Anesthesiology, great hours, great salary, low competitiveness, why??

Blue Scrub

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thats interesting....my friend is a 1st yr resident in anesthesiology and he picked it b/c of the nice lifestyle and good pay...i have no idea why its not a competitive residency position (or at least according to that article)
 
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I shadowed one recently and he gets 10 weeks of vacation a year, makes over 500large, only is on call 1 day a week, and he's 29.

Blue Scrub said:
thats interesting....my friend is a 1st yr resident in anesthesiology and he picked it b/c of the nice lifestyle and good pay...i have no idea why its not a competitive residency position (or at least according to that article)
 

PBR727

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I'm pretty sure the insurance premiums are high and I've heard that the licensing exam is one of the hardest.
 

Blake

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I don't know. I know nothing about it so far, but it doesn't seem exciting. And lifestyle isn't high in my priorities, unlike 99 % of med students in my class.
 

OnMyWayThere

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The malpractice insurance premium is very high... hey "AStudent" what kind of practice did that Gas Doc work in? Was he a partner in a surgery center or what's the deal?
 
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Worked in a medium sized hospital in the suburbs of Detroit.

OnMyWayThere said:
The malpractice insurance premium is very high... hey "AStudent" what kind of practice did that Gas Doc work in? Was he a partner in a surgery center or what's the deal?
 

shantster

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AStudent said:
Can anyone explain why more medical students don't choose anesthesiology? Am I missing something? Is there something horribly wrong with the profession that would turn medical students off??


http://medicine.wustl.edu/~residenc/outside/spec/AN_info.html
Malpractice Insuarance. From doctors that I have talked to, Anesthesiology is one of the highest ones. So that coupled with the fact that the malpractice insuarance would be high because a large number of them are sued would turn off people to that field.
 

firebody

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AStudent said:
I shadowed one recently and he gets 10 weeks of vacation a year, makes over 500large, only is on call 1 day a week, and he's 29.
i know of 2 that can say otherwise. and one at the aforementioned website you linked to. doesn't matter how many weeks of vacation you get, you still have to work pretty grueling hours. then again, lots of people in private practice people can easily make 500 large if they're workaholics.
 

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my dad and brother are both anesthesiologists... i dont understand why it is considered a lifestyle field.. hours are pretty long, they have to be in very early but the real kicker is the stress that comes with liability.. and theyre also treated like crap in the OR by surgeons.. maybe med students dont wanta do anes simply becuse they want to be leading and not be taking orders.
 

firebody

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and let's not even talking about CNA's trying to bag on there turf. less training, less school, and 'supposedly' do a good portion of procedures that anesth. doctors while being paid in 6 figures...
 

firebody

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davedavedave said:
my dad and brother are both anesthesiologists... i dont understand why it is considered a lifestyle field.. hours are pretty long, they have to be in very early but the real kicker is the stress that comes with liability.. and theyre also treated like crap in the OR by surgeons.. maybe med students dont wanta do anes simply becuse they want to be leading and not be taking orders.
listen to this man. and it's not one of those exception to the rule type things....it's pretty much a clear generalization of the field. but some do get paid exceptionally well and work less hours, but generally the lifestyle isn't as great as some make it out to be (especially those with opinions from hearsay)
 

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AStudent said:
Can anyone explain why more medical students don't choose anesthesiology? Am I missing something? Is there something horribly wrong with the profession that would turn medical students off??


http://medicine.wustl.edu/~residenc/outside/spec/AN_info.html
I'm pretty sure that anesthesia has some of the worst malpractice around, second only to OB-GYN. I vaguely remember from one of my bioengineering design courses that most accidental surgical deaths are due to anesthesia and most anesthesia deaths are due to failure of equipment rather than failure of anesthesiologist.

In my current job I spend a substantial amount of time running anesthesia for experimental surgeries on large animals. Administering anesthesia is definitely a delicate and challenging art, but not one for the faint of heart. It is fairly tedious once things are up and running. Unless something goes horribly wrong, you just monitor the stats. And things do go horribly wrong, partially due to allergic reactions. You are paid so well because when $%*# hits the fan you MUST not fall apart, you MUST think very fast, and you MUST not be wrong. I have had surgeons tell me stories of stepping in for emergency tracheotomies because the anesthesiologist freaked out. It is said that anesthesia is a popular specialty for non-trad soldier/policeman types: 99% boredom and 1% pure terror.

