Anesthesia vs IM

[Critical Mass REACHED]

CRNAs made sacrifices to get where they are as well. Most try hard to provide safe, quality anesthesia every day. We Anesthesiologists add a lot of value to the care of their patients in my opinion. WE avoid disasters, put out fires and quite bluntly bail out CRNAs regularly. Unfortunately, do the administrators care? Does Medicare value our services like they do Gi , Ortho or Neurosurgery (hint: look at CMS reimbursement rates vs private payers)?


I wish you well in your career decision. But, in the end the facts speak for themselves.

And the day nurses start doing surgery, that will be the day they will get equally reimbursed. Who's fault is it they passed law calling for equal pay for what they call equal work. It's not just a anesthesiology problem, it's going on in all practices where mid levels are encroaching. So once we as Physicians sound the alarm they can get a NP or MD for an equal amount of cost, who do you think they'll see? You know the answer.

Please stop making this an Anesthesiology only problem. People like you posting negativity of the "battle is over" before we have even waged the war, is far from the truth.

---

Members don't see this ad.

 

[sheeed]

I mean it's pretty clear to see that things are heading to an employment model. I wouldn't call blade a troll based of what he says. Of course things are still good to some practicing physicians you may have spoken to, but with direction we are heading will things still by the time we're applying for jobs?

To blindly believe that things will still be all peachy would require you to ignore all the trends.

 

[Critical Mass REACHED]

Are you in high school or college?

I'm an Anesthesia resident, at a good program, who came to Gas after a few years of unique medical adventures in the service of the regime. I had a chance to experience and assess many different fields of medicine along the way, besides what I had been exposed to as a medical student and intern. I still chose Anesthesiology, but I chose it with a discerning mind and exit strategies already in place.

You are a fool to discount the opinions of BladeMDA, and the other experienced members on this forum. What reason on earth would they have to deceive you? They are not your program director, or an academic attending or a VA anesthesiologist supervising 1:1 and doing crossword puzzles in the lounge. They are PP veterans who have already made their mark and their money in this field. Do you think that (Consigliere excepted) they come here simply to vent their spleen? Did it ever occur to you that they might be trying to mentor you and offer advice about the realities of this field? Open your eyes, wake up, stop being so naïve and foolish.

This field is changing rapidly. You'll see when you're a resident. Anesthesia has become so safe that CRNA's CAN do the majority of ASA 1-2 cases without supervision. Some even do 3-4's. The model for PP Anesthesia is rapidly devolving from partnership/ownership ---> AMC/hospital employment with ever increasing supervisory ratios. The golden days are gone. Will you still make good money? Yes. Will the 300-400K ceiling be enough to compensate for the vicissitudes of OR anesthesia ie. militant midlevels, being a chart monkey, being a surgeon's bitch, "table up, table down" nights/weekends, stress...I could go on. I guess that's for you to decide- when you actually graduate medical school.

I'm not worrying, I'm planning. I've already decided that OR anesthesia in the future is not a place I want to be. I'll work my butt off and excel in this residency, taking the opportunities it affords to become a master of procedures and critical care management as these are incredibly useful skills and set us apart. But you bet your *** I'm going to do a fellowship- chronic pain to start and if the sky falls there then transition to critical care. Maybe eventually I'll go back to academics, who knows.

Take your blinders off, be proactive about your future. Do a lot more listening than talking, both to potential mentors (with no vested interest) in your community and on this forum.

ex- 61N

Your sadly mistaken,I wasn't expecting 300-400K. I love medicine, it's not solely about money. You sound highly discontent, I'm gladly ok with being behind the curtain than doing Lap-appys all day, or round all night. I'll gladly raise the table, no ego here champ.

 

[BLADEMDA]

And the day nurses start doing surgery, that will be the day they will get equally reimbursed. Who's fault is it they passed law calling for equal pay for what they call equal work. It's not just a anesthesiology problem, it's going on in all practices where mid levels are encroaching. So once we as Physicians sound the alarm they can get a NP or MD for an equal amount of cost, who do you think they'll see? You know the answer.

Please stop making this an Anesthesiology only problem. People like you posting negativity of the "battle is over" before we have even waged the war, is far from the truth.

I'm sorry to have to tell you this but we can't win the war. The best we can do is hold the line against the enemy. Even then we lose ground every few years. When will the walls collapse leading to complete disaster? I don't know. The AANA propaganda machine is formidable opponent. You can wage battle all you want but the party line has been to just hold the line.

FYI, CMS (medicare, Medicaid) pays us so little in reimbursement that if that becomes the norm an Anesthesiologist will earn slightly more than a CRNA but not enough to justify the cost of the education and increased training.

Welcome to the forum. Welcome to Reality because this isn't the Disney World.

 

[Silent Cool]

Just look at the where the money is going. Talk is cheap. Are they selling out because they KNOW things look bleak or are they holding the course and keeping the Group intact? For every Group holding the line at least 3 have sold or are selling out. I love your posts.

Blade,

Who owns these anesthesia 'companies' and where does the money come from? What is to stop an enterprising group of anesthesia docs from competing?

 

[Critical Mass REACHED]

I'm sorry to have to tell you this but we can't win the war. The best we can do is hold the line against the enemy. Even then we lose ground every few years. When will the walls collapse leading to complete disaster? I don't know. The AANA propaganda machine is formidable opponent. You can wage battle all you want but the party line has been to just hold the line.

FYI, CMS (medicare, Medicaid) pays us so little in reimbursement that if that becomes the norm an Anesthesiologist will earn slightly more than a CRNA but not enough to justify the cost of the education and increased training.

Welcome to the forum. Welcome to Reality because this isn't the Disney World.

