with any of them, period. Whenever you supervise them, you teach them, passively. This entire PC pacifist movement towards embracing them should stop. 80+% have militant psychology, just not in our face.

Again, our leaders could not care less. All they care about is making their usual amounts of money and surviving till retirement, grunts be damned.

We need to unionize nationally and get them out of our shops, even take lower salaries if needed, whatever it takes. They need to become unemployed in large numbers, and hence discourage new generations from wasting money on CRNA school.

STOP TEACHING THEM AND ALLOWING THEM TO LOOK OVER YOUR SHOULDERS! Their schools are so weak that 90% of what they know is stolen from us, after graduation. Nobody has it as good as them: it's like we are keeping them in a supervised "residency" cocoon for decades. No surprise that, after a while, they feel they could do whatever we do (our CA-3's live with the same illusion after only 2.5 years).

(1) I've yet to meet any CRNA, even ones practicing for 20+ years, who are more skillful with their hands than I.
(2) I'm all-in for this. Turn 'em loose.
(3) Yes, the greedy fatcat grayhairs are not looking towards our future, only how to leverage us to their advantage. Do away with exclusive contracts and everyone will benefit.
 
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In the late 1990s the number of grads plummeted from ~1100 to ~600. That needs to happen again for the market to turn. Even that may not be enough. Churning out 1600 grads a year is just stupid.

That won't happen. Med school classes have never been larger:

2004 - 15,829
2013 - 18,156

+2,327 allopathic grads in 10 years. Then you add in the huge growth in DO schools:
2010 - 3,631
projected 2015 - over 5,300

There will be plenty of US grads to fill all anesthesia residency positions. (FMGs and IMGs are in trouble, but that's another topic.)
 
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That won't happen. Med school classes have never been larger:

2004 - 15,829
2013 - 18,156

+2,327 allopathic grads in 10 years. Then you add in the huge growth in DO schools:
2010 - 3,631
projected 2015 - over 5,300

There will be plenty of US grads to fill all anesthesia residency positions. (FMGs and IMGs are in trouble, but that's another topic.)

I just saw a video with Ezekiel Emanuel in the radiology forum and he said the two most over produced specialties are anesthesia and radiology. For some reason hearing him say that had more of an impact than all of the doom and gloom on SDN. It's clear those are the two fields most targeted by the Obama administration. Unless I enjoy critical care, I don't plan on pursuing anesthesia.
 
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As long as the Dems are running the country, you can bet that what he says is pretty close to their long-term policy. He wouldn't come up with all these ideas against the party's wishes; he doesn't have his own electorate.
 
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I've seen posting for up to 200K for CRNA jobs in BFE/opt out states with the golden schedule of m-f 7-3 no weekends/calls...very discouraging
 
In 2014, there were 1,662 positions filled. I don't disagree with the rest of your post, but I cannot find any data showing hundreds of spots being added recently.
That's still a 183 (12%) growth in the number of positions compared to 2004. That's huge for an already saturated anesthesiologist labor market.

Just to get an idea, there are only 464 full-time positions in the entire country right now on gaswork, and those include about 40-50% subspecialty positions.

Make no mistake: many of those positions are on gaswork not because there are no unemployed anesthesiologists, but because they are so crappy that people would rather do something else, like a(nother) fellowship, than take them.
 
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Is it CRNA worries you think? I'm interested in anesthesia but I don't really want to supervise CRNA's ever. If you do a fellowship do you do your own cases more often?


According to Dr. Emanuel we need more CRNAs and few Anesthesiologists. Emmanuel believes anesthesia should be primarily crnas.
 
May 2004 ASA Newsletter - American Society of ...
https://www.asahq.org/.../2004/05...
American Society of Anesthesiologists

May 5, 2004 - health than when residency slots were filled with those who did not ...... Table 1: Match Results for Anesthesiology 1990 - 04.

2004 1289 positioned offered. 1200 filled with 89 unfilled


1996 946 positions offered. 622 unfilled (all time high record)



The field needs to close 200 spots and stress fellowships to its graduates in order to remain competitive going forward.


http://www.asahq.org/For-Members/Pu...s/ASA-Newsletter/May-2004-ASA-Newsletter.aspx

Please read and evaluate pages 18 and 19. The time has come to return to those numbers in order to restore job opportunities to current and future graduates of programs.
 
