200+ Unfilled EM spots in 2022 match

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Every anesthesia rotation that has ever existed is fun and amazing (do your own cases, intubate, get out early!)- Unfortunately this does medical students a disservice as most anesthesia jobs are not like this. It’s hard to convey that to rotating students as what they experience during a rotation is unlike the reality of being an attending (there are exceptions obviously- I’m thankful that I’m in a practice where I get to do my own cases).

And apparently the student at Michigan never got the memo about ER.

I agree with you- these students probably had an amazing experience. And I wish them nothing but the best- I really do. But boy, if you’re smart enough to go to a top medical school, I’d expect you to do your homework. Or heed the warnings. Especially ER. Maybe ER will become like anesthesia in 1996, with an eventual large upswing. But given what we know now and the trends for such hospital based specialties, I don’t know how anyone can enter such a field.
I personally think the ER predictions are not true. I think this is the time to go into ER. Anesthesia will be all CRNAs in the next 20 years,(maybe 10) with a few fire fighter MDs putting out fires and doing blocks and epidurals at a frenetic pace. And these CRNAs have stopped taking direction from MDs a long while ago after all they are equivalent according to the AANA. IN fact they too are Anesthesiologists...... albeit nurse anesthesiologists. It is not only not enjoyable, but only a few people can do that kind of job well. The rest will be unhappy.... very unhappy... That is my prediction.
I know it feels good to these applicants that they have matched into Anesthesia, but that doesnt mean they will like the job and moreover the politics of the job.

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Everything you say is correct. I still am not Bullish on anesthesia. There are many problems with this field long-term that will not be fixed. It is anything but stable.

Dude this is the direction medicine as a whole is going. Run like a business, corporate execs penny pinching to make their fat bonuses. Clinicians have no power. Patients exist as entities to extract money out of. We see this already with huge hospital systems, private equity, and dying private practice groups. We are all just a cog in a big wheel where patient lives and risk are weighed against cost savings. Having the most skilled and experienced physicians only make sense if the cost of malpractice and ligitation from midlevel mistakes exceed the salary premium that physicians command.
 
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I personally think the ER predictions are not true. I think this is the time to go into ER. Anesthesia will be all CRNAs in the next 20 years,(maybe 10) with a few fire fighter MDs putting out fires and doing blocks and epidurals at a frenetic pace. And these CRNAs have stopped taking direction from MDs a long while ago after all they are equivalent according to the AANA. IN fact they too are Anesthesiologists...... albeit nurse anesthesiologists. It is not only not enjoyable, but only a few people can do that kind of job well. The rest will be unhappy.... very unhappy... That is my prediction.
I know it feels good to these applicants that they have matched into Anesthesia, but that doesnt mean they will like the job and moreover the politics of the job.
Guess who has been predicting this same scenario since 2007? But, I have been wrong in terms of the outcome, mostly. What is happening is a narrowing of the salary gap between CRNA and MD/DO providers. What used to be a 100% wage gap, and still is for 1/2 the practices out there, is more like at 50-60% wage gap between providers when one accounts for overtime. My prediction is this wage gap will narrow to 25-30% over the next decade making the 1:3 coverage model as expensive as all physician care in many places. That said, the need for providers is not decreasing so job security looks quite good.

COLA and overall pay relative to inflation is an issue facing physician providers as well as the single payer model for the nation. No other specialty does as poorly as anesthesia under a 100% CMS model. For those out there making hay while the sun shine suns I wish you success because I wouldn't bet on the current payor model for the next generation of attendings.
 
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Medicine is/was weird. No new medical school (LCME) from 1976 (university of south florida) all the way to year 2000. Since 2000 tons of new lcme medical schools 17? I believe. Plus all the DO schools.

Jobs report said rads/em/anesthesia over supplied in 1994. That’s what caused 1996
Being the worst (aka easiest year to match or get a job in 1996 residency class)

Historically those same finishing residents (many of them not the greatest) accounted for horrible ABA written and oral passing rates in 2000-2002 years. I think the passing rate was in the high 60s for first time test takers (vs in the high 80s in this current era)

The best of the best (in my opinion) were med students entering residency in 1990. They were simply the most competitive Sadly as they finished in 1994. Lack of jobs. Cause many to do fellowships they really didn’t want to.