Folks who are just coming into this thread let me summarize all the negativity on here.

News flash: you won't be a millionaire in medicine, and Mid levels think they can do what we do. End of story. Welcome to nightmare on elm st SDN style.

 

[BLADEMDA]

You know that you been on SDN too long when Med Students start calling you a troll after 10,830 posts. The truth is a hard thing to read sometimes when it crushes your dream. I"m sorry for that but it doesn't change the truth.

PGG, has a much better style of posting than I do. I readily admit that we can post the same content but he comes across so much better while saying the same thing. It must be those years dealing with RN Superiors in the military. God Bless you PGG.

 

[msmith83]

Any incite on how much the area in which one practices matters in all of this? Like a rural area may have more potential to have private practice opportunities?

btw thanks to all the attending physicians and residents who have offered their advice on this board. I know a great deal of it may be negative but the sad truth is thats its probably mostly true. I greatly respect the honesty rather than just blowing smoke, these are things that we have to take into consideration like it or not. Many medical students are guilty of being naive or optimistic... and its understandable that many of us need to convince ourselves that it WILL be different. After all, most of us have poured so much time into it, are already >100k in debt, and have been dreaming of it for some time

 

[BLADEMDA]

Folks who are just coming into this thread let me summarize all the negativity on here.

News flash: you won't be a millionaire in medicine, and Mid levels think they can do what we do. End of story. Welcome to nightmare on elm st SDN style.

Yes. You will be a Millionaire my young friend. Do a Fellowship. Land a $400K job. Save money. Invest. Live modestly. When you reach my age you will easily have in excess of $1 million and ZERO debt.

If you want to be rich (I'm talking Yacht, multiple homes, Ferrari,etc) then do GI, Ortho or Neurosurgery.

 

[AnesDiva]

I'm sorry to have to tell you this but we can't win the war. The best we can do is hold the line against the enemy. Even then we lose ground every few years. When will the walls collapse leading to complete disaster? I don't know. The AANA propaganda machine is formidable opponent. You can wage battle all you want but the party line has been to just hold the line.

FYI, CMS (medicare, Medicaid) pays us so little in reimbursement that if that becomes the norm an Anesthesiologist will earn slightly more than a CRNA but not enough to justify the cost of the education and increased training.

Welcome to the forum. Welcome to Reality because this isn't the Disney World.

This is a post I find helpful

A few more states are about to let NPs open independent primary care practices with completely equal billing practicing etc privileges.

My biggest fear is what you allude to: that someday in my life it just won't make any financial sense at all-- bordering on irresponsible-- to go the MD/DO route even if it's what one wants to do. It's happening all over in medicine.

 

[Critical Mass REACHED]

Yes. You will be a Millionaire my young friend. Do a Fellowship. Land a $400K job. Save money. Invest. Live modestly. When you reach my age you will easily have in excess of $1 million and ZERO debt.

If you want to be rich (I'm talking Yacht, multiple homes, Ferrari,etc) then do GI, Ortho or Neurosurgery.

There, seems like you have gotten In touch with your inner unicorn. Like I said, we on SDN would appreciate your pros and cons, and making 400K doesn't sound like a death sentence when the median fx income in USA is 55K. Yay for unicorns.

 

[BLADEMDA]

There, seems like you have gotten In touch with your inner unicorn. Like I said, we on SDN would appreciate your pros and cons, and making 400K doesn't sound like a death sentence when the median fx income in USA is 55K. Yay for unicorns.

My posts are honest. You choose to read a lot of negativity into them. I've posted the salary range on this thread multiple times. But, remember due to the glut of CRNAs and AMC employers the trend for salary is DOWN.

FYI, why choose a field which pays 1/2 another field in medicine? If that is your decision then do it like the Docs who pick Family practice. Don't come back whining on SDN in 5 years when the AMC is paying you $275K while the Ortho dude is STILL earning $650K under Obamacare. Please make your choice with yours eyes OPEN.

Anyone reading this thread should NEVER post that he/she wasn't told the TRUTH By me on SDN. That's one excuse you can't make for the decision.

 

[wolverine09]

Blade, personally I enjoy reading your posts. Do you think a republican in the white house in 2016 would help us/change things in the right direction?

 

[Critical Mass REACHED]

My posts are honest. You choose to read a lot of negativity into them. I've posted the salary range on this thread multiple times. But, remember due to the glut of CRNAs and AMC employers the trend for salary is DOWN.

FYI, why choose a field which pays 1/2 another field in medicine? If that is your decision then do it like the Docs who pick Family practice. Don't come back whining on SDN in 5 years when the AMC is paying you $275K while the Ortho dude is STILL earning $650K under Obamacare. Please make your choice with yours eyes OPEN.

Even If they paid 1 million a year for specialities like IM, surgery, you could not pay me enough. Money isn't everything. I'd prefer being happy and financially stable than miserable at 1 million a year. Paying my loans off and being stable is all I ask.

Thank you for the clarification. I'll take back my troll designation of Mr. Nicholson.

 

[BLADEMDA]

Even If they paid 1 million a year for specialities like IM, surgery, you could not pay me enough. Money isn't everything. I'd prefer being happy and financially stable than miserable at 1 million a year. Paying my loans off and being stable is all I ask.

Thank you for the clarification. I'll take back my troll designation of Mr. Nicholson.

I'd be happily miserable for $1 million year and so would 90% of your classmates. Please look at the most competitive matches in medicine and then rank them by salary.
Any correlation between INCOME And difficulty in matching? I'm betting an 85% correlation or more. http://en.wikipedia.org/wiki/Correlation_coefficient

Med Students are smart and KNOW where the money is. Do you?

