Dismiss Notice
SDN members see fewer ads and full resolution images. Join our non-profit community!

Anesthesia vs IM

Discussion in 'Anesthesiology' started by msmith83, Feb 25, 2014.

  1. msmith83

    Joined:
    Dec 22, 2013
    Messages:
    75
    Likes Received:
    4
    Sorry if this topic has been done before but I was wanting some general advice on choosing IM vs Anesthesia. I have a strong interest in both but there are a couple of things in Anesthesia that concern me. First I was wondering about concentrating for long periods of time, which isn't my best quality.... I've been known to space out in lectures quite a bit. Then there's the whole emergent aspect of it, I generally am not good at making decisions very rapidly and am worried this would also cause issues in Anesthesia as well.

    I'm planning on trying to do an away elective in Anesthesia this upcoming year so I know that will help, but I just wanted any kind of incite that any of you had that could possibly help.

    Any advice is greatly appreciated, thanks
     
  2. Thread continues after this sponsor message. SDN Members do not see this ad.

  3. demubckma

    Joined:
    Jan 19, 2014
    Messages:
    13
    Likes Received:
    14
    Status:
    Non-Student
    I would say that having difficulty concentrating for long periods of times would not be a problem for Anesthesia only.

    As far as decision-making goes, however, it's not only during emergence where you would potentially have to make quick decisions to avoid a bad outcome, but any time during the perioperative period. In IM, you have lots of time (maybe too much time??) to make decisions about patient plans, unless you're working in a MICU. Even then, you would have a bit more luxury to mull over a decision than in the OR.

    Don't count yourself out though and certainly give the away elective a go.

    Good luck in your decision!
     
    #2 demubckma, Feb 25, 2014
    Last edited: Feb 25, 2014
    DermViser, msmith83 and AnesDiva like this.
  4. msmith83

    Joined:
    Dec 22, 2013
    Messages:
    75
    Likes Received:
    4
    Thanks for the reply, concentration is not usually an issue for me so long as I'm doing something I enjoy. I just know that from what I've read on Anesthesiology that just seems to be an extremely important quality in Anesthesia and its not my strongest.
     
  5. Gaseous Clay

    Gaseous Clay ASA Member

    Joined:
    Apr 1, 2008
    Messages:
    259
    Likes Received:
    66
    Status:
    Attending Physician
    I would definitely stay away from anesthesia as well as emergency medicine and surgery just to throw a few other fields out there.
     
    DermViser likes this.
  6. sakata8242

    Joined:
    May 5, 2011
    Messages:
    119
    Likes Received:
    29
    Status:
    Resident [Any Field]
    I hated the endless rounding on medicine, the social work/discharge aspect, endless note writing, and consult calling. Some sub specialties are not entirely this way, but it's still 3 years of it just to get to a coveted EP/Cards/GI fellowship....

    And I also dislike clinic/managing chronic problems.

    Basically left only a few options, liked anesthesia the best.
     
    DermViser, Psai and IkeBoy18 like this.
  7. msmith83

    Joined:
    Dec 22, 2013
    Messages:
    75
    Likes Received:
    4
    Thanks for the reply, I feel the same way when it comes to pretty much everything you just mentioned. If I did go into medicine I would most likely want to specialize as well, though I'm not really sure in what. The thing about IM that I do like is not having to work for the hospital, in that I could either have my own practice or become a partner somewhere. Of course I don't know much about Anesthesia practice options but most of their work is done in hospitals I'm sure.
     
  8. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    IM is versatile - easily the most versatile field in the business. You can do outpatient, inpatient, intense, chill, procedural, non-procedural. You can be on the forefront of research if you wanted, or you can run your own business and answer to no one. I'm going into allergy/immunology (derm of IM) so I'm choosing the latter, but that's just one of many many options.
    And don't let the 3 years of medicine residency deter you too much. I agree that it does suck having to go through months and months of gen med when you know you won't be doing it for a career, but PGY3 is a breeze at most programs. Residents at most non-malignant programs only have to do 3-4 inpatient months as a third year and they can easily make 50-75k from moonlighting alone. One of the current heme onc fellows who was a PGY3 last year made almost 100k moonlighting (not including resident salary), which he did without coming close to breaking hours.
     