For those looking for the satisfaction of helping their patients, this may be an unpopular choice. Aside from epidural injections for pain relief, the anesthesiologist paves the way for the surgeon to treat the patient. In the meantime, there is a small but non-negligible chance that even the healthiest of patients will not wake up. So you may put under a healthy patient for an elective surgery and end up with a brain dead or just plain dead patient. I spoke to a pediatric orthopedist about this yesterday. He is very conservative about taking kids to the OR. 999/1000 kids wake up, but how do you tell the 1000th set of parents: "Well, your previously healthy son's distal radius fracture has been repaired flawlessly. Unfortunately, he had a fatal reaction to the propofol we used to put him under."

Props to the anesthesiologists out there. You do not have an easy job.
 

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davedavedave said:
my dad and brother are both anesthesiologists... i dont understand why it is considered a lifestyle field.. hours are pretty long, they have to be in very early but the real kicker is the stress that comes with liability.. and theyre also treated like crap in the OR by surgeons.. maybe med students dont wanta do anes simply becuse they want to be leading and not be taking orders.
Agreed completely. My father is also an anesthesiologist and the hours are in no way as glamorous as people seem to think they are--it seems he's on overnight call more often than not. And because the services are often contracted with hospitals/surgeons, there is usually also the issue of reduced autonomy unless you run your own pain clinic or something.
 

Brainman

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Pain Management Anesthesiology = Good Income in almost any setting and good hours (averages about $400,000/year and 50/week). As for why it is not a very competitive specialty, I have heard the possibility of nurses trained to administer anesthestia being given more freedom and needing less oversight. This could potentially reduce the number of positions for anethesiologists, but no one can predict this. One other possibility for the low competitiveness is the common misconception that anethesiologists are poorly treated by surgeons. At least from my experience this is definitely not the case and the two seem to work very well together as a team, but that is only based on what I have seen. I would be interested if anyone else has any ideas about why the specialty is less competitive than others.
 

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firebody said:
and let's not even talking about CNA's trying to bag on there turf. less training, less school, and 'supposedly' do a good portion of procedures that anesth. doctors while being paid in 6 figures...
Did you really mean CNA's or nurse anesthetists? The nurse anesthetists are usually R.Ns with advanced training that could be well on their way to N.Ps. I've never, ever heard of a CNA being a gas passer in an OR.
 

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Larsitron said:
Did you really mean CNA's or nurse anesthetists? The nurse anesthetists are usually R.Ns with advanced training that could be well on their way to N.Ps. I've never, ever heard of a CNA being a gas passer in an OR.
He probably meant CRNA.
 

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AStudent said:
Can anyone explain why more medical students don't choose anesthesiology? Am I missing something? Is there something horribly wrong with the profession that would turn medical students off??


http://medicine.wustl.edu/~residenc/outside/spec/AN_info.html
I read somewhere that anesthesiology is becoming more popular because of increased patient interaction before & after surgery. I think it's a cool specialty, but suffers from seeming subordinate to the surgeons...
 

Larsitron

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EvoDevo said:
He probably meant CRNA.
Fair 'nuff. But as we all know, omitting letters in acronyms can be pretty important. :)
 

SocialistMD

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Anesthesia is cyclical in its competitiveness; the recent autonomy given to CRNAs has cut into the turf and turned many people off because it was more competitive in the past, but I think it is beginning to pick up again. The hours really aren't that great, as they have to be in the hospital as early as the surgeons operating. There is also a relatively low amount of patient interaction (well, conscious patient interaction, anyway) and next to no continuity of patient care unless you do something like pain management. The malpractice is very, very expensive. It also can be a bit boring and repetitive to some people (just as can any specialty; different strokes for different folks).
 

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Don't forget Urology in there.

