Anesthesiology... Not too competitive?

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usermike8500

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Why is the "A" in "ROAD" less competitive? First Aid says the mean Step 1 is 220. Anesthesiology seems like a great choice for specialty: Interesting physiology-oriented work saving lives in real time, high salary, and probably more controllable lifestyle than surgery. So I have a couple questions:

1. Why do you think Anesthesiology is less competitive to match into?

2. My Step 1 score is 216, My class rank sucks (45th percentile), and my one research publication was in a tiny journal in a non-Anesthesiology field. Do I even have a chance applying for residency in Anesthesiology?


So I know there was a post on this topic 4 years ago. I just wanted to see if there's any new info. Thanks in advance!
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usermike8500 said:
Why is the "A" in "ROAD" less competitive? First Aid says the mean Step 1 is 220. Anesthesiology seems like a great choice for specialty: Interesting physiology-oriented work saving lives in real time, inflated salary, and probably more controllable lifestyle than surgery. So I have a couple questions:

1. Why do you think Anesthesiology is less competitive to match into?

2. My Step 1 score is 216, My class rank sucks (45th percentile), and my one research publication was in a tiny journal in a non-Anesthesiology field. Do I even have a chance applying for residency in Anesthesiology?


So I know there was a post on this topic 4 years ago. I just wanted to see if there's any new info. Thanks in advance!
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Short answer, lots of spots in anesthesiology with a huge array of programs in different tiers of competitiveness. For example there is an academic program on the coast that has average step 1 of a 240 and most applicants with research experience vs. that many other community programs in less desirable locations. Another reason is that a lot of students don't get much exposure to it beyond their surgery clerkship. Finally, it takes a certain personality to deal with a job that can be highly stressful at any moment. I definitely wouldn't go around calling anyone's salary inflated.
 
Then there's the CRNA issue. I think midlevel encroachment is an issue for most specialties nowadays, but particularly so for Gas.
 
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081003-anesth.jpg
 
Anesthesia has different tiers as said above. It's a misconception that it's hugely competitive because it's a ROAD residency - i.e. big bucks for less strenuous residency/lifestyle. I know people who matched with scores of 215 on their Step 1 after doing numerous aways and some research at good universities.

Rads, Ophtho, and Derm on the ROAD mnemonic however are considerably more competitive.
 
peppy said:
Then there's the CRNA issue. I think midlevel encroachment is an issue for most specialties nowadays, but particularly so for Gas.
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Why is midlevel encroachment an issue? I haven't personally heard of any doctor's life being adversely affected by midlevel providers. What do you think?
 
usermike8500 said:
Why is midlevel encroachment an issue? I haven't personally heard of any doctor's life being adversely affected by midlevel providers. What do you think?
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The CRNA issue is blown out of proportion on the internet. They are more like an annoyance, but not a real threat to any physician anesthesiologist. If you like anesthesiology, go for it.
 
badasshairday said:
The CRNA issue is blown out of proportion on the internet. They are more like an annoyance, but not a real threat to any physician anesthesiologist. If you like anesthesiology, go for it.
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I agree to a point...but they can practice independently so they make some dent in the physician need.

Especially with everyone trying to cut the budget somewhere......

a place may decide to hire two CRNAs instead of another Anes doc.
 
BenzylAcetate said:
081003-anesth.jpg
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Why did his chair magically disappear?
Why isn't he wearing gloves?
For that matter, why is he recording notes int he buff?
No, no, no...none of this is making any sense at all.
:thumbdown:
 
Alvarez13 said:
Why did his chair magically disappear?
Why isn't he wearing gloves?
For that matter, why is he recording notes int he buff?
No, no, no...none of this is making any sense at all.
:thumbdown:
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chair is gone because it is time for action!!

Gloves...:rolleyes:

and he is a stick figure.......he aint got no peen!!!!! :laugh:
 
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badasshairday said:
The CRNA issue is blown out of proportion on the internet. They are more like an annoyance, but not a real threat to any physician anesthesiologist. If you like anesthesiology, go for it.
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This actually isn't completely true. I have family who work in hospital administration and they pretty much admitted that while anesthesiologists are necessary, they don't need to hire as many due to CRNAs.
 