  9. TeamZissou

    TeamZissou jaferd

    Joined:
    Sep 29, 2008
    Messages:
    1,402
    Likes Received:
    31
    Status:
    Resident [Any Field]
    Posts like this are encouraging, as I'm about to enter IM.
     
    OutRun likes this.
  10. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    I was in the same position years ago. I was actually offered both a categorical and a prelim IM position at the same time.

    If I were you, I would choose IM and go from there. Not because anesthesia is not fit for you (you can learn how to make decisions quickly, how to treat first and debate with yourself second), but because of the future of the specialty. Otherwise, anesthesia is a way more interesting specialty than IM for anybody who loves physiology, pathophysiology and internal medicine - you can actually run circles around some internists when about fast decision-making and treatment based on limited information. I find most internists boring (as doctors), and most internal medicine books the same (a lot of recipes, very little independent thinking) - and this coming from somebody who could never imagine doing anything else but internal medicine, and who used to pass out in the OR during medical school.

    But, again, the future of anesthesia is pretty murky, and I would not give up the flexibility IM allows. With IM, though, it's very important to get in a good academic program with high chances of fellowship post-residency. Stay away from primary care; it will kill your soul and put you at high risk for losing your job to midlevels.
     
    #9 FFP, Mar 1, 2014
    Last edited: Mar 1, 2014
    OutRun, bashwell, qmcat and 2 others like this.
  11. wolverine09

    Joined:
    Dec 17, 2009
    Messages:
    39
    Likes Received:
    3
    Status:
    Medical Student
    which field offers the best lifestyle though? it appears that with anesthesia (and w/ the lack of continuity of care), you have more freedom to go on vacations/take time off? and with the trend of private practices been bought out and getting larger, does that mean less call for anesthesiologists due to call being spread out amongst a larger group of anesthesiologists? how is call/vacation handled in academic medicine?

    basically, I am interested in your thoughts on what the future outlook of the anesthesiologist lifestyle will be like vs. IM lifestyle
     
    #10 wolverine09, Mar 1, 2014
    Last edited: Mar 1, 2014
  12. msmith83

    Joined:
    Dec 22, 2013
    Messages:
    75
    Likes Received:
    4
    Thanks for the reply, a lot of great points

    Could you elaborate a little on the future being murky for Anesthesia? Do you mean as far as demand goes or just in general and do you think the same applies for Anesthesia subspecialties? This is another question I had about anesthesia, I know nobody can predict the future but I was curious about that. As far as IM goes, I would say I'm fairly certain if I did go into IM that I would want to specialize and I wonder if thats a dangerous thing to do. Because when it comes down to it, what if I can't get into the specialties I'm interested in due to them becoming more and more competitive.
     
  13. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Don't underestimate the versatility of anesthesia. Pain and critical care are quite different and interesting (and you dont have to suffer IM residency to get it), not to mention the variety of patient populations from psych/ect to ob to peds amd hearts. General anesthesia I think is a lot like doing general IM as far as prospects but fellowships are the way to go with both fields so just decide on what you like as a primary specialty and after that decide on what you would want to specialize in. Good luck!
     
    DocOk likes this.
  14. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    Say what? With the exception of pain and critical care (which you can do from IM AND be boarded in pulmonary), anesthesia fellowships are still anesthesia. You have to like anesthesiology to like those sub-specialties. With IM, practicing interventional cardiology, EP, GI, or allergy/immunology is nothing like practicing general IM. The bottom line is this - if you like anesthesiology (or interventional pain), then do anesthesia. If any of the IM subspecialties interest you, then do IM.
     
    bashwell, Psai and DermViser like this.
  15. DermViser

    Joined:
    Apr 4, 2009
    Messages:
    17,616
    Likes Received:
    12,906
    Status:
    Resident [Any Field]
    Not to mention, in Internal Medicine, you are NO WAY guaranteed in matching into GI, Cardiology, or Allergy/Immunology, which are some of the most competitive fellowships after Internal Medicine. You are directly competing and compared to your peers of your residency class for those fellowships. At least with Anesthesia, you're still a specialist even if you don't do a fellowship.

