Anesthesiology Over the Last Two Decades

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Anyone know how the speciality has changed over the last two decades? I'm trying to answer for myself why Anesthesiology has suddenly become so popular.

For example, I'd like to know:

1.) Are more medical students exposed to Anesthesiology during medical school? In other words, is Anesthesiology gaining more credibility as a discipline now that a generation of medical students have better exposure in medical school.

1.) Has the training for an Anesthesiologist changed at all? Are there more procedures that an Anesthesiologist is expected to master than existed 20 years ago?

2.) Has the practice of Anesthesiology become more precise [? if that makes sense] and less like guesswork? I know the technology has improved dramatically over the last 40 years. ie. Prior to measuring O2 sat Anesthesiologists used to wait until a patient's fingers turned blue before realizing a patient was desaturating.

3.) Were there Anesthesiologists who specialized in Cardiothoracic, Pediatrics, OB and so on or were Anesthesiologists more jacks of all trades?

4.) What were the salaries, hours worked, number of jobs and burn out rates like for Anesthesiologists 20 years ago?

If you can think of any other explanations for why Anesthesiology has suddenly become so popular as opposed to 20 years ago I'd love to hear them.

 

[militarymd]

It's more popular because of ONE thing only...

lots of lazy folks....wants to make a lot of money...and have a good lifestyle...

And I will be the first to tell all of you.....YOU ARE ALL SCREWED...because there will be a glut of anesthesiologists....and you will be getting paid 90,000 a year....that is if you get a job at all.

 

[johankriek]

And I will be the first to tell all of you.....YOU ARE ALL SCREWED...because there will be a glut of anesthesiologists....and you will be getting paid 90,000 a year....that is if you get a job at all.

must be true considering the source............

 

[johankriek]

Anyone know how the speciality has changed over the last two decades? I'm trying to answer for myself why Anesthesiology has suddenly become so popular.

For example, I'd like to know:

1.) Are more medical students exposed to Anesthesiology during medical school? In other words, is Anesthesiology gaining more credibility as a discipline now that a generation of medical students have better exposure in medical school.

1.) Has the training for an Anesthesiologist changed at all? Are there more procedures that an Anesthesiologist is expected to master than existed 20 years ago?

2.) Has the practice of Anesthesiology become more precise [? if that makes sense] and less like guesswork? I know the technology has improved dramatically over the last 40 years. ie. Prior to measuring O2 sat Anesthesiologists used to wait until a patient's fingers turned blue before realizing a patient was desaturating.

3.) Were there Anesthesiologists who specialized in Cardiothoracic, Pediatrics, OB and so on or were Anesthesiologists more jacks of all trades?

4.) What were the salaries, hours worked, number of jobs and burn out rates like for Anesthesiologists 20 years ago?

If you can think of any other explanations for why Anesthesiology has suddenly become so popular as opposed to 20 years ago I'd love to hear them.

umm im not sure that anesthesia has become more popular then other specialties have become unpopular..

i think its multifactorial as you pointed out.. It probably has gained more precision with more monitors (oxygen monitoring and carbon dioxide) , better and shorter acting drugs. The training is longer.. total four years when i think it used to be 2 years.. BUt in essence I dont think the job of an anesthesiologist has changed much..

so I think the reason that anesthesia is more popular is multifactorial.

 

[OB1🤙]

YOU ARE ALL SCREWED...because there will be a glut of anesthesiologists....and you will be getting paid 90,000 a year....that is if you get a job at all.

Luckily for me I can be happy living in a tent on the beach in Hawaii. And if I still can't afford food, I can put on my mask and fins and go spear it.

 

[markneil]

i just remember being interested in this field when i had my circumcision and the doc told me that i won't feel a damn thing which i thought at the time was pretty miraculous. that was over 12 years ago when i had no idea what the pay was or what the work conditions were. my interest has grown to anesthesia/ccm..😀 . anyways, it's still my top choice no matter what.