RunMimi said:
A third year med student was explaining the ROAD to success to me:
R-radiology
A-anesthesiology
O-ortho
D-derm

:D
 

Darth Asclepius

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One other possibility for the low competitiveness is the common misconception that anethesiologists are poorly treated by surgeons. At least from my experience this is definitely not the case and the two seem to work very well together as a team
From my experiences in the OR, this is true, but then maybe it's just because the surgeon I shadow is awesome. I've never heard any of the anesthesiologists complain about anyone treating them badly.

I asked the anesthesiologist I was working with the other day why he picked that specialty. His answer? Lifestyle. He has kids and says that the great thing is that you can get into a group and work as much or as little as you want. He says that many groups will let you work 3 days a week (or shorter days) for a reduced salary. He also said that when he's done for the day, he's done. He doesn't have to take it home with him and he doesn't get calls in the middle of the night about the patients like the surgeons do. I asked if it bothered him that he didn't get to follow up with the patients long term to see how things go, but he said no. He loves his job.
 

i61164

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RunMimi said:
A third year med student was explaining the ROAD to success to me:
R-radiology
A-anesthesiology
O-ortho
D-derm

:D
I think that O = optho
 

durak

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I love how people in this forum take the opinion of one person and turn it into generalized fact. For example, "Well, the doctor I shadow says that..." or "When I was in the ED for one day I saw something totally different..." and so it must be like that EVERYWHERE in the US and in EVERY specialty.

One of the great things about medicine is that you can find practically any situation that you want. If you want to be a surgeon and only work X amount of hours a week, you can find some place in this blessed country where you can do that. If you want to be a Family Prac doc that works 4 days a week, be my guest. There's not rule that says if you are in X specialty, you have to work a minimum of Y hours. You obviously won't get paid as much as the other doc working twice as many hours (kinda goes without saying), but we're not in it for the money, right? HAH.

So if you want lots of hours and good pay, you can find it. If you want to work less hours and get less pay, you can find that too. If you want lots of pay AND great hours, then go into derm (unless you're like me and would rather die than go into derm)

And that, my good friends, is why medicine is great.
 

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Although actual competitiveness for getting into anesthesiology may be perceived as “low” according to that website, more anesthesia residency positions are becoming available, and more students are choosing to enter the field. So it’s not as if fewer med students are pursuing anesthesiology, it’s just a matter of supply and demand: the demand is increasing, just not at as high a rate as the supply is becoming available.

I worked as an anesthesia tech in an OR before going to grad school. I worked with 22 doctors who were all part of a private group practice. These docs were overall some of the coolest and brightest people I have ever worked with. Surgeons respected them, and they respected the surgeons. I think that the idea of anesthesiologists not getting respect from surgeons, though it does happen, has become somewhat of a myth and is actually a rarity these days. The reality is that surgeons consult with the anesthesiologists with various aspects of patient care. As a group they averaged $400K/year. Some worked all the time, others hardly at all (that is the beauty of a large group practice). Generally speaking, they averaged pretty decent hours (40-50 hours/week), depending on when they were required to be in the O.R (i.e., CT surgeons started cutting at 7:30, meaning the anesthesia doc was there by 6:30). They took turns taking evening and weekend call and seemed to have plenty of free time.

I think that anesthesiology attracts people who are somewhat more technically-minded, enjoy physiology and pharmacology, hands-on type work, and want to have time for things in life other than their careers. Anesthesiologists are masters of CPR - when a code is called in a hospital, guess who's the first person called? Yep, an anesthesiologist. Anesthesia docs do not have to deal with a lot of the crap that other physicians do: arguing with insurance companies over reimbursement, non-compliant patients, excessive paperwork and bureaucracy, overhead/administrative costs, etc. It’s true that the turf war with CRNAs may be something to consider, but anesthesiologists will always have a job because someone has to supervise these specialized nurses. Also, pain management is a quickly developing sub-specialty. I currently work in an Interventional Pain Clinic. This is definitely the specialty for ppl who like to do quick procedures (avg 15-20 minutes), want to receive a high degree of satisfaction, and want to establish relationships with their patients over the long term.
 

japhy

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malpractice for gas docs is really not that bad. it used to be one of the highest, but now it is lower than most surgical specialties.
 

OrthoFixation

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i61164 said:
I think that O = optho
Optho pay has decreased. They are not in this group.