ArcGurren said:
This actually isn't completely true. I have family who work in hospital administration and they pretty much admitted that while anesthesiologists are necessary, they don't need to hire as many due to CRNAs.
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Yes and no. Most places have anesthesia care teams with MDs supervising CRNAs, so you need fewer MDs, but their salaries, and jobs, are intact. The number of places with unsupervised CRNAs, in areas where an MD might want to work, is not high. I'm not worried about the next 20 years. Beyond that, who knows. Subspecializing in Peds was cheap insurance as well.
Midlevel expansion is a reality throughout many fields in medicine.

You have to be able to deal with high stress situations with a clear head. If that's not you, and you don't think you can be the calm rock during the storm, anesthesia's probably not for you. You might be able to work through it, but your stress levels will be too high. One guy in my class washed out and I know a couple attendings that I work with now that are baseline stressed and miserable, and borderline basket cases when the stool hits the fan.
 
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IlDestriero said:
Yes and no. Most places have anesthesia care teams with MDs supervising CRNAs, so you need fewer MDs, but their salaries, and jobs, are intact. The number of places with unsupervised CRNAs, in areas where an MD might want to work, is not high. I'm not worried about the next 20 years. Beyond that, who knows. Subspecializing in Peds was cheap insurance as well.
Midlevel expansion is a reality throughout many fields in medicine.

You have to be able to deal with high stress situations with a clear head. If that's not you, and you don't think you can be the calm rock during the storm, anesthesia's probably not for you. You might be able to work through it, but your stress levels will be too high. One guy in my class washed out and I know a couple attendings that I work with now that are baseline stressed and miserable, and borderline basket cases when the stool hits the fan.
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I'm in agreement with everything you've said. Regarding the bolded - that's more or less what I was trying to get at; subspecializing is also a good idea in Anesthesia, I wasn't even aware there were too many subspecialties.
 
The main subspecialties w/i anesthesia are Peds (complex peds), pain, cardiac, and ICU. All have sub specialty certification/boards. Peds cardiac is an unboarded subsubspecialty.
One can also do additional fellowship training in OB, neuro, trauma, and regional, but I don't think it really offers you much if you trained at a very strong program. It might help you get a job in a tight market though, or in academia.
 
IlDestriero said:
You have to be able to deal with high stress situations with a clear head. If that's not you, and you don't think you can be the calm rock during the storm, anesthesia's probably not for you.
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Isn't that something that's learned through experience?...

It's hard imagining someone making it through a Gas residency and still being super stressed when anything goes wrong.

I guess stressful situations are just more common in academic settings...
 
badasshairday said:
The CRNA issue is blown out of proportion on the internet. They are more like an annoyance, but not a real threat to any physician anesthesiologist. If you like anesthesiology, go for it.
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I have talked to some of the final year gas residents, and they have told me the job market is pretty tight and getting worse every year. They are still getting offers, but starting salary is lower and partner track jobs are pretty rare to find nowadays. So I agree that it is probably not a threat in the sense that you won't be unemployed. However, anesthesiology may not be the big bucks for good lifestyle field that it used to be. CRNA's are saturating the market, and while they aren't a replacement they can handle the majority of cases. Some states already don't require physician supervision. It's not too complicated to imagine what is going to happen to those big salaries and cushy schedules when you look at the reality that hospitals can hire people for 1/3 the salary to cover the majority of the work. The hospital gets paid the same whether it is a nurse or an MD doing the gas.
 
Yeah, but I've heard the malpractice for independent CRNAs is also much much higher than for an anesthesiologist. I think the ACT model is how its going to stay.
 
muhali3 said:
Isn't that something that's learned through experience?...

It's hard imagining someone making it through a Gas residency and still being super stressed when anything goes wrong.

I guess stressful situations are just more common in academic settings...
Click to expand...

Stressful situations can happen anywhere.

I've seen both residents and attendings that were stress cases. The latter always seemed to add to the problems the former had.
 
turkeyjerky said:
Most anesthesiologists I know would actually prefer the latter.
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ONE GAS MAN said it is becoming more and more difficult to get a job in the anes field since you might have one anestiology who might be responsible for 10 to 20 CRNA. The hospital or clinic saves money and the CRNA get $$$. However, remember that there are also Anes Assistants, they are just like CRNA but they are not nurses, they are more connected to physician assistants. Anes will be reduced to rubble in the future by the mid level fields of CRNA and AA.