 

[amyl]

me and many of my classmates (third year med students) want anes for a number of reasons. but mainly i think that it is right that other things have become less popular instead of anes becoming more popular. for me i love pharm and physio so it was natural but also i really don't like anything else. for my classmates, i think that it is a combo of disliking everything else (no one is interested in primary care at all, no one) and liking anes: lifestyle, compensation, hands on, flexibility to work in OR or clinic if you do a pain fellowship, or a laidback surgery center, play with drugs all day, etc.

also with anes you are always doing something, or should be.

everything else seems super boring to me.

 

[pgg]

It's more popular because of ONE thing only... lots of lazy folks....wants to make a lot of money...and have a good lifestyle...

I have no doubt those factors contribute to the increased interest. As others mentioned though, I think a lot of medical students are becoming disillusioned with the nasty mess that much of primary care medicine has devolved into. I can't blame them for wanting no part of it, and for being interested in this stupendously wonderful field.

10 years ago, I thought I might be a primary care doc. Today, if you told me I had to do FP, I'd simply quit and get out of medicine entirely - which would be a neat trick since the military still owns me. But I'd find a way. You could not pay me enough or threaten me with enough prison time to make me sit in a primary care clinic all day. A pair of pliers and some lemon juice might convince me, but maybe not.

And I will be the first to tell all of you.....YOU ARE ALL SCREWED...because there will be a glut of anesthesiologists....and you will be getting paid 90,000 a year....that is if you get a job at all.

OMG!!! Oh noes!!! 🙂

 

[aredoubleyou]

i just remember being interested in this field when i had my circumcision .

WOW - too much information!

Hope you didnt put that in your personal statement

 

[CaptKirk]

It's more popular because of ONE thing only...

lots of lazy folks....wants to make a lot of money...and have a good lifestyle...

And I will be the first to tell all of you.....YOU ARE ALL SCREWED...because there will be a glut of anesthesiologists....and you will be getting paid 90,000 a year....that is if you get a job at all.

I could be completely wrong but... it seems like the babyboomers are some of the most demanding unrealistic egotistical and materialistic when it comes to healthcare. As they get older the healthcare system will become more taxed... right? Yes, I know not every one of them is going to require surgery and thus anesthesia, but proportionally to the the demand as of today, won't the demand increase? Won't that offset the increased numbers of people going into anesthesia? Besides, I think it was stated earlier that interest in fields like anesthesia is cyclic...

Before you jump all over me militarymd, realize I'm not telling, I'm asking. Is the thought process above at all logical in your opinion?

Physician shortages are projected across the board, I thought... I could be wrong, it happens a lot.

 

[militarymd]

I could be completely wrong but... it seems like the babyboomers are some of the most demanding unrealistic egotistical and materialistic when it comes to healthcare. As they get older the healthcare system will become more taxed... right? Yes, I know not every one of them is going to require surgery and thus anesthesia, but proportionally to the the demand as of today, won't the demand increase? Won't that offset the increased numbers of people going into anesthesia? Besides, I think it was stated earlier that interest in fields like anesthesia is cyclic...

Before you jump all over me militarymd, realize I'm not telling, I'm asking. Is the thought process above at all logical in your opinion?

Physician shortages are projected across the board, I thought... I could be wrong, it happens a lot.

There will be more Medicare cases...and if you read the other thread...Medicare reimbursements will fall.

Essentially, the government has decided how much money it is going to spend on anesthesia....independent of the number of cases that will be done..

So.. yes, there will be more "work", but the pot of money to pay of the "work" is the same....so what does that mean? It means the outcome is what I stated above.

Anesthesia reimbursement, for the most part, is not a free market where the supply/demand curves dictate reimbursement.

Reimbursement is dictated by bearucrats who make 50,000 a year and think that docs make too much.

 

[BostonGas]

In the late 80's-early 90's anesthesia residency applications were on a similar trajectory. Up to 10% of many medical school classes were applying into anesthesia. The field was becoming very competitive. There were a bunch of marginal, puppy-mill programs pumping out graduates who they used as a cheap source of labor. Programs training CRNA's were churning them out in parallel. There was a relative glut of anesthesiologists.

This came to a head in the early-late 90's with the Clinton administration and the threat of universal health care. It was feared that Hillary, who was given the assignment by Bill, would cause massive decreases in reimbursement accross the board but heavily weighted to subspecialty care. Combine this with the proliferation of managed care plans who made hospitals compete with each other to get market share, thus driving down rates. Unlike the Hillary threat, this was actually happening.