I have seen other threads where current doctors posted that malpractice insurance for AN has dropped seriously since the introduction of the PulseOx monitors. Like $20K/yr, less than many other specialties.
 

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RunMimi said:
Well, I actually think she meant ortho, but I could see the eye doc thing as well (no I'm not even going to attempt to spell it ;) ) She worked for an ortho doc and said they all leave at 5 and rarely come in after hours on the weekend and are pulling in major money. .
I can see this--I broke my arm a long time ago and the doctor who oversaw all my surgeries runs a sports medicine clinic with a few partners, and they have a contract with the hospital for orthopaedic surgeries. Since they can put appointments on their calendar, and most of their surgeries are non-emergencies (i.e. ACL tear that doesn't need to be operated on right away unlike a life-threatening heart malfunction), it's not difficult for them to keep it a mostly 9-5 practice.
 

45408

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the anesthesiologist I've shadowed puts in killer hours right along with the surgeons. His house is enormous though.

My friend's dad is one too, and he works under 30-40 hours a week and makes something to the tune of 300 grand. Go figure. Small town though for him.
 

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Don't choose a specialty because the LIFESTYLE outside the hospital is good. Choose a specialty that you will enjoy doing for the rest of your life.

Sure anesthesiology has some benefits, but if I had chosen it, I would be miserable at work and would probably come home depressed. Getting up in the morning would have been a problem too.

So, choose the career you love to do. It will make you life happier overall.
 

njbmd

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Hi there,
I would caution your thinking that anesthesiology is not competitive. While some programs may be fairly easy for American grads to enter, the best programs are very, very competitive.

I would also caution you about looking at lifestyle, hours and projected income as a reason to choose a specialty. All of these things ebb and flow according to cycles. Anesthesia was at a very low cycle fours years ago and now is a very popular career choice for many graduates. By the time many folks finish residency, all of this may have changed.

Also, surgeons and anesthesiologists work together and are colleagues. I have never witnessed any bad behavior between these specialists while in the operating room. In the OR, the patient comes first and everyone tends to keep this in mind. Gone are the days when surgeons or anyone else can display unprofessional behavior in the OR.

For those who love anesthesia, it is a great field with many rewards. Some have described it as "hours of boredom punctuated with minutes of sheer terror". Others have avoided anesthesia because they prefer to have a long-term relationship with patients. In the case of Pain Management, an anesthesiologist can establish a long-term relationship with their patients. For those who like do do procedures, many anesthesiologists choose Critical care fellowships. Anesthesia is a specialty with lots of options.

If you think that anesthesia may be for you, do a fourth-year elective and explore the field. No matter what specialty you choose from pediatrics to PM&R, doing an anesthesia elective can broaden your skills.

njbmd :)
 

rcd

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i was under the impression that hospitals usually pay for your malpractice insurance...
 

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rcd said:
i was under the impression that hospitals usually pay for your malpractice insurance...
no, but that would be nice!
 

japhy

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Don't choose a specialty because the LIFESTYLE outside the hospital is good. Choose a specialty that you will enjoy doing for the rest of your life.
i am sick of this pretentious bs. people make decisions on their career for a multitude of reasons. why do you have to deride someone for having a set of critieria that is different from yours? it is just as easy to say that if i chose something i really loved, like neurosurgery, that my home life would suffer to such an extent that i would be miserable.

in the end, it is always a balance. there are numerous factors that go into making this decision; lifestyle can be one of those factors. if your career is most important, that is fine by me. but for many of us, we are trying to find a specialty that fulfills us, yet lets us be humans still.
 