Starting salary was as low as 70k in the south in 1995. My family members were paid 110k for full time ob cardiac trauma etc in 1996 year. The salaries were horrible in many large cities.


Most of the anesthesiologists at my first job out of residency were a product of this era. They were some of the dumbest (and perhaps coincidently most unethical) individuals I’ve ever encountered in medicine. So this historical perspective totally makes sense.
 
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Dude this is the direction medicine as a whole is going. Run like a business, corporate execs penny pinching to make their fat bonuses. Clinicians have no power. Patients exist as entities to extract money out of. We see this already with huge hospital systems, private equity, and dying private practice groups. We are all just a cog in a big wheel where patient lives and risk are weighed against cost savings. Having the most skilled and experienced physicians only make sense if the cost of malpractice and ligitation from midlevel mistakes exceed the salary premium that physicians command.
Why don’t anesthesiologists (and physicians more generally) form a union of sorts and just refuse to work with midlevels.

Every other field seems to encourage unionization (I mean just look at the MLB, NFL, NBA to show that unions aren’t antithetical to higher paying jobs)
 
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Guess who has been predicting this same scenario since 2007? But, I have been wrong in terms of the outcome, mostly. What is happening is a narrowing of the salary gap between CRNA and MD/DO providers. What used to be a 100% wage gap, and still is for 1/2 the practices out there, is more like at 50-60% wage gap between providers when one accounts for overtime. My prediction is this wage gap will narrow to 25-30% over the next decade making the 1:3 coverage model as expensive as all physician care in many places. That said, the need for providers is not decreasing so job security looks quite good.

COLA and overall pay relative to inflation is an issue facing physician providers as well as the single payer model for the nation. No other specialty does as poorly as anesthesia under a 100% CMS model. For those out there making hay while the sun shine suns I wish you success because I wouldn't bet on the current payor model for the next generation of attendings.
Wouldn’t one think that Calcare’s failure probably makes single payer DOA for at least the next few decades? I mean if California couldn’t pass single payer with supermajorities and the governorship, I don’t think it will pass anywhere
 
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Wouldn’t one think that Calcare’s failure probably makes single payer DOA for at least the next few decades? I mean if California couldn’t pass single payer with supermajorities and the governorship, I don’t think it will pass anywhere
You would think our spending 6-8 trillion dollars we don't have the past 2 years would deter any sane person from a single payer system. But "sane" and Congress have nothing to do with each other.
 
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Why don’t anesthesiologists (and physicians more generally) form a union of sorts and just refuse to work with midlevels.

Every other field seems to encourage unionization (I mean just look at the MLB, NFL, NBA to show that unions aren’t antithetical to higher paying jobs)


I think that’s the idea behind USAP, NAPA, Envision, Somnia, etc. The problem with unions is that the union bosses get most of the perks and the profits.
 
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What do you see as the floor for Anesthesiologists over the next few decades? Maybe corporate employment with current CRNA wages and no way to avoid supervision? What would happen to CRNAs if things bottom out?
Pushing down to CRNA salary seems entirely likely. I can see the hospitals refusing to pay a stipend for any form of call/underpayment coupled with using their induced "shortage" as an excuse to hire independent "cheaper" CRNAs. Then we will essentially compete with them. When that happens though I don't see why we would agree to supervise anyone since the CRNAs will have achieved salary equivalence. In all reality the CRNAs probably are pay equivalent to physicians in lots of institutions given they often don't take call and have hours capped at 40/wk yet get full benefits.

Idk, it still seems better than primary care in that scenario if not part of the "ROAD" to happiness it was/is. Better job security than fields like Rad Onc or Pathology where its hard to find a job period, and more flexible fellowships than fields like Dermatology or Radiology if those went sour due to PE, AI, etc.

Primary care is a mixed bag but the 7 on 7 off hospitalist jobs seem pretty good.

Honestly if my salary got depressed too much more I'd retrain in another field if I could do an abbreviated thing (e.g. 2 yrs of family medicine to complete a residency, 1 yr of sleep medicine fellowship, an "aesthetic medicine" pivot, and so forth). Or I'd just leave medicine altogether and do consulting. Or heck maybe just retire super early and call it a day. Anesthesiology is cool and I enjoy my job but a lot can go wrong and it's stressful taking a ton of call, nights, weekends, holidays, and the like.
 