Now for every MD there is a mid level specialist
All you have to do is name a speciality and put assistant next to it and you will see a school for that.
Lets try oh!! lets say..hmm..orthopedic surgery assistants.

http://education-portal.com/article...reer_as_an_Orthopedic_Surgeons_Assistant.html


Yep click the link above and you will see orthopedic surgery assistants
So for any kid out there who does not get into med school straight from college , I would suggest they do one of these programs in the specialty they want to practice and this will help build their CV for med school and residency
 
Joseph Ransohof said:
ONE GAS MAN said it is becoming more and more difficult to get a job in the anes field since you might have one anestiology who might be responsible for 10 to 20 CRNA. The hospital or clinic saves money and the CRNA get $$$. However, remember that there are also Anes Assistants, they are just like CRNA but they are not nurses, they are more connected to physician assistants. Anes will be reduced to rubble in the future by the mid level fields of CRNA and AA.

Now for every MD there is a mid level specialist
All you have to do is name a speciality and put assistant next to it and you will see a school for that.
Lets try oh!! lets say..hmm..orthopedic surgery assistants.

http://education-portal.com/article...reer_as_an_Orthopedic_Surgeons_Assistant.html


Yep click the link above and you will see orthopedic surgery assistants
So for any kid out there who does not get into med school straight from college , I would suggest they do one of these programs in the specialty they want to practice and this will help build their CV for med school and residency
Click to expand...

the difference i've seen though is that PAs and NPs in specialties outside of anestesia r very helpful to the physicians and increase their productivity dramatically. in ortho for example i've seen that they were crucial in both taking care of inpatients on the floor and during surgery in the OR. there is absolutely no way that a midlevel provider will ever be able to replace an orthopedic surgeon in the OR. this same relationship is true for many other specialties where the midlevel provider actually increases your productivity by seeing the straight-forward cases, allowing you to increase your case load or do more procedures.
 
skinMD said:
the difference i've seen though is that PAs and NPs in specialties outside of anestesia r very helpful to the physicians and increase their productivity dramatically. in ortho for example i've seen that they were crucial in both taking care of inpatients on the floor and during surgery in the OR. there is absolutely no way that a midlevel provider will ever be able to replace an orthopedic surgeon in the OR. this same relationship is true for many other specialties where the midlevel provider actually increases your productivity by seeing the straight-forward cases, allowing you to increase your case load or do more procedures.
Click to expand...

so can't you make the argument that since midlevel allows the surgeon to see more cases by handling the straight-forwards cases, the hospital doesn't need as many surgeons
 
XRanger said:
so can't you make the argument that since midlevel allows the surgeon to see more cases by handling the straight-forwards cases, the hospital doesn't need as many surgeons
Click to expand...

no, because the midlevel can't operate on any case independently and never will. i've seen midlevels do 100% of the post-op management on the floor freeing up the resident and attending surgeons to have more time in the OR. midlevels in the OR help with productivity and make the procedure go more quickly/smoothly so that you can do more procedures.

the part about handling the straight-forward cases wasn't in reference to surgical specialties but rather specialties like primary care and EM, though i have seen this work quite well in outpatient surgery post-op visits.
 
Joseph Ransohof said:
ONE GAS MAN said it is becoming more and more difficult to get a job in the anes field since you might have one anestiology who might be responsible for 10 to 20 CRNA. The hospital or clinic saves money and the CRNA get $$$. However, remember that there are also Anes Assistants, they are just like CRNA but they are not nurses, they are more connected to physician assistants. Anes will be reduced to rubble in the future by the mid level fields of CRNA and AA.

Now for every MD there is a mid level specialist
All you have to do is name a speciality and put assistant next to it and you will see a school for that.
Lets try oh!! lets say..hmm..orthopedic surgery assistants.

http://education-portal.com/article...reer_as_an_Orthopedic_Surgeons_Assistant.html


Yep click the link above and you will see orthopedic surgery assistants
So for any kid out there who does not get into med school straight from college , I would suggest they do one of these programs in the specialty they want to practice and this will help build their CV for med school and residency
Click to expand...

This isnt true, I believe that the max CRNA's a Doc can supervise i.e. cover different rooms is 3-4? Anything above this and billing tanks, and its no longer profitable.

CRNA's with independence is a different beast I believe
 
officedepot said:
It's pure arrogance and stupidity that all these residents graduating think they deserve to be "partner". No one deserves anything. You have to earn it. If you choose anesthesia you accept the working environment and salaried role. Just because a person is a doctor doesn't mean they should automatically have a "track" to become a partner of a business they had no involvement in until they graduated and are whining that they can't be partner. Suck it up.
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this x 1000

sounds like someone who has actually had real life work experience in fields other than medicine
 
muhali3 said:
Isn't that something that's learned through experience?...