The golden days of anesthesia were now over. Overnight, groups stopped hiring, period. Folks would rather give up vacation or work longer hours than give up their level of income. Combine this with the glut and you have a large number of residents graduating with ****ty jobs or no job at all. Dinky community hospitals that did bread and butter peds cases like tubes and tonsils could hire a fully fellowship trained pediatric anesthesiologist.

Death knell-1995 (I believe)-front page Wall Steet Journal article on how anesthesiologists were starving and working in doc-in-a-boxes. Overnight, American grads stop going into the field in a complete overreaction. Residency programs unable to fill. Start taking candidates they wouldn't even interview in past years (some capable, some licensed killers).

Late 1990's huge shortages in the field. OR's not able to staff because of lack of anesthesiologists. ORs close. Surgeons upset start beating on administrators (because hospital brass did not listen to our earlier warnings). Administartors cannot lose valuable revenue as they make most of their margin on the ORs, start throwing money at the problem, providing anesthesia departments with subsidy. Salaries come up. Anesthesia now lucrative again. Combine this with the universal health falling flat on its face and anesthesia groups and hospitals getting better at negotiating, and getting the upper hand, on occassion, (see now large anesthesia group, via mergers in Charlotte) with managed care. Anesthesia now very lucrative again. However shortage of capable bodies means starting salaries high and years to partnership low.

Where do we stand now? Anesthesia is quite competitive again. Good for the field. Unfortunate for some top notch IMG's and DO's, but like in the stock market, timing is everything. More good news, the population is aging and will need more operations. More good news is that during the black years of the mid-90's many marginal programs were shut down and the ability to add anesthesia residents to a program was made much more difficult. Hopefully a balance has been struck between man-power needs and work force. There will still be an imbalance in big cities where most grads want to remain, and rural America.

Now the downside. The goverment doesn't really care about the doc's too much and Medicare reimbursement will continue to go down, like it or not. As the population ages a large percentage of patients will be Medicare so do the math. More downside-many groups have gotten used to the chunk of change the hospital has been paying in subsidy. As the shortage goes away, hospitals may figure this out and start curtailing their stipends. Now groups may choose to work harder rather than decrease their income. Starting salaries ? down, years to partnership up? Who nows. Hopefully folks have learned their lessons of the last decade and the pendulum will not swing too far one way or the other. The pendulum will swing, but let's hope for all our sakes the extremes are less.

If you are going into it because of the money it may not always be as lucrative as it is now. If you are going into it for the hours, think again as another shortage means you will be working your tail off. Hopefully you are going into it because it is the best field out there bar none.

There has been alot to learn from the last ten years.

 

[threepeas]

speaking from little experience, the essence of anesthesia hasnt changed much in the recent decades, but salaries have gone up. this gets people to look at the field more closely. people still have to choose it because they like it, but i know more people are considering it because of the money and quality of life. same goes for derm, rads, rad onc and others. i dont think the popularity is soley dependent on the money. i dont want to do derm regardless of how much they pay. i am considering rads, one for the money, two for the quality of life, three b/c of the technology, four providing important consultant info to colleagues, and five being able to make a final diagnosis and be an expert. some of these same reasons can be applied to anesthesia for most people with more patient care, and physiology instead of physics.

 

[markneil]

speaking from little experience, the essence of anesthesia hasnt changed much in the recent decades, but salaries have gone up. this gets people to look at the field more closely. people still have to choose it because they like it, but i know more people are considering it because of the money and quality of life. same goes for derm, rads, rad onc and others. i dont think the popularity is soley dependent on the money. i dont want to do derm regardless of how much they pay. i am considering rads, one for the money, two for the quality of life, three b/c of the technology, four providing important consultant info to colleagues, and five being able to make a final diagnosis and be an expert. some of these same reasons can be applied to anesthesia for most people with more patient care, and physiology instead of physics.

isn't radiology following a similar trend? i think this has been discussed over and over in the radiology sections concerning outsourcing, etc.? in addition to radiology, hasn't CTS been on the same path, but for different reasons such as more interventional cards, etc.?