    If you enter IM, you have to be prepared for the possibility of being stuck in general Internal Medicine, something I wouldn't wish on my worst enemy.
     
    #14 DermViser, Mar 1, 2014
    Last edited: Mar 1, 2014
    stsa84 likes this.
  16. Thread continues after this sponsor message. SDN Members do not see this ad.

  17. BLADEMDA

    BLADEMDA ASA Member

    Joined:
    Apr 22, 2007
    Messages:
    16,510
    Likes Received:
    2,677
    Status:
    Attending Physician

    If you match into a strong academic IM program (think name recognition here) and you EXCEL as a Resident the odds are high you will secure a nice, lucrative fellowship.
    The bottom line is the IM subspecialty route is a much better choice than Anesthesiology for an MS-4.
     
  18. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    I'm an MS4 who started with IM (thinking of fellowships) then switched into anesthesia after what I saw. Cardiologists, not to mention fellows, were not the happiest bunch. The GI doc used to complain how he wishes he had done something like anesthesia. Rheum and endocrine were boring as heck (RA and DM, respectively get really dull and made up almost the entire practice for each). I thought scopes were really cool at first but I can see how that will get old fast and it's pretty crappy, no pun intended. I hated the entire pimping and ego-boosting mentality of residents and fellows and how this study or that study showed this much percent vs that much percent better for this bs or that and then listen to them argue with so much smugness in their voice.

    None of that existed in anesthesia. I/resident/anesthesiologist got to joke with and explain things to the patient preop then think through what can happen intraop for some complicated cases and prep for that. It was really hands on and awesome seeing them do something like a pheo case or a cardiac case where someone got stabbed in the heart. Then when patients were nauseous and in pain after the procedure the anethesiologist was in the pacu, taking care of it. No social work, no ego-boosting, minimal note writing. CRNAs/CA1 were doing some basic, boring case but the complex ones were always very MD involved and I cannot imagine a CRNA doing an intraop TEE.

    Lastly, I just want to mention one more thing I noticed interviewing and that is how many residents I met who switched into anestheiology. From gen surg to urology to peds and yes, IM (a couple had already finished IM and view this as a fellowship of sorts). So again, I can see how some could like IM and the fellowships but really I hated the personalities and loved the work in anesthesiology so I chose it. Maybe I'll regret but currently I am very excited to get started.
     
  19. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    I hope you don't have student loans.
     
  20. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Yes. Think of which cardboard sign you'd rather hold in a few years: "Will pass gas for food" or "Will round, prescribe, scope for food"
     
  21. Consigliere

    Joined:
    May 28, 2008
    Messages:
    2,047
    Likes Received:
    1,608
    Status:
    Attending Physician
    DO NOT go into anesthesiology. You have been warned. Most say the field is dying; I say that it is dead.
     
  22. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    Actually, my post was meant at your being excited to start anesthesia residency.
    When CRNAs can pick and choose what they do and don't, without punishment, regardless of what the medically directing anesthesiologist wants, anesthesia as a physician-directed specialty seems to be over.
     
  23. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    I would have done anesthesiology if it wasn't for the CRNA threat, changing market forces, and knowing that you're second fiddle to the surgeon. Interesting OR cases are cool, but I'd have to say "no, thank you" to taking on that kind of liability day in and day out. Like anything in the field of medicine, things get stale - and so do "cool" anesthesia cases. When things do get stale, I'd rather be working a regular 40 hour week with zero call in clinic giving immunotherapy and pulling good cash (while answering to no one but myself) than taking attitude from the surgeon while being employed by an AMC.

    And not all IM residents/attendings act like what you describe. No one from my program quotes studies to toot his/her own horn.
     
    bashwell and CityLights like this.
  24. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Well I guess I better get used to living in a van down the river. Looking for a spot to park it now. Thanks for the advice.
     
