Anesthesiology vs. Ophthalmology

[xkitto]

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Hi all,

Current M3 having trouble deciding between anesthesiology and ophthalmology which I loved my electives in. I understand they are very different but have found that my clinical pro/con list balances out for both, so turning to purely financial/lifestyle aspects now.

I'm super grateful in that I'm at a T10 school that historically matches very well to both specialties and will finish with $50k in student loans due to scholarship. Would prefer a specialty that is procedural, sustainable, and allows for family time as well (ex: can cut back if burnt out, need to take care of sick/aging parents, etc). My main concerns are in my opportunity costs.

More details on my dilemma:

Anesthesiology (4 year residency + 1 year fellowship); Would likely pursue pediatrics fellowship. I would not enjoy chronic pain management/running pain clinic. Enjoy teaching and can see myself happy in academics, working with complex cases and doing light research. No research year needed to match and higher starting salaries than ophtho, so can pay off student loans very quickly. My concerns are the heavy call schedules and burnout, as it seems quite physically demanding and high acuity cases with call may get old when I'm in my 50s. Potential friction with CRNAs and surgeons, if work culture isn't great, would contribute to my unhappiness too. But, the shift-based schedule and not taking work home is super appealing. Enjoy procedures much more than clinic but still happy doing both.

Ophthalmology (1 potential research year + 4 year residency + 1-2 year fellowship); Would prefer private practice in this case--have found ophthalmology research less engaging than anesthesiology/critical care for me, and see myself loving to operate. Fellowship has been recommended to me by mentors due to job market. Have seen lots of concerns about job saturation, low starting salaries, and partners/PEs screwing younger associates over. May need to take a research year as my CV so far has all been in anesthesiology/critical care, equating to 2 years of lost attending income compared to pursuing anesthesiology. However, burnout seems lower, schedule is more controllable as an owner of a practice, more opportunities to invest in ASCs, and have met many happy ophthalmologists working into their 60s-70s.

 

[Dr. Robb Bassett]

Hey, just wanted to say how refreshing it is to see someone think this deeply, especially at the M3 stage. You are approaching this decision with clarity, humility, and long-term perspective; and honestly, that is the kind of reflection most people avoid until much later.

Since your clinical interest seems well balanced and you have already explored both fields, it makes sense to zoom in on long-term lifestyle, sustainability, and how well each path fits with the kind of person you want to be. Between anesthesia and ophtho, you are not choosing between good and bad. You are choosing between two very different versions of good, and that is exactly why it feels hard.

With that in mind, here are a few thoughts and questions that might help clarify things.

Anesthesia gives you earlier financial freedom, a more structured schedule, and a clear path to academic involvement. You mentioned liking complex cases and teaching—those strengths fit well with peds anesthesia and academic practice. But the physical and emotional demands are real. I haven’t spent long days in the OR and ICU for years, but I have seen how even the most motivated physicians can get worn down by the weight of call and the high-acuity environment over time.

So here is one to reflect on: when you picture yourself in your 50s, managing family responsibilities and running on less sleep, how does a rough week in anesthesia sound? Can you picture yourself navigating that with energy, or would that start to chip away at you?

Ophtho, on the other hand, offers a different rhythm. Less call, high procedural precision, and a clearer path to building autonomy and owning your schedule. I know many attendings in ophtho who genuinely enjoy practicing well into their 60s. If the surgical side energizes you and the idea of investing in or running your own ASC excites you, this might feel more sustainable over time.

But let’s not gloss over the tradeoffs. A potential research year, delayed income, and a more complex private practice landscape are all meaningful factors. Here is how I often frame it with students I coach: would you be willing to delay attending income by 18 to 24 months if you knew the clinical work and lifestyle would be a better match for the next 30 years? If yes, that delay becomes a down payment on alignment.

That said, a quick reality check is also fair. An extra $150,000 to $200,000 earned earlier in your career—invested conservatively with average returns—can easily turn into one to two million dollars by the time you retire. And if the path you choose takes an extra two years of training at PGY-level pay, the opportunity cost compounds quickly. It is not about chasing the money; it is about acknowledging what that money buys you later in terms of freedom, flexibility, and margin for unexpected life events.

So the real question becomes: how much are you willing to invest now—in time, earnings, and effort—for the version of your future that feels most aligned? And which of these two futures feels more like a match for who you want to be, not just what you want to do?

You are in an excellent position. Strong match potential, minimal debt, and a clear head on your shoulders. The next step is not to find the perfect answer, but to ask better questions. Happy to keep this conversation going if it helps.

 

[Dantrolene FC]

I’m an anesthesiologist. I love my job and could not see myself doing anything else. I am fortunate to have an excellent job with a good variety of cases, lots of time off, minimal call burden, and good pay. With all that being said, I’d do optho. Much better lifestyle.

 

[Dr. Robb Bassett]

I’m an anesthesiologist. I love my job and could not see myself doing anything else. I am fortunate to have an excellent job with a good variety of cases, lots of time off, minimal call burden, and good pay. With all that being said, I’d do optho. Much better lifestyle.

This 👏 is 👏 exactly 👏 why the attending perspective is so powerful.