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A 50% increase in total Anesthesiology Residency spots (compared to 1996 and 1997 ) with a large shift towards ACT means lower payer and few job opportunities.

Emanuel is correct in emphasizing there are too many Anesthesiology positions and if I could waive my wand I would reduce positions to 1000 with simultaneous expansion of AA programs
 
http://www.nrmp.org/wp-content/uploads/2013/08/resultsanddata1996.pdf

Historically, Anesthesiology slots hovered around 1300 positions except for 1996 and 1997. That said, market conditions today are almost as bad as that time period so a reduction in slots to below 1200 seems prudent and wise. Again, I propose a reduction to 1,000 positions with expansion of AA programs; the type of move that Dr. Emanuel would applaud.

While some of you may view 1,000 positions in Anesthesiology as radical I don't think it goes far enough. With CRNAs obtaining the DNAP, the ACA recomending expansion of CRNA roles and the surplus of mid level labor perhaps the answer is a reduction to 800 positions.

Perioperative Physicians play a vital role in the care of the surgical patient but the need to actually perform all anesthetics is not cost effective. Hence, the shift to cheaper midlevel labor is occuring throughout the USA with expansion of the medical supervision/QZ model.

The ASA/AAAA should partner to expand AA practice to the level which QZ billing is allowed.
Medical Supervision should be permitted for AAs as it is for CRNAs. Emanuel and the Democrats could get behind such a law.
 
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I don't believe the ASA leadership will do anything to change the minds of Academic Chairs regarding available positions. Instead, the new graduate will be sold out to AMCs as cheap labor because the law of supply vs demand works in the real world. An abundance of cheap mid level labor combined with record numbers of new Anesthesiology graduates means LOW salaries.

Unlike 1996 and 1997 the Chairmen can fill their positions with DO/IMG and lower quality MD candidates so from their viewpoint there is no need to scale down free labor in order to alter the current surplus of graduates. The naive Med Student is unaware of the implication of this supply vs. demand metric in Anesthesiology and by the time he/she realizes the future is Family practice type pay for high risk/demanding work it is too late.
 
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Yes, you are correct, Blade. In part. But need more elucidation.

The real problem is the push to the 4:1 ACT model with CRNA supervision. The bigger problem with that is that the CRNA/AANA programs are churning out a lot of marginally qualified 25-year-old nurse anesthetists who are getting thrown into complex cases where they don't necessarily have skills or experience to handle the complexity of what's actually occurring during that case. And with 4:1 medical "direction" the supervising anesthesiologist is running around doing so much regulatory b.s. outside of the OR that it's damn near impossible to have "eyes on" during every case. I know. I experienced this firsthand for a short time and subsequently decided that this wasn't how I wanted to practice medicine. It was risky. Some might even say unsafe. Hard to quantify that, though, most of the time.

For example, my first day in that job I had to "rescue" a CRNA who induced, paralyzed, and subsequently couldn't intubate the patient without ever calling me beforehand when I was in another room. Fortunately she could ventilate him, but I still had to leave one of my other rooms in the middle of an induction to attend to that problem. I knew I was up the... ahem... "you-know-what creek" my very first day in that job.

Until this changes, and even if you make it all AAs instead of CRNAs, this is not going to change. There is going to be a glut of anesthesiologists expected to practice in this model. And they will spend their time filling in paperwork and rescuing "near misses" for the bulk of their careers only to defend themselves in court when something bad happens and they subsequently get blamed for it.

My job now is 60-70% solo care. This is the way the hospital wants it. The rest of the time I work with CRNAs who all have 20+ years of experience (a couple 30+ years) and have not been through the brain-washing that is now CRNA training. Mostly when I do cases with CRNAs it is in the ortho or neurosurg rooms. In the ortho rooms, I'm 2:1 and I do the blocks. The CRNAs are essentially there to monitor the patient during the actual case while I personally do all of the anesthesia procedures. No one has a problem with this. The CRNAs I work with don't. The hospital doesn't. Everyone still makes money and gets paid.