  25. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Seems that if anything all these ACGME accredited fellowships that are starting to pop up as the gold-standard for cases is becoming more and more the way of the future. Complication in an Ob patient? Complication in a cardiac case or peds case? Why didn't your group employe fellowship-trained specialists? It's new right now but this will become gold standard. Maybe I am wrong about all this like I said from the beginning... oh well, pray for my soul please.
     
  26. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Isn't this what they said in the '30s '50s '70s '90s? Guess who were the smart ones... It's really like the stock market, buy low and sell high. If you honestly believe that anesthesiology is going to disappear as a whole then please avoid it. If you think this bs is all cyclical that undergo adaptations and has highs and lows with a low approaching soon (and more highs to come) then this is the time to join. Anyone who claims to know the future should quit medicine and go to Wall St. When times get rough everyone sells and thinks it's the end of the world and swear to never invest again. Those people are cowards. Everything has risks and you should evaluate the situation yourself but ultimately do something you think you will enjoy more.
     
  27. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    I guess you wouldn't be so sure of yourself if you were a stock broker. You know, that very lucrative line of work that basically disappeared when advanced information technology took over, and when transaction fees went from $70 to $7. Are you really so sure this is not what's happening in anesthesia?

    You should not do something "you think you will enjoy more". That's how people end up broke (look at all those stupid and worthless college degrees). You should do something society values and is willing to pay decently for.
     
    BorntobeDO? and QueenJames like this.
  28. wolverine09

    Joined:
    Dec 17, 2009
    Messages:
    39
    Likes Received:
    3
    Status:
    Medical Student
    again, i think its important in this debate to discuss the lifestyle of both fields. many people go into medicine to not only do rewarding work, but to raise a family and have life outside of work. one of the major attractions to anesthesiology is the perceived lifestyle, and i say perceived because Im still a student and not an anesthesiologist. it appears that with anesthesia (and w/ the lack of continuity of care), you have more freedom to go on vacations/take time off? and with the trend of private practices been bought out and getting larger, does that mean less call for anesthesiologists due to call being spread out amongst a larger group of anesthesiologists? am i correct in my assumptions and how does the future outlook of the anesthesiologist lifestyle look? your comments would be greatly appreciated
     
  29. msmith83

    Joined:
    Dec 22, 2013
    Messages:
    75
    Likes Received:
    4
    Does this hold true for the subspecialties in Anesthesia as well? or just general anesthesia?
     
  30. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    For the thousandth time, anesthesia is not a lifestyle specialty. Especially now that we are becoming employees all around the country. The parasites that live on our backs don't care about our lifestyle; they care about their own profits and "production" incentives.
     
  31. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    I agree and disagree. No, I am not sure. If I believed that it was happening then I would avoid it. But I think anesthesia is going through a transformation and I think very sick people are having higher expectations and require more advanced training than that of a CRNA. Weigh 1 ton and want surgery while smoking 2 packs earlier that day? 95 years old and want a colonoscopy because you're constipated? Ask how comfortable the GI doc is at not perforating the bowel or having nothing other than a CRNA in the room. 50 years old and delivering an implanted baby? Expect it to go smoothly? Sure lets not get a physician anesthesiologist in the room.

    I also have a strong interest in Pain and is one of my reasons for choosing anesthesia. People will pay more for staying out of pain than living longer, they prove this everyday when you ask why they aren't taking their insulin but never forget their pain meds or their scheduled ESI.
     
  32. DermViser

    Joined:
    Apr 4, 2009
    Messages:
    17,616
    Likes Received:
    12,906
    Status:
    Resident [Any Field]
    EXCELLING in an Internal Medicine residency is much easier said that done. A lot of getting into competitive, lucrative fields like GI involve a lot more than just "excelling", but a lot of politics and gamesmanship, in which you're competing against a lot more people in an IM residency vs. in Anesthesia.
     
  33. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    What do you think? If a CRNA is allowed to work in a subspecialty, even supervised, it's just a matter of time till "s/he knows better" (I have seen it in OB). And since they are the darlings of healthcare administrators (who are mostly middle-aged or older female nurses and, as a group, have a deeply ingrained hate/envy for physicians), guess who wins?
     
  34. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    I'm not in anesthesia, so I can't comment too much on their lifestyle, but I assume there will be nights - as for the quantity or the difficulty of those nights, idk.