 

[Critical Mass REACHED]

I'd be happily miserable for $1 million year and so would 90% of your classmates. Please look at the most competitive matches in medicine and then rank them by salary.
Any correlation between INCOME And difficulty in matching? I'm betting an 85% correlation or more. http://en.wikipedia.org/wiki/Correlation_coefficient

Med Students are smart and KNOW where the money is. Do you?

90% of medical students don't match ortho, plastics, ENT, Cards, derm. Let's be realistic, people chose what they'll be happiest in, while making a descent income.
Mr. Nicholson, you've been in the game long enough to know that specialty income is like wall st, you gotta get in while the market is hot. And just like wall st. Specialties trend up, and down. Remember when Medicare was implemented? I don't know how old you are, but physicians were crying "doom and gloom" and it turned out to be very profitable years. Remember when Ortho was laughed at? Remember when Anesthesiology was practically begging for people to join the specialties in the 90s? Guessed who laughed all the way to the bank.

I'm no fortune teller, but if you go into a specialty looking at numbers and not happiness you're setting yourself up. Hey, radiology looks good now, let's see what happens 5 years from now. Hey, cardiology looks good now, wait until everyone and their mother starts encroaching on their territory of stent placements. The list goes on and on my friend. So if Anesthesiology takes a pay cut, but still pays a descent income I'll be happy, as opposed to chasing money, only to find out all the ponies and unicorns left the barn 5 years earlier

 

[LeverArm]

Yes. You will be a Millionaire my young friend. Do a Fellowship. Land a $400K job. Save money. Invest. Live modestly. When you reach my age you will easily have in excess of $1 million and ZERO debt.

If you want to be rich (I'm talking Yacht, multiple homes, Ferrari,etc) then do GI, Ortho or Neurosurgery.

Not so much GI speaking to many, although they do fairly well. True of Ortho and Neurosurg but the problem with those, especially the latter is you will never have the kind of time to enjoy any of it. One of the benefits of anesthesia in my opinion is although the pay may be lower than certain fields, the hours are more negotiable depending on what you value more. It is the most common reason I heard from former surgical (including highly competitive subspecialties) residents switching into anesthesia. Correct me if I'm wrong, but it is still the most common switched into field and the least switched out of.

 

[Critical Mass REACHED]

Not so much GI speaking to many, although they do fairly well. True of Ortho and Neurosurg but the problem with those, especially the latter is you will never have the kind of time to enjoy any of it. One of the benefits of anesthesia in my opinion is although the pay may be lower than certain fields, the hours are more negotiable depending on what you value more. It is the most common reason I heard from former surgical (including highly competitive subspecialties) residents switching into anesthesia. Correct me if I'm wrong, but it is still the most common switched into field and the least switched out of.

Oh no, why would anyone want to switch out of a surgical specialty! It's not like they'll get called in from home at 2am, or your dad's funeral because the patient sneezed and now has a bowel evisceration.

You stand correct, I met quite a few people who decided to go behind the curtain "ENT, Peds, 2nd&3rd year Gen surg residents, Urology, PLASTICS, IM etc. I didn't meet any surgeons who were former anesthesiologist. Excellent point.

 

[Baller MD]

90% of medical students don't match ortho, plastics, ENT, Cards, derm. Let's be realistic, people chose what they'll be happiest in, while making a descent income.
Mr. Nicholson, you've been in the game long enough to know that specialty income is like wall st, you gotta get in while the market is hot. And just like wall st. Specialties trend up, and down. Remember when Medicare was implemented? I don't know how old you are, but physicians were crying "doom and gloom" and it turned out to be very profitable years. Remember when Ortho was laughed at? Remember when Anesthesiology was practically begging for people to join the specialties in the 90s? Guessed who laughed all the way to the bank.

I'm no fortune teller, but if you go into a specialty looking at numbers and not happiness you're setting yourself up. Hey, radiology looks good now, let's see what happens 5 years from now. Hey, cardiology looks good now, wait until everyone and their mother starts encroaching on their territory of stent placements. The list goes on and on my friend. So if Anesthesiology takes a pay cut, but still pays a descent income I'll be happy, as opposed to chasing money, only to find out all the ponies and unicorns left the barn 5 years earlier

Dude can't you just disagree without sounding like a total dick to Blade?

 

[pgg]

There are some really exceptional people here with a wealth of experience, clinical and nonclinical.

When I think "clinically brilliant" there's a long list of members that come to mind, some still active, some who haven't posted in years, but all people who really exemplify what physician anesthesiologists bring to the table. When I think "knows his **** about the business side of private practice anesthesia" the list is a lot shorter ...

I don't want to try to make a list, mostly for fear of forgetting someone who really deserves to be listed but Blade knows his **** about the business side of private practice anesthesia. Anyone who dismisses him as a troll is really missing an opportunity to learn something.

PGG, has a much better style of posting than I do. I readily admit that we can post the same content but he comes across so much better while saying the same thing. It must be those years dealing with RN Superiors in the military. God Bless you PGG.

Heh, thanks. Actually, one of the reasons I decided to stick out a few extra years in order to collect the .mil retirement cheese, instead of getting out when my service obligation ends, was our conversations about private practice anesthesia, job security, reimbursement issues, trends toward employment and supervision models. But having non-clinician bosses has made me more mindful of the words I use to tell them they're wrong. Not easy. It helps that I've moved up the chain a couple notches since the days when my department head was a CRNA (an arrangement that mostly worked out fine believe it or not).