The greedy notion that anesthesiology should "run lean" and be a huge "profit" center also has to change. Until then, the 4:1 ratio will supervene and this will be the model into the future. And, as a result, new residency grads will have to take what they can get or get lucky and find a job like I have.

I can also tell you this, though. We don't hire any "unknown entities". I think that's a big part that's also changed. We hand pick the docs that we want to work with us. Gaswork is not even in our vernacular. So make good contacts in residency, residents, because that is your best bet to securing a good job when you're done.
 
I don't believe the ASA leadership will do anything to change the minds of Academic Chairs regarding available positions.

At the residency program I graduated from in 2007, we had 14 CRNAs with 66 total residents. The hospital has grown and expanded since then. What was the Chair's response? He hired 30+ more CRNAs with no increase or decrease in residency spots. Why? Because they're cheaper. This is the future. The expectation is that you will "manage" CRNAs when you graduate, and not actually provide intraop care.

I wouldn't choose go back that program to train again at this point. No way in hell.
 


I might be wrong about this, but I think you are referring to the data on page 11 and 12:

2010 : 1385 positions
2011: 1407 positions
2012: 1476 positions
2013: 1580 positions
2014: 1564 positions

The huge surge between 2012 and 2013 can be attributed to the NRMP's "All-In Policy", in which every single ACGME funded position must be provided either All-In or All-Out of the match. For example, before 2013, a residency program with 20 residents could sign 3 residents "outside" the the March 20th Match and give the other 17 positions in the Match.

That little rule changed caused a surge of Match position between 2012 and 2013 for ALL specialties, from 26772 in 2012 to 29171 in 2013 (a 9 percent surge).
 
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You are correct masterchef.

Residency programs do not train managers right now. They train doctors able to practice anesthesiology. That's the way it should be. I don't see reducing the number of spots as the answer. I see the answer in removing exclusive contracts and allowing CRNAs to practice independently without any expectation of help from anesthesiologists. That way the current "cartels" that form in areas would vanish and hospitals would be more competitive leveling the playing field for everyone. The CRNAs that would want to work with docs would do so and the rest would suffer and/or realize that they should've been careful what they wished for...
 
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I might be wrong about this, but I think you are referring to the data on page 11 and 12:

2010 : 1385 positions
2011: 1407 positions
2012: 1476 positions
2013: 1580 positions
2014: 1564 positions

The huge surge between 2012 and 2013 can be attributed to the NRMP's "All-In Policy", in which every single ACGME funded position must be provided either All-In or All-Out of the match. For example, before 2013, a residency program with 20 residents could sign 3 residents "outside" the the March 20th Match and give the other 17 positions in the Match.

That little rule changed caused a surge of Match position between 2012 and 2013 for ALL specialties, from 26772 in 2012 to 29171 in 2013 (a 9 percent surge).
This.
 
The reality is the vast majority of new anesthesiology graduates are looking at employment by AMCs or hospitals for a low starting salary. AMCs have decreased starting salaries over the past 2 years. If you are one of the fortunate few to land a good job (fewer and fewer each year) be grateful. Many newly minted Anesthesiologists are delegated to being lowly paid employees for their career.
 
1. Don't be average and strongly consider a fellowship. It's only a year. Bringing more to the table means more options. Options for starting jobs and options to leave for greener pastures when necessary.
2. Work network connections for leads. Keep the network alive throughout your career.
3. Be flexible in location, at least a little. San Francisco or bust is a recipe for a bad job.
4. Don't be a chump and settle for a bad job.

If you do 1, 2 and 3 you can do 4.
There's still plenty of gold in them there hills.

I don't live in my dream location with my fantasy dream job with my family across town, but I'm still doing exactly what I want in a desirable city where my wife and I can make hay while the sun shines.
 
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Still better than general surgery. Better hours, better pay, better residency and more job opportunities in big cities. Many general surgeons are envious of you.

Although on the east coast here, it is shocking how many procedures are done by CRNAs now. If you're mid-career it's still a great specialty, if you're just starting residency, well 30 years is a long time to predict.
 