It's hard imagining someone making it through a Gas residency and still being super stressed when anything goes wrong.

I guess stressful situations are just more common in academic settings...
Click to expand...

I've seen it first-hand. During residency there is always an attending to bail you out when needed. Once you're out on your own those stressers don't go away.
 
officedepot said:
It's pure arrogance and stupidity that all these residents graduating think they deserve to be "partner". No one deserves anything. You have to earn it. If you choose anesthesia you accept the working environment and salaried role. Just because a person is a doctor doesn't mean they should automatically have a "track" to become a partner of a business they had no involvement in until they graduated and are whining that they can't be partner. Suck it up.
Click to expand...

meh, call me crazy but after 8 post grad years of work I'm not working for someone making salary while they get rich off me. If I generate profits then I want to have an opportunity, in the contract, after a few years to buy in and become a partner. Maybe that is just me though.
 
officedepot said:
You act as if you don't benefit at all from working for that guy "getting rich off you". Typical liberal. But whatever. If that is something you must have then that's your choice. However you are NOT entitled to anything. Just because you trained a long time doesn't mean you deserve anything. More power to you if you can find that job but again don't go around thinking that you deserve it. That's the problem. That's not the way the world works. You need to earn your keep.

you have the capability of starting your own business and doing what you will with it.
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come at me bro.... haha just kidding. Yeah, I didn't say anything about not working for it but if you think you are going to join a practice that doesn't have a clear path to partnership and your hard work ethic is going to dazzle them into making you a partner while they make money off of you, well... I have a position I would like to offer you in about 8 years.
 
officedepot said:
It's pure arrogance and stupidity that all these residents graduating think they deserve to be "partner". No one deserves anything. You have to earn it. If you choose anesthesia you accept the working environment and salaried role. Just because a person is a doctor doesn't mean they should automatically have a "track" to become a partner of a business they had no involvement in until they graduated and are whining that they can't be partner. Suck it up.
Click to expand...
I think you might have misunderstood the point.
The point is that for the last 50 years in anesthesia, excepting the late 90's, partnership tracks in private practice were the norm. Lately things have been returning to the 90's mentality again. A fair group used to offer 2-5 years to partner, with a salaried "buy in" period. Now many groups are not hiring anyone on the partner track, just salaried employees. There is no way to earn it. Nobody is expecting to become a partner straight away. But things have changed over the last few years. Non partner track jobs in anesthesia were commonly no call, no weekend, mommy track jobs. Fair wage for a fair day's work. Now some of the offers I see and hear about have changed, you're taking call, late shifts, etc. All the work with minimal reward.
The difference between an employee and a partner can be $2-300k, sometimes more. I know this from my own experience. They get shares of the hospital subsidy, they split the profits, you work late and do an extra case, they get that as well. So yes, the partners are quite literally getting rich off your sweat. And, the more non partner employees they hire the more they make. Anesthesia management companies are also proliferating. That's the same arrangement, but worse because no matter what happens you will never be asked to be a "partner". You'll always be an employee, and have two masters.
If you want to suck it up and take all the busy OB call for $275k with no plan to be offered partnership while the partners are covering all the rare OR call from home in bed for $600k that's great. That's not something I'm going to do.
 
Any group that is treating potential "employees" in such a way is ripe for a new group, AMC, etc. to come in and upend their apple cart. Especially any that is receiving much of a subsidy from the hospital. Beware new grads with business experience and drive. :)
 
I thought anesthesia was considered a road speciality, but not now. Now, there are issues with CRNA, less partnership opportunites, funding cuts more than other specialities, etc. Any opinions.
 
officedepot said:
exactly! A new group could just as easily form and if possible offer a lower rate to the hospital. Assuming the hospital has no long term contract they can't get out of with a group of anesthesia docs a new one could definitely come in. Think about it... patients don't choose a hospital because of their anesthesiologist. They go there because of their surgeons. So for example an anesthesia group has far less clout than a surgery group thus allowing for an easier source of competition in that field...
Click to expand...