 

[BLADEMDA]

90% of medical students don't match ortho, plastics, ENT, Cards, derm. Let's be realistic, people chose what they'll be happiest in, while making a descent income.
Mr. Nicholson, you've been in the game long enough to know that specialty income is like wall st, you gotta get in while the market is hot. And just like wall st. Specialties trend up, and down. Remember when Medicare was implemented? I don't know how old you are, but physicians were crying "doom and gloom" and it turned out to be very profitable years. Remember when Ortho was laughed at? Remember when Anesthesiology was practically begging for people to join the specialties in the 90s? Guessed who laughed all the way to the bank.

I'm no fortune teller, but if you go into a specialty looking at numbers and not happiness you're setting yourself up. Hey, radiology looks good now, let's see what happens 5 years from now. Hey, cardiology looks good now, wait until everyone and their mother starts encroaching on their territory of stent placements. The list goes on and on my friend. So if Anesthesiology takes a pay cut, but still pays a descent income I'll be happy, as opposed to chasing money, only to find out all the ponies and unicorns left the barn 5 years earlier

If you already know everything then place me on ignore. However, if you have a question about a specialty go ahead and ask it. FYI, radiology doesn't look good and hasn't looked good for years. They can't find jobs even with fellowships. Interventional rads is the best choice in Radiology but the field is saturated.

Anesthesiology won't be enjoying another period like the 2000s. That was an anomaly unlikely to be seen again under obamacare.

 

[inspirationmd]

If you already know everything then place me on ignore. However, if you have a question about a specialty go ahead and ask it. FYI, radiology doesn't look good and hasn't looked good for years. They can't find jobs even with fellowships. Interventional rads is the best choice in Radiology but the field is saturated.

Anesthesiology won't be enjoying another period like the 2000s. That was an anomaly unlikely to be seen again under obamacare.

What do you think the future prospects are in Emergency Medicine and Critical Care from both a private practice and academic standpoint? Both are heavily in demand right now with some ridiculous salaries being offered depending on the locale secondary to nationwide shortages. You think that may change? How prevalent have you seen burnout be and what do you recommend as a back-up?

 

[msmith83]

Anyone have an opinion on private practice in rural areas and whether this problem may not be as prevalent?

I plan on staying in the south, most likely GA, Alabama, or SC

 

[ihearttriangles]

While I do find it rude that a med student would call Blade a troll I must admit that I like his/her spunk. I have long thought that one of Anesthesia's main problems was that it tends to attract very chill, easy-going people. Which in a lot of ways is cool but also makes for a weak resistance force. You need your warriors to be spunky and irreverent sometimes if they are gonna take on a-hole surgeons and bitchy nurses.

 

[Critical Mass REACHED]

I apologize if I have offended SDN's most sacred member Mr. Nicholson.

Mr. Nicholson, I can't ask you any questions, because your usual answers are the same from what I've read. If I want to listen to the world is crashing speech all day, I'll just tune into Fox News.

But, I'll take back my troll remark.

And for the gentleman or women who talked about this magic list of SDN gods that has now shrunk to only include Mr. Nicholson for the most part, what do you think happened to those gods? I bet there all unemployed right now, so poor they couldn't afford the internet anymore. Or, they where just annoyed by the type of people on here who constantly cry about impending doom, and decided it was time to get off SDN.

SDN reads like a sad little novel where children are killed, and animals burned alive. I wonder how many "brilliant" people were talked out of medicine because of the cynical things they read on here. People who would of fought to advance the field, and protect the field.

Keep talking like this and the future of physicians will be made of baby lambs waiting to be preyed upon, and die. Not me.

 

[countingdays]

Anyone have an opinion on private practice in rural areas and whether this problem may not be as prevalent?

I plan on staying in the south, most likely GA, Alabama, or SC

Rural locations are not bring spared. AMC's are taking over everything.

 

[countingdays]

My posts are honest. You choose to read a lot of negativity into them. I've posted the salary range on this thread multiple times. But, remember due to the glut of CRNAs and AMC employers the trend for salary is DOWN.

FYI, why choose a field which pays 1/2 another field in medicine? If that is your decision then do it like the Docs who pick Family practice. Don't come back whining on SDN in 5 years when the AMC is paying you $275K while the Ortho dude is STILL earning $650K under Obamacare. Please make your choice with yours eyes OPEN.

Anyone reading this thread should NEVER post that he/she wasn't told the TRUTH By me on SDN. That's one excuse you can't make for the decision.

With the end of private practice anesthesia taking place at an ever accelerating rate, I'd be happy to be making 275k in 10 years. I'm not confident that 275k will be widely available. I hope so, but I'm not too sure. Salary will be dictated by supply and demand and monopoly control of an area by AMCs make it difficult or impossible to switch into a higher paying job near your home.

400k is overly optimistic for new grads in cities, and not just coastal cities. Most are getting 250-300 and no chance that partnership will raise their incomes in the future.

 

[Critical Mass REACHED]

With the end of private practice anesthesia taking place at an ever accelerating rate, I'd be happy to be making 275k in 10 years. I'm not confident that 275k will be widely available. I hope so, but I'm not too sure. Salary will be dictated by supply and demand and monopoly control of an area by AMCs make it difficult or impossible to switch into a higher paying job near your home.

400k is overly optimistic for new grads in cities, and not just coastal cities. Most are getting 250-300 and no chance of partnership raising it in the future.

Sounds like a good gig to me when IM makes 150-200. Or Peds making 100-150. I call that right there optimism. As opposed to, quit now, medicine is dead, anesthesiology is dead. Thank you, I enjoy that forecast.

 

[Pooh & Annie]

Ignore the noise. Recognize the VASTLY different interests folks have and how those interests effect their perception of the fields. I'm an anesthesiologist, pain fellowship, and I get to do both. I don't make anywhere near the upper levels of incomes, but I am very happy with my job. Everyone is different and entitled to their own opinion, but to me it's kind of disgusting when people in the medical fields talk about yachts and mansions. I can see how people would be unhappy if money is of such primary importance (ie. "I'd be miserable for a million a year"). My opinion is no more valuable than anyone else, but to me this is an unhealthy soul-less way of living life.