Dantrolene just dropped what I call a “retrospectoscope truth bomb” — the kind of insight you only get after climbing the full training mountain, stepping into real life as a practicing physician, and seeing the whole landscape clearly.


What he said isn’t a knock on anesthesiology — he said he likes it. But that subtle nudge toward ophthalmology? That’s the kind of unfiltered, hindsight-based truth that most med students never hear… unless they’ve created space for a real, candid conversation with someone on the other side of training.


And that’s the key. Students tend to hear most from med students and residents — which is useful, but still mid-climb. If you want the full picture, you have to hear from attendings. But more than that, you need the kind of relationship or setting where you can actually ask the deep, uncomfortable, off-the-record questions:

• What would you actually do differently?
• What do you envy in other specialties?
• What’s taken the biggest toll on your life outside medicine?

These aren't things you’re going to get in a lecture or pamphlet. And I know for a lot of students, it’s tough — the hierarchy, the fear of seeming ungrateful, or just not having attendings who are open to that level of honesty.


So if you’re struggling to find a way to access those kinds of conversations — or you don’t even know where to start — DM me. Happy to help however I can. This kind of insight isn’t just helpful… it’s often the difference-maker.

 

[Dantrolene FC]

This 👏 is 👏 exactly 👏 why the attending perspective is so powerful.


Dantrolene just dropped what I call a “retrospectoscope truth bomb” — the kind of insight you only get after climbing the full training mountain, stepping into real life as a practicing physician, and seeing the whole landscape clearly.


What he said isn’t a knock on anesthesiology — he said he likes it. But that subtle nudge toward ophthalmology? That’s the kind of unfiltered, hindsight-based truth that most med students never hear… unless they’ve created space for a real, candid conversation with someone on the other side of training.


And that’s the key. Students tend to hear most from med students and residents — which is useful, but still mid-climb. If you want the full picture, you have to hear from attendings. But more than that, you need the kind of relationship or setting where you can actually ask the deep, uncomfortable, off-the-record questions:

• What would you actually do differently?
• What do you envy in other specialties?
• What’s taken the biggest toll on your life outside medicine?

These aren't things you’re going to get in a lecture or pamphlet. And I know for a lot of students, it’s tough — the hierarchy, the fear of seeming ungrateful, or just not having attendings who are open to that level of honesty.


So if you’re struggling to find a way to access those kinds of conversations — or you don’t even know where to start — DM me. Happy to help however I can. This kind of insight isn’t just helpful… it’s often the difference-maker.

I’m glad to hear you agree.

Just for clarification:

I do love anesthesiology. If I happened to win the lottery tonight, I would still go to work. Maybe I would refuse call or weekends, or maybe go part time. But I’d still keep my job because I enjoy it and get satisfaction.

For me personally, if I somehow went back in time and started training over again knowing what I know now, I would still do anesthesia because I genuinely have an interest in it. With that being said, I have absolutely zero interest in the eyes and couldn’t do ophthalmology. But, if I had the same passion for ophthalmology (and could tolerate clinic) I would do ophthalmology for better lifestyle.

It’s not just the money, hours, or call, etc. it’s the little things about anesthesia. My only support staff is the anesthesia aides who clean my station and stock my supplies. I still have to setup for my own case (the surgeon probably doesn’t even know how to setup for the equipment they demand). When there’s delays on the nursing staff, they will expect me to bring the patient to the OR. I sometimes oblige, I sometimes don’t. But I will always point out that the surgeon is sitting at the desk doing nothing and is perfectly capable of pushing the bed too.

In anesthesia, I can’t dictate my case load. The surgeon can. If I show up late or the hospital or work slow, admin will talk to me. If the surgeon shows up late, nobody dares say a word.

Total double standard. But anesthesiologists are viewed a slight, small step above the OR nurses.

 

[eyeeye_captain]

Fellowship for the ophtho market is marketable/potentially helpful but not necessary if you’re planning on just doing comprehensive. If you use it to try to leverage a tougher market, you should be prepared to practice your subspecialty though. Saturation and PE depends on your market. I won’t sugarcoat it - I don’t know as much about the comp situation, but there are major metros where it’s more or less PE or nothing in retina. Some grads continue to be fine taking those positions, and some are happy, but we all hear the grumbles. Still, PE is just a vocal minority overall. As in all fields, if you’re willing to be a little outside a major metro or somewhere smaller, jobs and pay are more bountiful.

Lifestyle is good - most folks are around 4.5 days a week with normal business hours. I don’t believe the 40+ hours a week average often thrown around. I’m busy in retina (AKA the “worst lifestyle” subspecialty) and do maybe 35 hours while setting my own schedule. Never nights. Maybe 3 or 4 weekends a year for a couple hours.

An extra year isn’t insignificant, and yeah, you would lose some money. If you compare to academic peds anesthesia, you’re probably going to catch up very quickly even with low starting pay in ophtho. Academics generally pays worse than even PE, and PE does try to sucker people in with pretty decent initial pay (though they cut your earning potential by half or so). Community anesthesia has a higher floor with a lower ceiling.

Anesthesiology is a great field and is booming right now, also a good choice for students. The group I work with are all happy, even the 60+ cohort.

The major reason I didn’t do it was so I always have someone else to blame. /s