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1. Don't be average and strongly consider a fellowship. It's only a year. Bringing more to the table means more options. Options for starting jobs and options to leave for greener pastures when necessary.
2. Work network connections for leads. Keep the network alive throughout your career.
3. Be flexible in location, at least a little. San Francisco or bust is a recipe for a bad job.
4. Don't be a chump and settle for a bad job.

If you do 1, 2 and 3 you can do 4.
There's still plenty of gold in them there hills.

I don't live in my dream location with my fantasy dream job with my family across town, but I'm still doing exactly what I want in a desirable city where my wife and I can make hay while the sun shines.

Yes, yes, yes & YES!

Although on the east coast here, it is shocking how many procedures are done by CRNAs now. If you're mid-career it's still a great specialty, if you're just starting residency, well 30 years is a long time to predict.

What's worse is that they now demand to do these procedures or threaten to leave. Once their supply reaches a peak this won't be the case anymore. Their salaries are going down too. The key is getting rid of the restrictive covenants and the exclusive contracts. That will fix everything.
 
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We don't allow them to do much of anything. If they don't like it, OK. If they can do procedures better than ME, I may reconsider.
We have had a couple become unhappy and leave. Plenty more where they came from, and we generally won't even look at their CV without substantial pediatric experience. We get applications all the time for jobs that don't exist.
We also had a couple that were told by the head CRNA to get with the program or start looking for a new job. I guess a fair salary with a small bonus isn't so bad with no call, weekends, holidays and 3 12s as full time.
 
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The reality is the vast majority of new anesthesiology graduates are looking at employment by AMCs or hospitals for a low starting salary.

Working directly for the hospital is a better option all the way around. The pay is better. Less B.S.

In my mind it is currently:

(1) private practice with clear ownership/partner track > (2) hospital-owned practice >>> (3) AMC >>>>> (4) PP without clear partnership track

The last one is the true screw job right now. Low pay. No real ownership/decision-making potential. Carrot dangling in front of you (with nebulous promise of possible partnership "someday") all while being whipped from behind. Frequently 4:1 supervision scut-monkey job where you're just doing pre-ops and signing consents and running around putting out fires. And the fatcat grayhair greedy dinguses getting rich on your hard work while exposing you to all manner of liability while just waiting to sell the practice out from under you and cash-out when they're ready to retire... which is soon for many of them.

Don't take those jobs!
 
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I had another thought for those considering fellowship and possibly an academic career.
Some places pay notoriously poorly (UCSD, Hopkins, etc.) and some pay dramatically more, though they tend to work more as well. As many places tend to hire most of the faculty from their own fellowship, you might want to prioritize training at a place that is known to pay better than average vs. one that legendarily pays peanuts.
Ask around, the senior residents know some data as well as Jr faculty, who may have looked for jobs recently. You may be better off with your year long interview at a place you would consider working in the future.
 
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http://www.nrmp.org/wp-content/uploads/2013/08/resultsanddata1996.pdf

Historically, Anesthesiology slots hovered around 1300 positions except for 1996 and 1997. That said, market conditions today are almost as bad as that time period so a reduction in slots to below 1200 seems prudent and wise. Again, I propose a reduction to 1,000 positions with expansion of AA programs; the type of move that Dr. Emanuel would applaud.

While some of you may view 1,000 positions in Anesthesiology as radical I don't think it goes far enough. With CRNAs obtaining the DNAP, the ACA recomending expansion of CRNA roles and the surplus of mid level labor perhaps the answer is a reduction to 800 positions.

Perioperative Physicians play a vital role in the care of the surgical patient but the need to actually perform all anesthetics is not cost effective. Hence, the shift to cheaper midlevel labor is occuring throughout the USA with expansion of the medical supervision/QZ model.

The ASA/AAAA should partner to expand AA practice to the level which QZ billing is allowed.
Medical Supervision should be permitted for AAs as it is for CRNAs. Emanuel and the Democrats could get behind such a law.

So what can we do about this? I dont know that much about how it works but is there anything we can do to push for a decrease, or is it like many things in the world, up to the powers of a select few? How did so many spots go unfilled in the late 90s? How do we repeat something like that? It also doesn't make sense to me why spots are increasing when the job markets are so tight, and w/ increasing # of CRNAs coming our way.
 