What do you see as the floor for Anesthesiologists over the next few decades? Maybe corporate employment with current CRNA wages and no way to avoid supervision? What would happen to CRNAs if things bottom out?

Idk, it still seems better than primary care in that scenario if not part of the "ROAD" to happiness it was/is. Better job security than fields like Rad Onc or Pathology where its hard to find a job period, and more flexible fellowships than fields like Dermatology or Radiology if those went sour due to PE, AI, etc.


Path job market is red hot now. Again showing it’s hard to predict these things.
 
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Pretty good outcome all things considered. Most graduating USMDs and USDOs matched. Most programs filled.
 
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What do you see as the floor for Anesthesiologists over the next few decades?

The floor is CRNA wages and medical direction being dismantled . That is where it is headed. So hence, everyone goes into a room like I do everyday and sit their own cases. It actually is VERY relaxing. Some people will get CRNA care, and some people get MD care. There will be no mix and match. MDs will not be responsible for the CRNAs. Every state will be opt out. So those of you who think sitting your own case is boring, or havent done it in a while the future is coming to an OR near you.
 
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The floor is CRNA wages and medical direction being dismantled . That is where it is headed. So hence, everyone goes into a room like I do everyday and sit their own cases. It actually is VERY relaxing. Some people will get CRNA care, and some people get MD care. There will be no mix and match. MDs will not be responsible for the CRNAs. Every state will be opt out. So those of you who think sitting your own case is boring, or havent done it in a while the future is coming to an OR near you.
Haven’t some states (south Dakota, florida, texas, colorado etc.) already banned it. Do you see these bill that failed being revived?
 
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The floor is CRNA wages and medical direction being dismantled . That is where it is headed. So hence, everyone goes into a room like I do everyday and sit their own cases. It actually is VERY relaxing. Some people will get CRNA care, and some people get MD care. There will be no mix and match. MDs will not be responsible for the CRNAs. Every state will be opt out. So those of you who think sitting your own case is boring, or havent done it in a while the future is coming to an OR near you.
While I think this is possible the issue that inevitably comes up is call and after hours work.

If I’m paid the same as a CRNA, what is my incentive to take call, do hearts, or not demand to be clocked out at 3pm every day M-F only? Obviously now it’s partly my professional attitude and partly the salary difference. But if all hourly, that falls apart fairly quickly I think as a general rule.
 
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While I think this is possible the issue that inevitably comes up is call and after hours work.

If I’m paid the same as a CRNA, what is my incentive to take call, do hearts, or not demand to be clocked out at 3pm every day M-F only? Obviously now it’s partly my professional attitude and partly the salary difference. But if all hourly, that falls apart fairly quickly I think as a general rule.
In that model there is a sudden oversupply of providers. Remember every doc that was “medically directing “ is now available to do a room.
 
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The floor is CRNA wages and medical direction being dismantled . That is where it is headed. So hence, everyone goes into a room like I do everyday and sit their own cases. It actually is VERY relaxing. Some people will get CRNA care, and some people get MD care. There will be no mix and match. MDs will not be responsible for the CRNAs. Every state will be opt out. So those of you who think sitting your own case is boring, or havent done it in a while the future is coming to an OR near you.
More like a few MDs providing “general oversight “ to the CRNA department. Anesthetic disasters do happen and usually the hospital likes to blame someone with an MD….
 
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In that model there is a sudden oversupply of providers. Remember every doc that was “medically directing “ is now available to do a room.
I don;t think so. If there is, not by much. This is where it is going. 10 years this will be the norm.
 
While I think this is possible the issue that inevitably comes up is call and after hours work.

If I’m paid the same as a CRNA, what is my incentive to take call, do hearts, or not demand to be clocked out at 3pm every day M-F only? Obviously now it’s partly my professional attitude and partly the salary difference. But if all hourly, that falls apart fairly quickly I think as a general rule.
It is either take call or don't work. That will be the option.
 