I make several multiples of what the average American makes. I consider myself rich, though I'm definitely not by some of the standards on here.

Yes, take finances and economics into consideration. Then I suggest you do what will make you happy.

 

[Critical Mass REACHED]

Ignore the noise. Recognize the VASTLY different interests folks have and how those interests effect their perception of the fields. I'm an anesthesiologist, pain fellowship, and I get to do both. I some make anywhere near the upper levels of incomes, but I as happy as I could be with my job. Everyone is different and entitled to their own opinion, but to me it's kind of disgusting when people in the medical fields talk about yachts and mansions. I can see how people would be unhappy if all they care about is money (ie. "I'd be miserable for a million a year"). My opinion is no more valuable than anyone else, but to me this is an unhealthy soul-less way of living life.

I make several multiples of what the average American makes. I consider muself rich, though I'm definitely not be some of the standards on here.

Yes, take finances and economics into consideration. Then I suggest you so what will make you happy.

Thank you for the positive outlook, we need more people like you on here to suppress some of the loudest unhappiest people. If I wanted the yacht, I would of joined wall st. I don't know what the older generation of folks that went into medicine thought. But, I can tell you none of my classmates are naive enough to think they're going to be driving around Bentleys, buying a million dollar home etc. Majority simply ask to be able to make enough to pay off loans and live a financially stable lives, while doing what they love.

Thank you !

 

[Dwindlin]

I would of joined wall st.

This count as an iBank reference? My gut says it does. @pgg ruling?


Sent from my iPhone using Tapatalk

 

[Critical Mass REACHED]

This count as an iBank reference? My gut says it does. @pgg ruling?


Sent from my iPhone using Tapatalk

I have no idea where you're going with this question my friend.

 

[Pooh & Annie]

Also, I'm still in contact with everyone I did residency with. They are ALL sincerely happy with their jobs/lives, believe it or not.

 

[Critical Mass REACHED]

Also, I'm still in contact with everyone I did residency with. They are ALL sincerely happy with their jobs/lives, believe it or not.

That's awesome. Well, there is about 20 people in my class of 130 going into anesthesiology. These 20 are some of the brightest in our class. I'm sure this trend will only continue, flushing out people who really don't care for the field, protecting it's future.

 

[IkeBoy18]

That's awesome. Well, there is about 20 people in my class of 130 going into anesthesiology. These 20 are some of the brightest in our class. I'm sure this trend will only continue, flushing out people who really don't care for the field, protecting it's future.

wow thats quite a bit.. im sure there isnt 20 people in my whole class of almost 300

 

[Critical Mass REACHED]

wow thats quite a bit.. im sure there isnt 20 people in my whole class of almost 300

It was more than the usual 10-15 every year.

 

[countingdays]

That's awesome. Well, there is about 20 people in my class of 130 going into anesthesiology. These 20 are some of the brightest in our class. I'm sure this trend will only continue, flushing out people who really don't care for the field, protecting it's future.

You are assuming that Anesthesiologists will be deciding the future of our specialty. You are mistaken. Our future is being sold to AMC suits on a daily basis by the previous generation of anesthesiologists. Your only decision will be to take it or leave it, and after 9-10 years of training, leaving it isn't a viable option.

 

[HollATme]

I would not pursue anesthesiology if I had to do it all over again. However, I'm making amends by pursuing a fellowship that will take me out of the OR and allow me to enjoy what I do and provide actual patient care by owning my patients.

Go ahead and think that your "lack of naivete" and "spunk" will help you out in your future pursuit of an anesthesia career. If you think that's gonna save the profession from the nurses, you'll be in for a rude awakening. By that point in time, nurses will continue to blur the lines when it comes to anesthesia (and likely other fields).

I'm not saying one's life goals should be a yacht and a mansion - and I don't believe that was Blade's point either (however, of course, such examples get readily eaten up by those lacking actual life/career experience). His point had more to do with considering EVERYTHING. There are now more licensing exams, harsher clinical competency requirements, and this huge hoopla on case logs. We are essentially paper pushers ensuring everything is documented appropriately as that appears to be more important than ensuring a proper residency educational experience. I don't mind working late or giving CRNAs breaks or doing a BS lap appy/chole at 5am. I really don't. I just mind the fact that mid-level services dictate the flow of cases and, quite frankly, how WE provide care. Tack on the fact that you could be watching a patient exsanguinating and the surgeon flat out tell you it's only 100cc of the blood. Of course, I don't buy it, and I do what's needed.

We are supposed to be overseeing everything in the OR and often times we don't have anyone backing us up like the surgeons have the scrub tech and OR nurse. Of course, now that I've gotten to know the OR nurses it's changed and they're present at the bedside (often per my own request) as the patient is being induced. Now imagine out in practice where you're running around signing charts to 2-4 or potentially 5-6 rooms - do you honestly think you'll be there for induction for each of those cases you are "supervising?" No. Hell no. At that point, it's a leap of faith on the CRNA. Hope you got yourself some good ones assigned else you may be putting out fires to something you may not know anything about because quite frankly you rushed on over while in the middle of preopping your next 2-6 patients and the CRNA may not have a clue either.

Of course, you're the supervising physician. You're the one responsible for the care and the patients.