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So what can we do about this? I dont know that much about how it works but is there anything we can do to push for a decrease, or is it like many things in the world, up to the powers of a select few? How did so many spots go unfilled in the late 90s? How do we repeat something like that? It also doesn't make sense to me why spots are increasing when the job markets are so tight, and w/ increasing # of CRNAs coming our way.


Exactly. If the ASA and Chairs had your back they would cut the spots to 1,000 while increasing AA programs. Instead, the chairs and ASA both benefit from the increased number of graduates. The Chairs get free labor while the ASA/ABA generates more revenue from these Anesthesiologists. The losers here are the newly minted "generalist" who must go into the work force at sub par SALARY.
 
I've seen posting for up to 200K for CRNA jobs in BFE/opt out states with the golden schedule of m-f 7-3 no weekends/calls...very discouraging
I know crnas personally that make double that in opt-out bfe flyover country. It would be kind of interesting for a new(er) anesthesiologist to swoop in there. You'd think any hospital system would want an MD/DO vs crna any day of the week if the money worked out.
 
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Exactly. If the ASA and Chairs had your back they would cut the spots to 1,000 while increasing AA programs. Instead, the chairs and ASA both benefit from the increased number of graduates. The Chairs get free labor while the ASA/ABA generates more revenue from these Anesthesiologists. The losers here are the newly minted "generalist" who must go into the work force at sub par SALARY.

Yea that sucks. Im planning on going into anes, which means i'll graduate in 6 yrs after fellowship if i dont take breaks.. hopefully it wont be awful when i get out. My schools anes chair was a previous ASA president. He said the future of the field is looking better and better lol..
 
Yea that sucks. Im planning on going into anes, which means i'll graduate in 6 yrs after fellowship if i dont take breaks.. hopefully it wont be awful when i get out. My schools anes chair was a previous ASA president. He said the future of the field is looking better and better lol..


The field has NEVER looked worse; that could change if the AMCs are ruled illegal (anti-trust) or the ACA gets nullified (SCOTUS could still rule 5-4 that each state must have its own health care portal in order for the citizen to receive a subsidy).

Both of those are a long shot so you should honker down for the long run which means a Fellowship (or even 2) with anticipation of a $240K starting salary.

The Democrats want Anesthesiology and Radiology to pay less than Family practice. While this may take time (7-10 years) they may ultimately get their way. Unlike many on this Board I wouldn't choose Anesthesiology over a far easier specialty with a better lifestyle if the pay was equal. While I rarely agree with the liberal Dr. Emanuel on anything he is correct in his assumption that income/salary is the largest deterrent to primary care in the USA.
 
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The field has NEVER looked worse; that could change if the AMCs are ruled illegal (anti-trust) or the ACA gets nullified (SCOTUS could still rule 5-4 that each state must have its own health care portal in order for the citizen to receive a subsidy).

Both of those are a long shot so you should honker down for the long run which means a Fellowship (or even 2) with anticipation of a $240K starting salary.

The Democrats want Anesthesiology and Radiology to pay less than Family practice. While this may take time (7-10 years) they may ultimately get their way. Unlike many on this Board I wouldn't choose Anesthesiology over a far easier specialty with a better lifestyle if the pay was equal. While I rarely agree with the liberal Dr. Emanuel on anything he is correct in his assumption that income/salary is the largest deterrent to primary care in the USA.

Is AMC even been reviewed for possible anti trust?? I was planning on doing cardiac fellowship (though still way too early to tell), i guess i'll have to do a pain fellowship too or something
 
I know crnas personally that make double that in opt-out bfe flyover country. It would be kind of interesting for a new(er) anesthesiologist to swoop in there. You'd think any hospital system would want an MD/DO vs crna any day of the week if the money worked out.

They won't trade a 20+ year experienced CRNA for a newly minted Anesthesiologist. Instead, the CEO will use the threat of bringing in the MD to drop the salary of the CRNA.
 
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My schools anes chair was a previous ASA president. He said the future of the field is looking better and better lol..

Just reiterates how out of touch those hiding in the Ivory Towers are about what actually happens off-campus.
 
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