My group has more than 60 fellowship trained anesthesiologists. Good luck putting your group together to under bid our contract. It's hard to find 5 people worth hiring. The hospital wanted us all to become employees vs our corporation. We declined their offer. They can play hardball with the stipend, but they might find availability for coverage for unfunded mandates and future expansion limited. Our situation is odd and complex though. In any case, there's no way they could realistically replace us without crippling fallout that would damage the "brand". Can't have that. Smaller groups don't have that kind of protection.
Lysinee, if I changed jobs I would not accept a private practice job that was not on a partnership track, unless it was eat what you kill. There are still good jobs out there, but people who are very geographically limited to tight markets can find themselves in a difficult position. Our fellows all have good jobs lined up, except for one who is struggling to get a break in one of the hardest markets. I'm not worried about CRNAs taking my job. They could help to cause salaries too fall, though theirs will first as they saturate more and more markets. Places like mine can cushion the blow by increasing efficiency and maximizing productivity. We're the opposite of that now.;) Nobody really has any idea what things will look like in 10-20 years. Too many variables to consider. I'd go into anesthesia again. I also think that ths partner track positions will open up again. There is a lot of fear and uncertainty out there about the next 5-10 years, also people have held off on retiring because of recent losses. We have a couple of them. They're going to be leaving in the next couple years. You can only delay retirement so long.
 
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Lysinee said:
I thought anesthesia was considered a road speciality, but not now. Now, there are issues with CRNA, less partnership opportunites, funding cuts more than other specialities, etc. Any opinions.
Click to expand...

This could also apply to other ROAD specialties - notably radiology. From talking with my advisers and other rads people when I was deciding between anesthesia and rads, they are facing comparable issues between greater reimbursement cuts, outsourcing readings, greater fellowship emphasis, etc.
 
IlDestriero said:
My group has more than 60 fellowship trained anesthesiologists. Good luck putting your group together to under bid our contract. It's hard to find 5 people worth hiring. The hospital wanted us all to become employees vs our corporation. We declined their offer. They can play hardball with the stipend, but they might find availability for coverage for unfunded mandates and future expansion limited. Our situation is odd and complex though. In any case, there's no way they could realistically replace us without crippling fallout that would damage the "brand". Can't have that. Smaller groups don't have that kind of protection.
Lysinee, if I changed jobs I would not accept a private practice job that was not on a partnership track, unless it was eat what you kill. There are still good jobs out there, but people who are very geographically limited to tight markets can find themselves in a difficult position. Our fellows all have good jobs lined up, except for one who is struggling to get a break in one of the hardest markets. I'm not worried about CRNAs taking my job. They could help to cause salaries too fall, though theirs will first as they saturate more and more markets. Places like mine can cushion the blow by increasing efficiency and maximizing productivity. We're the opposite of that now.;) Nobody really has any idea what things will look like in 10-20 years. Too many variables to consider. I'd go into anesthesia again. I also think that ths partner track positions will open up again. There is a lot of fear and uncertainty out there about the next 5-10 years, also people have held off on retiring because of recent losses. We have a couple of them. They're going to be leaving in the next couple years. You can only delay retirement so long.
Click to expand...

Thanks for the input, much appreciated! Do you find this business setup works well? I am finding this to be a pretty popular setup for anesthesiologists.
 
officedepot said:
exactly! A new group could just as easily form and if possible offer a lower rate to the hospital. Assuming the hospital has no long term contract they can't get out of with a group of anesthesia docs a new one could definitely come in. Think about it... patients don't choose a hospital because of their anesthesiologist. They go there because of their surgeons. So for example an anesthesia group has far less clout than a surgery group thus allowing for an easier source of competition in that field...
Click to expand...

You are very much in the wrong if you believe it's that easy to just "start up" a new group for anesthesia - or any specialty, for that matter. These groups tend to be (a) huge and (b) very well established. It's near impossible especially in urban areas to be competitive with them.
 
officedepot said:
exactly! A new group could just as easily form and if possible offer a lower rate to the hospital. Assuming the hospital has no long term contract they can't get out of with a group of anesthesia docs a new one could definitely come in. Think about it... patients don't choose a hospital because of their anesthesiologist. They go there because of their surgeons. So for example an anesthesia group has far less clout than a surgery group thus allowing for an easier source of competition in that field...
Click to expand...

This sounds like unrealistic idealism to me. How are you supposed to outcompete the large, well-established anesthesia group, much less attract other physicians to your startup? Also, your treatment of "entitlement" as you put it also seems to be ignoring reality; its not that newly board-certified physicians are feeling entitled, its the expectations from decades of precedent. It's how its worked in the medical field, and if those opportunities are drying up in specific fields (like anesthesia, apparently), then that reduces to market-driven incentive for an MD to go into that field.