Anesthetic disasters do happen and usually the hospital likes to blame someone with an MD….
Disasters do happen. If everyone is opt out, then the blame falls on whoever the independent provider is. Oh and by the way, you are the only one worried about liability and blame and bad outcomes. Administrators and nurses do not worry themselves with this sorta thing. Even when bad **** happens.
 
Disasters do happen. If everyone is opt out, then the blame falls on whoever the independent provider is. Oh and by the way, you are the only one worried about liability and blame and bad outcomes. Administrators and nurses do not worry themselves with this sorta thing. Even when bad **** happens.
I know of jobs, usually in BFE, where it is an independent CRNA model with an MD in house “to consult when needed”. MD doesn’t have to go in the room or anything just be available. I assume the role is to help out in a disaster and/or to be the face of the department when **** hits the fan. Maybe coming soon to a hospital near you. Either way the job market will be affected pretty much the same way as a completely independent CRNA model.
 
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The anesthesia lifestyle, while not easy or glamorous, does have its perks.


Hey man, we have soggy turkey sandwiches, frozen microwave pizzas, and all the cereal you could want in our lounge. Who says it’s not glamorous?!
 
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Either way the job market will be affected pretty much the same way as a completely independent CRNA model.
Yes. Medical direction will be dismantled at some point in the future. I give it 10-15 years. Prior to the affordbale care act I was vehemently pushing for 1 MD 1 patient solo care but there is no coming back from the damage done to quality with obama care. The only thing i can foresee that would maintain medical direction is pushing for AAs in all 50 states and having AAs compete directly with CRNAs. It really isnt too late.
 
Yes. Medical direction will be dismantled at some point in the future. I give it 10-15 years. Prior to the affordbale care act I was vehemently pushing for 1 MD 1 patient solo care but there is no coming back from the damage done to quality with obama care. The only thing i can foresee that would maintain medical direction is pushing for AAs in all 50 states and having AAs compete directly with CRNAs. It really isnt too late.
It is somewhat funny, doing research on all this CRNA stuff. There are threads from the early 2000s basically saying the same exact thing and it seems like not too much has changed. Maybe it has changed but some of the threads make it seem like all drs would be working side gigs to make ends meet or standing in breadlines by now








And that is with Google favoring more recent results.
 
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It is somewhat funny, doing research on all this CRNA stuff. There are threads from the early 2000s basically saying the same exact thing and it seems like not too much has changed. Maybe it has changed but some of the threads make it seem like all drs would be working side gigs to make ends meet or standing in breadlines by now








And that is with Google favoring more recent results.
Staffing ratios have increased. 1:4 has gone from rare to common.
MD Anesthesia as a percentage of anesthetics nationally is down.
Docs are working harder to maintain their incomes.
Non Medically directed CRNA anesthesia is up.
The ratio CRNA/MD hourly rate is up.

Not breadlines. But not a good trend that shows no sign of reversing.
 
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Staffing ratios have increased. 1:4 has gone from rare to common.
MD Anesthesia as a percentage of anesthetics nationally is down.
Docs are working harder to maintain their incomes.
Non Medically directed CRNA anesthesia is up.
The ratio CRNA/MD hourly rate is up.

Not breadlines. But not a good trend that shows no sign of reversing.
When I recently had an outpatient surgery, my CRNA introduced himself as a doctor of anesthesiology. Unfortunately in my field I worry the same thing is happening; I have patients referred to ER that have A. No pathology B. Don’t need my eval and C. Have never been seen by a physician for this complaint. It’s a race to the bottom in terms of standards. I imagined there had to be a breaking point but I think I’m mistaken. Not to say that the physician consults I get are always much better but at least we’ve agreed on a minimum standard
 
When I recently had an outpatient surgery, my CRNA introduced himself as a doctor of anesthesiology. Unfortunately in my field I worry the same thing is happening; I have patients referred to ER that have A. No pathology B. Don’t need my eval and C. Have never been seen by a physician for this complaint. It’s a race to the bottom in terms of standards. I imagined there had to be a breaking point but I think I’m mistaken. Not to say that the physician consults I get are always much better but at least we’ve agreed on a minimum standard

You should have complained to the hospital for misrepresentation of qualifications
 
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When I recently had an outpatient surgery, my CRNA introduced himself as a doctor of anesthesiology. Unfortunately in my field I worry the same thing is happening; I have patients referred to ER that have A. No pathology B. Don’t need my eval and C. Have never been seen by a physician for this complaint. It’s a race to the bottom in terms of standards. I imagined there had to be a breaking point but I think I’m mistaken. Not to say that the physician consults I get are always much better but at least we’ve agreed on a minimum standard
If this is true, you can absolutely still contact the hospital. Mis representation of credentials in the hospital is not ok. That individual needs to be corrected.
 