Surgeonizer

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AStudent said:
Can anyone explain why more medical students don't choose anesthesiology? Am I missing something? Is there something horribly wrong with the profession that would turn medical students off??


http://medicine.wustl.edu/~residenc/outside/spec/AN_info.html
It is rather strange that anesthesiology remains a relatively noncompetitive specialty, given the excellent reimbursement (gas docs in private practice can pull 400K/yr), decent hours (40-50 hr wks with very little, if any, call), and relatively low malpractice premiums. Without a doubt, gas is a lifestyle specialty, but it's not for everyone. The principal reason why medical students aren't scrambling en masse to become gas docs is threefold:

1) The nature of the work: One of the surgeons at my med school, whose father is an anesthesiologist, described the specialty as hours of boredom punctuated by moments of sheer terror. At the beginning and end of surgical procedures, and when the proverbial **** hits the fan, anesthesiologists work like madmen. If a patient crashes in the OR, the anesthesiologist takes over--they really are experts in critical care (which also explains why some anesthesiologists work as intensivists). Aside from the critical moments at the beginning and end of surgical procedures, and the occasional crash, the bulk of an anesthesiologist's "work" in the OR is pretty boring. They mostly just sit around and keep an eye on various monitors; periodically they mix up some drug cocktails to fine tune some aspect of the anesthesia or whatever.

2) Anesthesiologists don't get their egos stroked. Most laymen are clueless about the specialty of anesthesiology. Some don't even know that anesthesiologists are medical doctors; they think that gas docs are some kind of technician. Talk to any anesthesiologist and he/she will tell you that if you want your ego to be stroked, anesthesiology is the wrong career choice for you.

3) Many medical students never really get adequate exposure to the field, so many of us never develop any interest in the field. At my school, anesthesiology isn't a core clerkship. I don't know of any schools where anesthesiology is a required clerkship.

That said, anesthesia really is a great specialty choice if: a) you enjoy physiology and applied pharmacology b) you don't want the frustration of managing chronic illnesses c) you prefer short, intense encounters with patients d) you don't care if the average joe thinks you're some kind of glorified technician and e) you want to make an outrageous amount of money and not work 80+ hours/wk.
 

Surgeonizer

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shantster said:
Malpractice Insuarance. From doctors that I have talked to, Anesthesiology is one of the highest ones. So that coupled with the fact that the malpractice insuarance would be high because a large number of them are sued would turn off people to that field.
Actually, the malpractice rates for anesthesiologists aren't very high. They're nowhere near those of neurosurgery, orthopaedics, and OB/GYN. The gas docs at my med school pay 12 grand per year in malpractice, which is peanuts compared to ob/gyn, ortho, etc. (my cousin, who is an orthopaedic hand surgeon in West Virginia was paying $100,000/yr in malpractice). If you focus on the financial aspect of gas, it's almost too good to be true--absurdly high reimbursement in private practice and very high salaries in academia (the salary figures published by the AAMC are for academic positions, not private practice), coupled with reasonable malpractice premiums.
 

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I would think that it wouldn't be as competitive as many others due to the fact that 95% of your patient contact is when they are knocked out. For many, that doesn't make a deepening doctor-patient relationship. Furthermore, the malpractice insurance PREMIUM is averaging at $190k p/yr, NATIONWIDE. That may deter some people as well..

<shrug>
 
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Is it wrong that I don't really mind if the patient is knocked out? Don't get me wrong, I'm a people people (seriously) but wouldn't it be great not to have to deal with bitchy patients :D

Sanctuary said:
I would think that it wouldn't be as competitive as many others due to the fact that 95% of your patient contact is when they are knocked out. For many, that doesn't make a deepening doctor-patient relationship. Furthermore, the malpractice insurance PREMIUM is averaging at $190k p/yr, NATIONWIDE. That may deter some people as well..

<shrug>
 

i61164

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firebody said:
just since someone nitpick me earlier it's OpHthamology
My bad.
 

i61164

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OrthoFixation said:
Optho pay has decreased. They are not in this group.


I have seen other threads where current doctors posted that malpractice insurance for AN has dropped seriously since the introduction of the PulseOx monitors. Like $20K/yr, less than many other specialties.
It is my understanding that ROAD is a memory tool for the "lifestyle" specialties. If you want to be anal about it, you can certainly argue that other specialties can have a better effective hourly pay rate. Some consider pathology to be a lifestyle specialty and I have even heard of emergency medicine added to this group. This classification is based more on hours than pay.

Although some established orthopods have decent schedules and most probably make fists full of money, it is still a surgical specialty. The vast majority of surgeons do not have the lifestyle of a rads, gas, derm, or ophtho doc. If you happen to be an orthopod that works 40 hours per week, I will gladly start referring to it as the ROOAD to success.
 