You were bashing liberals earlier in this thread, but this ungrounded idealism makes you sound like one
 
Lysinee said:
I thought anesthesia was considered a road speciality, but not now. Now, there are issues with CRNA, less partnership opportunites, funding cuts more than other specialities, etc. Any opinions.
Click to expand...

Anesthesia is still greatly part of ROAD, but the market is getting worse compared with a few years ago. Same can be said of Radiology. Ophthalmology has had market trouble for years now.

What do you define as ROAD (other than the letters) anyway? Radiology and Anesthesiology are the top two earners of the ROAD, and neither of them require the same sort of office setup (read: overhead) as the other two. If you ask me, that in and of itself makes RA > than OD.
 
To be honest, all specialties have problems. If you have the scores to enter a ROAD specialty, no matter how the future turns out you'll still make great income.

Psych=psychologists getting prescribing rights
Optho= optometrists getting surgery rights
FP,Peds= NP's can practice on their own
Derm and Anesthesia: PA's in derm and CRNA's in reduce the need for docs (one Anes covering 4 rooms with CRNAs'=3 less Anes needed.)
Reds: Because of computer systems like Nighthawk, soon each radiologist will be competing with every other radiologist for business. Intense competition = salary becomes less.
Surgery= People dont want to get surgery. So as drugs become better, most surgical problems are now treated medically. Europeans now treat early appendicitis with antibiotics
Dentists=fluoride in drinking water!! now people have good teeth
Podiatrists=because of the internet, now there's a entire group of people with foot fetishes >> people take better care of their feet
Plastic surgeon=because of shows like Ugly Betty, people are more accepting of their ugliness.:laugh:
 
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Reactions: 1 user
Oxer45 said:
Podiatrists=because of the internet, now there's a entire group of people with foot fetishes >> people take better care of their feet
Plastic surgeon=because of shows like Ugly Betty, people are more accepting of their ugliness.:laugh:
Click to expand...

lol these two are ridic
 
Oxer45 said:
To be honest, all specialties have problems. If you have the scores to enter a ROAD specialty, no matter how the future turns out you'll still make great income.

Psych=psychologists getting prescribing rights
Optho= optometrists getting surgery rights
FP,Peds= NP's can practice on their own
Derm and Anesthesia: PA's in derm and CRNA's in reduce the need for docs (one Anes covering 4 rooms with CRNAs'=3 less Anes needed.)
Reds: Because of computer systems like Nighthawk, soon each radiologist will be competing with every other radiologist for business. Intense competition = salary becomes less.
Surgery= People dont want to get surgery. So as drugs become better, most surgical problems are now treated medically. Europeans now treat early appendicitis with antibiotics
Dentists=fluoride in drinking water!! now people have good teeth
Podiatrists=because of the internet, now there's a entire group of people with foot fetishes >> people take better care of their feet
Plastic surgeon=because of shows like Ugly Betty, people are more accepting of their ugliness.:laugh:
Click to expand...

:po
 
Oxer45 said:
To be honest, all specialties have problems. If you have the scores to enter a ROAD specialty, no matter how the future turns out you'll still make great income.

Psych=psychologists getting prescribing rights
Optho= optometrists getting surgery rights
FP,Peds= NP's can practice on their own
Derm and Anesthesia: PA's in derm and CRNA's in reduce the need for docs (one Anes covering 4 rooms with CRNAs'=3 less Anes needed.)
Reds: Because of computer systems like Nighthawk, soon each radiologist will be competing with every other radiologist for business. Intense competition = salary becomes less.
Surgery= People dont want to get surgery. So as drugs become better, most surgical problems are now treated medically. Europeans now treat early appendicitis with antibiotics
Dentists=fluoride in drinking water!! now people have good teeth
Podiatrists=because of the internet, now there's a entire group of people with foot fetishes >> people take better care of their feet
Plastic surgeon=because of shows like Ugly Betty, people are more accepting of their ugliness.:laugh:
Click to expand...

:thumbup:
 
It was pointed out before that if you normally have 100 new job openings for anesthesia and 100 new grads, they get good jobs. But if even 20% of their work can be done by CRNA, there is now a surplus of md anesthesia. So employers have no need to give you partnerships. "Bad market"=bad.:eek:
 
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