People on this board are either delusional or way too optimistic. Seriously, think about this... if I was a corporate executive running an AMC why on Earth would I pay for an anesthesiologist? If I put a CRNA back there, the job will get done for 1/3 of the price. Do I care that you did your residency at the Mayo Clinic? No. Do I care that you did a fellowship? No. If anything that will deter me even more from hiring you because I know you will want to command 400k and I'm looking to cut overhead here. Trust me, I will find a CRNA willing to do that heart case. Do I care that they are not board certified in TEE? No, I don't. Once again, as long as it gets done I could care less. Now that medicine has progressed from private practice to corporations employing providers they will take advantage of the situation in any way possible to maximize profits for corporate executives and shareholders. This is happening in virtually every field of medicine so it's not something specifically with anesthesiology. In case you haven't noticed, ARNPs are now big in ERs, ICUs, IM, Pediatrics, Family Medicine, etc. Midwives are huge in OBGYN and psychologists are now prescribing medication in many places. Salaries are going down across the board so get used to it. Paying off those loans will get ever more difficult. I feel bad for Pathologists and Radiologists now because they have to compete on a global marketplace for a job. You have to do something that accepts no insurance or government payment where you are the boss running your own practice as a plastic surgeon, dermatologist, ophthalmologist, etc. in a wealthy unsaturated area. Otherwise, go corporate.