250K is not enough for that. 400K pre-tax ain't enough either. Academia is funny. It provides this "blanket" that "protects" you from a real world perspective. It's nice knowing how the real world is --- and Blade is correct in his assessment of the state of anesthesia. I've had a lot of former PP attendings sell out and come here to work in academia essentially for a better lifestyle and a steady flow of income. They have told me various stories from their PP experience. The types of things you'll experience out in PP will astound you. Surgeons will dictate the care and you'll have to anesthetize the patient, else your colleagues will quickly toss you out for canceling a case. You are essentially the surgeon's bitch, and that's not just in the OR - but also in the periop setting. If there's a bad event, they'll all quickly point the finger at you. Not the surgeon, but you. Your colleagues will be the first to pull the trigger. Now soon we have to take care of these patients post-op? Better pay me twice then, as an anesthesiologist and an intensivist.

Of course, that's not gonna happen.

----------------------------------

Here's my top 10 career choices - in no particular order

1. EM - shift work, work 40-50 hrs, no call, decent pay for being a glorified triage nurse (i guess we're glorified CRNAs, ha!)
2. Urology
3. ENT/facial plastics
4. Plastics - go reconstruction - you get to do all the boutique stuff plus do some real good pro bono, and actually be able to do these cases
5. OMFS - of course, requires you to do dentistry - but honestly, they make bank and while their hours can be erratic, it's still a helluva lot better than what we got
6. Neurosurg/Spine
7. Orthopedics/Spine
8. Rad onc - no nurse would touch this with a 10 foot pole
9. PM&R - pay may not be great, but you have a more laid back residency experience, and being an attending is nice too. I've spoken to several. Plus, there's the backdoor route to Pain
10. Critical Care - more laid back, very sick patients - a lot of it is like a puzzle, and very rewarding when you see a patient doing so well they can be transferred out or even sometimes directly sent home. I can be a real doctor, get paid like one, and do shift work while at the same time not working almost 45-50 weeks per year.

I would not do radiology. Too saturated. Why even bother doing it for IR - it's 6 years. None of them are happy and they always end up getting suckered into doing something.
Note - I did not list IM residency. I personally felt it to be extremely painful. However, if you can bear through it, then the options are almost limitless. Go be a cardiac slave for the next 3-4 years, or scope your way to a million, or run an allergy clinic and make bank without ever seeing pts in the hospital or taking call, or go into rheumatology working derm hrs and run a little boutique option on the side to supplement. Palliative is not a bad gig either, and may be a need considering the rationed care that obamacare will bring forth. Critical care - personally felt the medical side to be more challenging than the surgical side.

Bundled payments will not be in favor of anesthesia.

I went into anesthesia without knowing all the politics that goes on. I wasn't privy to SDN until it was late for me. I went into anesthesia because, like you, "everyone seemed super chill and nice and they taught and zomg!!! the procedures!!!!!!1111" It didn't hurt that I enjoyed the OR setting, but then again, I was simply a fly on the wall (not literally) but I wasn't the one providing the anesthesia. There's a lot more to it than just pushing prop, roc/sux, fent and tube. You'll get a healthy dose or 2 of the politics starting out in residency with all that spunk you got.

The perceived lifestyle is just that. It's a perception, an illusion. Don't think for a second anesthesia is a lifestyle specialty. Is there any wonder why a good bit of anesthesia residents jump ship from the OR into pain (and now critical care?) You guys talk as if anesthesia is some perfect specialty where everyone jumps right in but never leaves. There's plenty of folks who switch out of anesthesia. One of my EM attendings in med school did that. He thought it was the best decision he ever made. Might be right.

 

[Critical Mass REACHED]

I would not pursue anesthesiology if I had to do it all over again. However, I'm making amends by pursuing a fellowship that will take me out of the OR and allow me to enjoy what I do and provide actual patient care by owning my patients.

Go ahead and think that your "lack of naivete" and "spunk" will help you out in your future pursuit of an anesthesia career. If you think that's gonna save the profession from the nurses, you'll be in for a rude awakening. By that point in time, nurses will continue to blur the lines when it comes to anesthesia (and likely other fields).

I'm not saying one's life goals should be a yacht and a mansion - and I don't believe that was Blade's point either (however, of course, such examples get readily eaten up by those lacking actual life/career experience). His point had more to do with considering EVERYTHING. There are now more licensing exams, harsher clinical competency requirements, and this huge hoopla on case logs. We are essentially paper pushers ensuring everything is documented appropriately as that appears to be more important than ensuring a proper residency educational experience. I don't mind working late or giving CRNAs breaks or doing a BS lap appy/chole at 5am. I really don't. I just mind the fact that mid-level services dictate the flow of cases and, quite frankly, how WE provide care. Tack on the fact that you could be watching a patient exsanguinating and the surgeon flat out tell you it's only 100cc of the blood. Of course, I don't buy it, and I do what's needed.

We are supposed to be overseeing everything in the OR and often times we don't have anyone backing us up like the surgeons have the scrub tech and OR nurse. Of course, now that I've gotten to know the OR nurses it's changed and they're present at the bedside (often per my own request) as the patient is being induced. Now imagine out in practice where you're running around signing charts to 2-4 or potentially 5-6 rooms - do you honestly think you'll be there for induction for each of those cases you are "supervising?" No. Hell no. At that point, it's a leap of faith on the CRNA. Hope you got yourself some good ones assigned else you may be putting out fires to something you may not know anything about because quite frankly you rushed on over while in the middle of preopping your next 2-6 patients and the CRNA may not have a clue either.

Of course, you're the supervising physician. You're the one responsible for the care and the patients.