    For internal medicine, it depends on your subspecialty. Cardiology (gen, EP, or interventional) will work you hard, regardless of pp or academic. You will probably work slightly less in academic, but I would say the hardest working people in IM academia is still cards. You will take call as well, but it will be just home call where you staff admissions and significant events with the housestaff. PP cardio is much different, as you'll be the one doing the grunt work. You will frequently go into the hospital to manage sick patients that can't be cared for by the nocturnist.

    GI is pretty varied as far as lifestyle, but it has the potential to be very chill if you just scope for cash. However, I do know of many GI guys who get KILLED in pp from doing scopes, seeing consults, seeing clinic patients, etc. But, they easily make 700k+. There are emergencies in GI, but it's much much rarer compared to cardiology.

    Pulm/CC is an up and coming field for IM that most people don't understand very well. The job market is pretty good, as most hospitals are trying to hire full time intensivists to cover their ICUs, instead of having open ICUs that are co-managed by the hospitalists. Pay is pretty good due to this increased demand, and most offers I hear about are average of 350k for 7 on/7 off. If you see clinic patients on your off weeks, then your salary easily goes up to 400-450k. Your "on" weeks will be very tough, however, and you will likely have to cover a couple of weeks of nights a year.
     
    bashwell, qmcat and DermViser like this.
  35. DermViser

    Joined:
    Apr 4, 2009
    Messages:
    17,616
    Likes Received:
    12,906
    Status:
    Resident [Any Field]
    A lot of Internal Medicine is a self-masturbatory exhibitionism intellectually. Actually doing something and correcting what the patient has? Not so much. People in Anesthesia tend to be a "cooler" bunch who get along well. Just look at how active the Anesthesia forum is here on SDN. You rarely see people from Anesthesia switch into IM. There are always people IM wanting to switch into Anesthesia.
     
    Taco Time likes this.
  36. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    Many of those really sick cases are covering by Medicare and Medicaid, jointly known as Medicrap, because they pay almost crap for your work. That's why hospitals around the nation have to charge exorbitant fees to the few suckers who are still paying for their treatment out of pocket, to compensate for all the losses from treating those sick patients. You know what a hospital's overall profit margin is? 2-3%. And that's after counting in all the patients who actually pay something for our work.

    Besides the fact that there won't be enough cases like that for everybody. Which means that the supply of anesthesiologists will be a few times higher than the demand, even in the subspecialties. Which means crappy life, crappy pay; just look at the pilots, with their $22K starting salaries.

    ROTFL. When people believe in chiropractors and all kinds of placebo-type medicine, what you do can be done by anybody who can write a narcotic prescription. Why do you think all those pain doctors are returning to anesthesia in droves? Because of the great pay and lifestyle in pain medicine? These are the guys who went into pain because they hated the OR in the first place!
     
    #34 FFP, Mar 2, 2014
    Last edited: Mar 2, 2014
  37. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    Wait, you want to make a career out of providing anesthesia to ASA infinity patients? The fact that CRNAs are cherry picking easy cases is not a thing to rejoice, since you will need those to buffer your 90 year olds with 50 co-morbidities. Because the sh**ty thing is that despite their 50 co-morbidities, their expectations for zero complications are just as high as your healthy 30 year olds.
     
    FFP likes this.
  38. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    FFP you apparently know little about pain other than what you hear from pain mills. It's a very new field and you are really ignorant if you don't understand its future. Not that it matters to you, so be it.

    Alright friends, I am done arguing and speculating. Do what you want and if you decide on your life based on what people on SDN say then you really deserve what you get (for better or worse). I would be lying if I said I am confident 100% in my decision but I think I am making the right decision. To OP, I really hope you make an informed decision. Good luck.
     
  39. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    I just love when medical students or interns call attending physicians ignorant. It's a sign of wisdom that I mostly get to see in militant nurses.
     
    BorntobeDO? likes this.
  40. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    No, doctor. You are all-knowing of the future even in subjects you are not involved in. All hail!
     