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It is somewhat funny, doing research on all this CRNA stuff. There are threads from the early 2000s basically saying the same exact thing and it seems like not too much has changed. Maybe it has changed but some of the threads make it seem like all drs would be working side gigs to make ends meet or standing in breadlines by now








And that is with Google favoring more recent results.
You will have a job. The trend for more cases/anesthetics is up. CRNAs won't ever take over the field to the point you won't have a job giving or supervising anesthesia. But, they have been chipping away at it for decades. I would describe it as the "paper cuts" model where they keep at it over decades until you finally bleed out. The end game is and always has been independent, solo practice for the AANA. Regardless of income that is the goal.

Anesthesiology is "dying" in the sense that the nurses are winning the very long battle to turn the profession into a nurse driven provider field from a medical specialty. Again, the need for Nurse Anesthesiologists or Physician Anesthesiologists remains very high for the future.
 
If this is true, you can absolutely still contact the hospital. Mis representation of credentials in the hospital is not ok. That individual needs to be corrected.

Really? Show me any state law or hospital bylaws cut and paste or CRNA employment contract cut and paste where a CRNA or other APN who has a PhD, DNP, DNAP, etc. can’t refer to themselves as “doctor” when speaking to patients.

The term physician enjoys this protection but not “doctor”.
 
You will have a job. The trend for more cases/anesthetics is up. CRNAs won't ever take over the field to the point you won't have a job giving or supervising anesthesia. But, they have been chipping away at it for decades. I would describe it as the "paper cuts" model where they keep at it over decades until you finally bleed out. The end game is and always has been independent, solo practice for the AANA. Regardless of income that is the goal.

Anesthesiology is "dying" in the sense that the nurses are winning the very long battle to turn the profession into a nurse driven provider field from a medical specialty. Again, the need for Nurse Anesthesiologists or Physician Anesthesiologists remains very high for the future.
Of course that end goal is very stupid and not at all in the interest of its members. What happens when independence is gained? You suddenly have a situation where if the MD is not signing the chart, he is competing for your job. It will be a race to the bottom in terms of salary and hours for CRNAs and MD’s
 
Again, the need for Nurse Anesthesiologists or Physician Anesthesiologists remains very high for the future.
I think you are right, but it will be at vastly different terms. It will be all stool sitting. Which is fine, i do not mind that but not at the same wages as a nurse.
 
Really? Show me any state law or hospital bylaws cut and paste or CRNA employment contract cut and paste where a CRNA or other APN who has a PhD, DNP, DNAP, etc. can’t refer to themselves as “doctor” when speaking to patients.

The term physician enjoys this protection but not “doctor”.
 
Really? Show me any state law or hospital bylaws cut and paste or CRNA employment contract cut and paste where a CRNA or other APN who has a PhD, DNP, DNAP, etc. can’t refer to themselves as “doctor” when speaking to patients.

The term physician enjoys this protection but not “doctor”.

Look its an inflated job title that sounds important, and is meant to bolster the nurses ego and to misrepresent them to patients. There is no other reason. A nurse calling themselves Doctor of Anesthesiology is like a window washer calling themselves a Vision Clearance Engineer
 
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Really? Show me any state law or hospital bylaws cut and paste or CRNA employment contract cut and paste where a CRNA or other APN who has a PhD, DNP, DNAP, etc. can’t refer to themselves as “doctor” when speaking to patients.

The term physician enjoys this protection but not “doctor”.
I know this is SDN, and people say a bunch of stuff, but you should contact the hospital. I really would if I found out after the fact that my ID “doctor” or cardiology “doctor” was not a physician. I trust most of my NP and CRNA colleagues but they should not be representing themselves as physicians
 
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