250K is not enough for that. 400K pre-tax ain't enough either. Academia is funny. It provides this "blanket" that "protects" you from a real world perspective. It's nice knowing how the real world is --- and Blade is correct in his assessment of the state of anesthesia. I've had a lot of former PP attendings sell out and come here to work in academia essentially for a better lifestyle and a steady flow of income. They have told me various stories from their PP experience. The types of things you'll experience out in PP will astound you. Surgeons will dictate the care and you'll have to anesthetize the patient, else your colleagues will quickly toss you out for canceling a case. You are essentially the surgeon's bitch, and that's not just in the OR - but also in the periop setting. If there's a bad event, they'll all quickly point the finger at you. Not the surgeon, but you. Your colleagues will be the first to pull the trigger. Now soon we have to take care of these patients post-op? Better pay me twice then, as an anesthesiologist and an intensivist.

Of course, that's not gonna happen.

----------------------------------

Here's my top 10 career choices - in no particular order

1. EM - shift work, work 40-50 hrs, no call, decent pay for being a glorified triage nurse (i guess we're glorified CRNAs, ha!)
2. Urology
3. ENT/facial plastics
4. Plastics - go reconstruction - you get to do all the boutique stuff plus do some real good pro bono, and actually be able to do these cases
5. OMFS - of course, requires you to do dentistry - but honestly, they make bank and while their hours can be erratic, it's still a helluva lot better than what we got
6. Neurosurg/Spine
7. Orthopedics/Spine
8. Rad onc - no nurse would touch this with a 10 foot pole
9. PM&R - pay may not be great, but you have a more laid back residency experience, and being an attending is nice too. I've spoken to several. Plus, there's the backdoor route to Pain
10. Critical Care - more laid back, very sick patients - a lot of it is like a puzzle, and very rewarding when you see a patient doing so well they can be transferred out or even sometimes directly sent home. I can be a real doctor, get paid like one, and do shift work while at the same time not working almost 45-50 weeks per year.

I would not do radiology. Too saturated. Why even bother doing it for IR - it's 6 years. None of them are happy and they always end up getting suckered into doing something.
Note - I did not list IM residency. I personally felt it to be extremely painful. However, if you can bear through it, then the options are almost limitless. Go be a cardiac slave for the next 3-4 years, or scope your way to a million, or run an allergy clinic and make bank without ever seeing pts in the hospital or taking call, or go into rheumatology working derm hrs and run a little boutique option on the side to supplement. Palliative is not a bad gig either, and may be a need considering the rationed care that obamacare will bring forth. Critical care - personally felt the medical side to be more challenging than the surgical side.

Bundled payments will not be in favor of anesthesia.

I went into anesthesia without knowing all the politics that goes on. I wasn't privy to SDN until it was late for me. I went into anesthesia because, like you, "everyone seemed super chill and nice and they taught and zomg!!! the procedures!!!!!!1111" It didn't hurt that I enjoyed the OR setting, but then again, I was simply a fly on the wall (not literally) but I wasn't the one providing the anesthesia. There's a lot more to it than just pushing prop, roc/sux, fent and tube. You'll get a healthy dose or 2 of the politics starting out in residency with all that spunk you got.

The perceived lifestyle is just that. It's a perception, an illusion. Don't think for a second anesthesia is a lifestyle specialty. Is there any wonder why a good bit of anesthesia residents jump ship from the OR into pain (and now critical care?) You guys talk as if anesthesia is some perfect specialty where everyone jumps right in but never leaves. There's plenty of folks who switch out of anesthesia. One of my EM attendings in med school did that. He thought it was the best decision he ever made. Might be right.

Another sad case, retire please. I skimmed your history on here, and you're another one of those that went into it for the wrong reasons.

 

[Pooh & Annie]

I don't think it requires much "interpretation" to determine the motives of some people. If posts seem honest and straightforward, I take the poster at their word.

There are lots of opinions on the field, as there should be and always will be. Ultimately, I have to rely on my own experiences and the info I get from people I know. Here's what I consider hard data:
I'm happy. Since becoming an attending, I've bought all kinds of goodies that VERY few people would be able to afford. I pay $4000 monthly toward my loans. I contribute the max to my retirement. I'm looking to buy a place but I currently live in a kick ass high rise downtown in a desireable and expensive city. And I have lots of extra money to buy things I absolutely do not need. (No kids, no alimony, big debt).
In a group of about 25 anesthesiologists, all except one or two are very happy. And we are well below the income upper percentile for anesthesiologists.
All my co-residents work elsewhere, and range from happy to very happy. NONE are disappointed.

I am fully aware of the future uncertainties. That being said, I don't believe JACK when people say "this is what's going to happen". Those people don't know ANY MORE THAN YOU OR I DO. The determining factors of the future are way to complex and variable. I'm fortunate to be part of a well-run department that continues to adjust to changes, and despite reimbursement changes, we continue to adapt and stay very important to our hospital. I don't see that changing.

 

[Pooh & Annie]

It also surprises me how great people think all these other fields are. I work very closely with ER docs, cardiologists (EP/interventional), GI docs, various surgery types, etc... EVERY SINGLE GROUP (maybe with exception of the urologists) has a grass is greener attitude toward other specialties, including anesthesiology.

 

[gasdoc77]

I am inclined to lean in a slightly more negative direction. I came from a major city where a mega successful group sold to an AMC for a lump sum and said screw anyone who isn't a partner (even if a day shy)and all the future docs. I appreciate that the current residents want to keep hope alive and in fact need to. However, it truly is dog eat dog and spreading like wildfire. The pie is only so big and too many hands are in it. Everyone wants to be compensated for their profession, and that compensation comes in many forms. However, trainees who think that practicing based upon principals will provide fulfillment will later learn that every day they find themselves bending those principles to keep the machine running. The machine operates on the principle of money and will use the lowest common denominator in an effort to maximize its bottom line. Unfortunately, patients are often a medium to feed the machine. I am simply here to safely guide them through to the best of my ability.