    Critical Mass REACHED likes this.
  41. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    I have been out of residency for less than 5 years, and I know of the previous crisis in the 90's, but this time it seems to be much worse, and not only for anesthesiologists, but for physicians in general.

    For me, the classical example of sh*tty medical job is family practice. Look where those guys are, after years of being micromanaged by CMS and insurance companies, even after having switched to a "care team" model, where they had NPs working for them. (Now many of those NPs are going independent, and they are also competing for the small population of patients who have good insurance that pays decently.) The PCPs are working their butts off seeing 40+ patients/day in a model which is anything but medicine. And the risk of mistakes does not go up proportionally, but exponentially with the number of patients, because of fatigue.

    Anesthesia is exactly in the same spot nowadays. We used to work solo, now we are being pushed to supervise CRNAs who try to steal as much knowledge as possible from us, before they go independent (it's just a matter of time). They are already cherry-picking the easy (read relatively healthy, relatively young, privately-insured) cases. As a consequence, we get the difficult cases who don't pay so well, and the bean counters get the feeling that CRNAs are making way more money/case for them. So the next push is for us to do/supervise as many cases as possible; the only reason we still have a 1 anesthesiologist:3 CRNAs limit is probably Medicare. (By the way I personally would never accept to be a patient in a 1:3 setting, that's how little the anesthesiologist matters there.) That's again a recipe for disaster, especially since we are directing CRNAs that don't always follow our directions (because they don't lose their license for disobeying a supervising physician). Not to speak about the stress; it's nothing like what you dream of in medical school.

    My advice is to choose a specialty where you can stand out and be your own boss (and where medical technology +/- trained monkeys cannot replace you easily in the future = almost none). Or just get a masters in something society still values. Anything else and you will be just a glorified worker in an assembly lane environment, in 10-20 years (if not already). The problem is that as demand/reimbursement for physician-level services decreases, and the supply of physicians stays the same or even increases (the more suckers the more money for lenders, medical schools etc.), you will end up making slightly more than the midlevels except with incomparable sacrifices. (Society has just decided not to give a crap about your sacrifices; just look at all the unemployed lawyers.)

    In the end, when the supply/demand ratio is f*cked up, it doesn't really matter how good you are; that's why the Great Depression was so "great".
     
    #39 FFP, Mar 2, 2014
    Last edited: Mar 2, 2014
  42. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    Please look up the minimal pain medicine-related requirements for graduating an anesthesia residency. Then look up the minimal requirements for graduating an internship. Then compare the two of them "involvement"-wise. Thanks.

    Please look on gaswork.com at the pain medicine openings, representing probably 50% of all jobs posted. Please explain why all those 100% "involved" and subspecialty board-certified pain attendings are getting out of pain, if it has such a bright future.
     
    #40 FFP, Mar 2, 2014
    Last edited: Mar 2, 2014
  43. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Maybe because ESI reimbursements and to a lesser extent so are spinal stims are going down? And it's much more difficult now to open your own clinic (true of almost any field of medicine). Research in pain is going up. New alternatives with better evidence based results are on their way, trust me. Don't think this will happen? Does a market exist? It is very up and coming and if you ask many anesthesia residents today what their plan is they'll tell you that it's going to involve pain. Interestingly, ask most applicants and they will say critical care. Not sure what to make of either. But I will tell drug-pushing mills should close and real clinicians in pain will rise with time. Guess who most of the leaders in this will be? Anesthesiology-pain docs. Unless they are all like you and give it up, which is possible.

    At this time tho I spoke with former neuro and pmr residents that switched to anesthesia with the goal of doing interventional pain. We lack leadership in anesthesiology and reading posts from people like you make me see why.
     
  44. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    Interventional pain procedures don't always help. Actually they don't help in most cases, and even when they do it's for a relatively short time. This is why, when insurers decrease reimbursements, you don't hear about patients getting into debt just to get their pain procedures privately. But they will do a lot more for their pills. ;)

    Not to speak about the fact that, for most of the stuff pain guys do (e.g. consults and office procedures), they are replaceable by competent PCPs, NPs, or non-pain-trained anesthesiologists. Heck, most of us can even do ESIs without X-ray support, or MBBs with; it's not rocket science, it's not critical care. <- This is where there is a chance that I might be wrong.