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japhy said:
i am sick of this pretentious bs. people make decisions on their career for a multitude of reasons. why do you have to deride someone for having a set of critieria that is different from yours? it is just as easy to say that if i chose something i really loved, like neurosurgery, that my home life would suffer to such an extent that i would be miserable.

in the end, it is always a balance. there are numerous factors that go into making this decision; lifestyle can be one of those factors. if your career is most important, that is fine by me. but for many of us, we are trying to find a specialty that fulfills us, yet lets us be humans still.
Chill out lil' monkey...

There is nothing pretentious about my statements. I never said that someone should choose their specialty the same way that I did. I warned that people should NOT choose a specialty because of the anticipated lifestyle associated with it. For example:

Don't choose Anesthesia because you "work less"
Don't choose Surgery because it has a "higher salary"
Don't choose ER because you can "work shifts"
Don't choose Radiology or Pathology because of the "fewer hours"

Choose your specialty because you enjoy it. I didn't say you have to pick the one you enjoy the most. But, I have seen many residents and even some attendings change their careers midstream because they realized that they chose a specialty for the wrong reasons.

As physicians, we are given the opportunity to have a career we love. So choose wisely.
 

tkim

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Sanctuary said:
I would think that it wouldn't be as competitive as many others due to the fact that 95% of your patient contact is when they are knocked out. For many, that doesn't make a deepening doctor-patient relationship. Furthermore, the malpractice insurance PREMIUM is averaging at $190k p/yr, NATIONWIDE. That may deter some people as well..

<shrug>
190K? Are you sure you didn't add a zero? This pubs says average for 2004 was $20K

http://depts.washington.edu/asaccp/prof/asa68_6_5_6.pdf
 

OrthoFixation

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i61164 said:
It is my understanding that ROAD is a memory tool for the "lifestyle" specialties. If you want to be anal about it, you can certainly argue that other specialties can have a better effective hourly pay rate. Some consider pathology to be a lifestyle specialty and I have even heard of emergency medicine added to this group. This classification is based more on hours than pay.

Although some established orthopods have decent schedules and most probably make fists full of money, it is still a surgical specialty. The vast majority of surgeons do not have the lifestyle of a rads, gas, derm, or ophtho doc. If you happen to be an orthopod that works 40 hours per week, I will gladly start referring to it as the ROOAD to success.
I don't know why your copping the negative tone, but if "lifestyle" is defined by good hours and good pay, an orthopod that works 30 hrs/wk will still pull in $300K. The same hours would put optho at <$200K. Granted there are few eye emergencies to wake you, ortho's looking for lifestyle could move away from midnight calls too, if they desire. Ortho's that work 50-55 hrs/wk will pull down about $500K.

Rad's and Gas are mostly hourly or shift based occupations, but certainly someone is on duty at larger hospitals at night and on weekends. Most fields have a variety of working conditions that can fit your desires.

It appears you are optho oriented. More power to you. Enjoyment in your chosen profession is more important than an extra $50K a year. For the record, I am not an orthopod.
 

YzIa

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OrthoFixation said:
I don't know why your copping the negative tone, but if "lifestyle" is defined by good hours and good pay, an orthopod that works 30 hrs/wk will still pull in $300K. The same hours would put optho at <$200K. Granted there are few eye emergencies to wake you, ortho's looking for lifestyle could move away from midnight calls too, if they desire. Ortho's that work 50-55 hrs/wk will pull down about $500K.

Rad's and Gas are mostly hourly or shift based occupations, but certainly someone is on duty at larger hospitals at night and on weekends. Most fields have a variety of working conditions that can fit your desires.

It appears you are optho oriented. More power to you. Enjoyment in your chosen profession is more important than an extra $50K a year. For the record, I am not an orthopod.
30 hours a week and pull in 300,000. Maybe in a perfect world, or just that ideal setting. National averages according the the AAMC are more like $300,000 at 60 hours a week. Well actually more like 190-360,000 and 58 hrs/week.

Yes, that is ortho.
Ophtha is 140-290 at 47 hrs/week (same source) and the other O, ENT is 150-300 at 53 hrs/week.