 

[Pooh & Annie]

We have had 2 local groups get hosed or battered. You HAVE to ask questions and know what you're getting in to, which I'm sure you all already know.

 

[Critical Mass REACHED]

It also surprises me how great people think all these other fields are. I work very closely with ER docs, cardiologists (EP/interventional), GI docs, various surgery types, etc... EVERY SINGLE GROUP (maybe with exception of the urologists) has a grass is greener attitude toward other specialties, including anesthesiology.

Urology is starting to get concerned now with the new recommendations for prostate cancer. Their money maker, which was found to be aggressively overly treated. I can go down that list, and list concerns for each.

 

[Psai]

Another sad case, retire please. I skimmed your history on here, and you're another one of those that went into it for the wrong reasons.

You need to watch your tone. You are a newcomer here and it's incredibly rude to talk down to these attendings who have posted here for years as if their point of view is useless simply because it doesn't match your worldview. I'm glad that we have all these experienced doctors telling us how it is as they see it so that we can walk in with our eyes open. Everything you think you know comes from what you read and what you hear. They're living it.

You're sitting at your computer "liking" all the posts that are saying the things you want to hear but in the real world, you'll have to deal with the stuff that you're trying your best to ignore now.

 

[Ronin786]

You need to watch your tone. You are a newcomer here and it's incredibly rude to talk down to these attendings who have posted here for years as if their point of view is useless simply because it doesn't match your worldview. I'm glad that we have all these experienced doctors telling us how it is as they see it so that we can walk in with our eyes open. Everything you think you know comes from what you read and what you hear. They're living it.

You're sitting at your computer "liking" all the posts that are saying the things you want to hear but in the real world, you'll have to deal with the stuff that you're trying your best to ignore now.

I agree with this post. There are always two sides to things, and it's good to hear both of them. Belittling people's opinions does nobody any benefit.

 

[Critical Mass REACHED]

You need to watch your tone. You are a newcomer here and it's incredibly rude to talk down to these attendings who have posted here for years as if their point of view is useless simply because it doesn't match your worldview. I'm glad that we have all these experienced doctors telling us how it is as they see it so that we can walk in with our eyes open. Everything you think you know comes from what you read and what you hear. They're living it.

You're sitting at your computer "liking" all the posts that are saying the things you want to hear but in the real world, you'll have to deal with the stuff that you're trying your best to ignore now.

Having a difference of opinion is not crime. There are multitudes of opinions in the world, and you pick which ones to ignore and which ones to accept. That's how opinions work. I'm choosing to ignore opinions coming from people who I feel are disrespecting their field and medicine in general "that is my opinion on how to handle it."

Makes no sense that any physician would devalue their role, and my opinion of these people are that they went into it for the wrong reasons and are now advising people against it.

I was advised to stay and go on to NP school, I had a lot of negative opinions thrown at me even from some physicians that medicine is dead. I'm so glad I found positive influences who were able to paint the pros & cons. I was told not to go to college, because it was a waste of money when I could of became a LPN for cheaper. Glad I had others who encouraged the pros and cons of going to college for my BSN.

So far from what I have learned is, avoid negative influences that can't even appreciate both sides of any debate. People really do use SDN to guide some of their life long decisions to their detriment from only hearing from the loudest screamers of negativity without providing both sides of the debate.

This is a forum, I don't honor former titles, but you better believe if this was a hospital setting, the tone would be different. You don't see titles and names on forums. So if I offended any attending's, I apologize. But, that still doesn't change how I feel about them, and what they portray on here.

 

[Pooh & Annie]

"Watch your tone"? Have you read these forums? As long as you're not threatening death or selling something there's no limit to what people say to each other here.

 

[HollATme]

Another sad case, retire please. I skimmed your history on here, and you're another one of those that went into it for the wrong reasons.

Oh you sure told me sistah!

So, essentially, BECAUSE this is a semi-anonymous forum, you feel it is okay to say what you're saying. You said that in real life, you'd never show such attitude to your superiors. Oh sistah, you're gonna have a lot of fun in residency! Hell, I would guess to venture that if you actually practiced as a nurse you were probably one of those snarky ones who questioned every order a physician placed. Not that there's anything wrong with asking questions, but there's a way to do it, and then there's a way to do it.

Don't take heed to people's warnings. Annie Pooh may have it good, but having it good is relative. If you are single or married with no kids and work for a great group in a city you like, and take home $200K, that may not be all that bad - for her. It may not be all that great for someone else. Everyone's situation is different. You're simply ignoring that part of the equation. Quite honestly, I could give 2 ****s what you decide to do. Just go out and be informed, that's all this is about.

 

[Critical Mass REACHED]

Oh you sure told me sistah!

So, essentially, BECAUSE this is a semi-anonymous forum, you feel it is okay to say what you're saying. You said that in real life, you'd never show such attitude to your superiors. Oh sistah, you're gonna have a lot of fun in residency! Hell, I would guess to venture that if you actually practiced as a nurse you were probably one of those snarky ones who questioned every order a physician placed. Not that there's anything wrong with asking questions, but there's a way to do it, and then there's a way to do it.

Don't take heed to people's warnings. Annie Pooh may have it good, but having it good is relative. If you are single or married with no kids and work for a great group in a city you like, and take home $200K, that may not be all that bad - for her. It may not be all that great for someone else. Everyone's situation is different. You're simply ignoring that part of the equation. Quite honestly, I could give 2 ****s what you decide to do. Just go out and be informed, that's all this is about.

I stopped reading after your subliminal racial undertones of "oh sistah"

Nice try though, you seem like some idiot who assumes all nurses are black, female, and thinks people actually go around saying "oh sistah." Racist prick, please quit now. Now I see why your hate your job, NO LIKES you.

Thanks for trying though.