    Where do you think this entire health "reform" is going, if not toward decreasing healthcare reimbursements at any price? Starting with all the "elective" procedures and consults, like pain? <- This is where I am probably not wrong.
     
    #42 FFP, Mar 2, 2014
    Last edited: Mar 2, 2014
  45. msmith83

    Joined:
    Dec 22, 2013
    Messages:
    75
    Likes Received:
    4
    Isn't pretty much everyone having the problem of midlevels getting more responsibilities and gaining more ground though? I could be wrong, just trying to get the complete picture.
     
  46. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    Probably. Except maybe for surgical specialties. You still don't see midlevels even coming close to operating unsupervised, without a surgeon in the room (they just do some of the dirty work, pre- and post-op). And the surgeon is still the undisputed captain of that ship.

    While patients can already look up their medical problem on the Internet, and hence feel "smarter" than their doctor (who might not know all of that by heart), they are still mesmerized by surgical procedures. Surgeons were much smarter than anesthesiologists and other specialists, by not letting midlevels decrease their role in the patients' care/cure. You don't just let any surgeon operate on you, but you will be OK with any anesthesiologist/midlevel s/he recommends, right?

    The problem is that even if one is really good at what one does, as long as the insurance company is writing the check (and not the patient), one will have a crappier and crappier life for less and less money. The only solution is to be so friggin good that even the insured patients will pay out of pocket for the honor of being treated by you. What are the chances that one will be in that <1% of ("concierge") specialists?

    As a solo anesthesiologist, about 10% of my GA patients will tell me about how extremely important I am to them, 80% will just thank me in the end without probably realizing that they have just been through a controlled coma, and 10% won't even say thanks (despite a perfect outcome). If only 10% actually understand the magnitude of what I do to them, I don't expect more than 10% to insist on having an anesthesiologist take care of them, versus a CRNA, when reassured by the hospital-employed surgeon. I would expect things to be not much different in other specialties; the more algorithm- and recipe-based, the less (and fewer) doctors will be needed.
     
    #44 FFP, Mar 2, 2014
    Last edited: Mar 2, 2014
  47. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Like I said, doctor, you sure know everything. People who know so much and think so much should be captain. I think you should retrain to surgeon. That way while youre hating life and bitching about how good anesthesiologists have it (like id constantly hear when a supervised crna was in the room), you can wear your white coat and a ship captain's hat while you walk around the neoghborhood.
     
    Critical Mass REACHED likes this.
  48. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    And you don't think people will pay out of pocket for their spine injections? Just curious.
     
  49. FFP

    FFP Grunt, cog, body, pompous ass, pissant
    Gold Donor Classifieds Approved

    Joined:
    Oct 17, 2007
    Messages:
    5,559
    Likes Received:
    4,632
    Status:
    Attending Physician
    I sincerely hope that you have a nice Sunday and a happy residency/fellowship, and 5 years from now we'll all laugh about how extremely wrong I was.
    If that's happening, why are the pain guys quitting?
     
  50. LeverArm

    Joined:
    Sep 5, 2009
    Messages:
    126
    Likes Received:
    21
    Status:
    Pre-Medical
    Of course they will. Talk to the 40% or so of people that it works for and tell them its no longer covered. Especially if they are older. Not only will people pay who are in pain but pain docs often have stronger lobbies than just asa. They have the old folks, veterans, and academics from various specialties backing them up. Not to mention the groups fighting opioids who want alternatives.
     
  51. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    Are they quitting? Isn't pain still very competitive? The spine guys (some are PM&R) at my institution are still pulling 250-300k with no call and clinic hours. I wouldn't go back to the OR with that gig available.
     
  52. bronx43

    bronx43 Word.

    Joined:
    Apr 22, 2006
    Messages:
    1,736
    Likes Received:
    428
    Status:
    Fellow [Any Field]
    Whoa there. 40%? You'll need to back that up with some reputable studies, especially if we're talking about chronic low back pain (majority of back complaints). My understanding is that the data is quite weak and muddled.
     

Share This Page