1. It’s Test Prep Week! Visit the Test Prep Forums to learn about test prep products and services, ask questions in test-related AMA threads, take advantage of exclusive SDN member discounts, and enter to win free stuff!
What can I do to get my MCAT, DAT, or OAT score up? Ask in the Test Prep Week AMA threads.

Any current anesthesiologists actually recommends pursuing anesthesia???

Discussion in 'Anesthesiology' started by bic_atlantis, Aug 27, 2017.

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
  1. bic_atlantis

    bic_atlantis

    7
    0
    Jun 3, 2017
    Was just interested with the current doom and gloom sentiment on these forums that if there are any current anesthesiologists who would still recommend a student pursue anesthesia and a career say 5 years from now. Any advice is appreciated. Thanks is advance.
     
  2. SDN Members don't see this ad. About the ads.
  3. bigdan

    bigdan SDN Donor 10+ Year Member

    2,328
    117
    Dec 30, 2002
    Ann Arbor
    I would.

    But you should do a search on the topic. It's been covered many, many, many times before
     
  4. anesthesiadoc

    anesthesiadoc ASA Member 7+ Year Member

    98
    24
    Feb 28, 2009
    I love my job. I don't know what the field will look like in 5 years and I am nervous about that. But honestly there is no field in medicine that I can imagine enjoying more. I am proud of the work I do and my role as a patient protector and advocate. I enjoy my relationship with most of my surgical colleagues and my role as a consultant in and out of the OR. Each day I strive to ensure that the people I take care of have the best outcomes possible. No field is perfect, but I'm pretty happy.


    Sent from my iPhone using SDN mobile
     
  5. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor 7+ Year Member

    5,098
    3,955
    Oct 17, 2007
    The happy ones will recommend it, the unhappy ones won't. Both groups agree that it depends a lot on location (the East coast and certain urban areas are worse). What they disagree on is the future; most of the "unhappies" think it's just a matter of time till most anesthesiologists' jobs become miserable, as the "evil" corporate forces penetrate the remaining markets, too.

    There are tons of threads on the subject, with pertinent advice. Do your homework, get educated, and you probably won't regret your decision, either way.
     
    Last edited: Aug 27, 2017
  6. GA8314

    GA8314 Regaining my sanity 2+ Year Member

    473
    305
    Jun 3, 2014
    You will find extremes of opinion here. I would recommend it. I'm happy with my choice of careers. This issue has been much discussed so, as others have pointed out, do some searching.
     
  7. Man o War

    Man o War 2+ Year Member

    664
    583
    Apr 13, 2015
    I would strongly encourage you to ask real life attendings. SDN tends toward doom and gloom when compared to actual anesthesiologists IMO. I'm happy. Would do it all again.
     
    Twiggidy and AdmiralChz like this.
  8. nimbus

    nimbus Member 10+ Year Member

    1,826
    985
    Jan 13, 2006
    I love my job. It is one of the best parts of my life. However that does not mean I recommend it to other people. At least in my specific practice, if you went into it for a predictable schedule, "good" lifestyle, and routine cases you would be miserable, and some of my partners are. But there are others who share my enthusiasm. Friday night I was up until 3am with a high speed blunt trauma (splenectomy, nephrectomy, damage control packing of liver, then down to IR for embolization) requiring massive transfusion and I was in hog heaven because I was doing good working with surgeons, nurses, and techs who are my friends. These kinds of cases will never go away. It all depends on your perspective and mindset. And maybe paycheck too;)
     
    Last edited: Aug 27, 2017
    sethco and anesthesiadoc like this.
  9. dr doze

    dr doze To be able to forget means to sanity Lifetime Donor 10+ Year Member

    3,264
    986
    Dec 6, 2006
    The work is often wonderful. The job often not. But every specialty feels that way.


    Sent from my iPhone using SDN mobile app
     
    Twiggidy, rakotomazoto, pgg and 2 others like this.
  10. Gern Blansten

    Gern Blansten Account on Hold 10+ Year Member

    2,104
    215
    Jun 20, 2006
    Northeast
    The real question is, how many people from any specialty would still recommend medicine as a career. Every specialty has its issues. Ours are simply more visible and imminent. If our specialty fails, others will follow.
     
    aneftp and AdmiralChz like this.
  11. Nivens

    Nivens Resident 2+ Year Member

    321
    222
    Dec 5, 2012
    Leafcull
    I've come to believe one's happiness in anesthesia is almost entirely dependent on personality. For those who discover they are actually quite content to show up, do the work they're asked to do, and go home (zero judgement implied here; everybody is looking for something different from their work life in terms of job v career mentality), anesthesia could be an awesome choice. For those who want more autonomy in their practice, more control over interactions with patients/admins/other docs, it's probably less than ideal. And then in the middle there are variations on these themes, such as those that desire autonomous decision making, but love the subject matter or the immediacy of the results or the lack of clinic/rounding/whatever, so that everything balances out.

    The tough thing is, very few (if any) medical students have the experience to know where they fall on this spectrum when they pick a specialty. They also know depressingly little about the specialties themselves and the environment in which those specialties are practiced, to the point where the decision comes down to a mixture of exposure, mentorship, perception from media/friends, and dumb luck.

    If there's one thing almost all docs agree on though, it's that medicine itself is f***** up. The degree of hustle required to have the sort of life and career I envisioned when I signed on is a source of near-constant amazement.

    I say this earnestly: good luck.
     
    gratefulgas, Twiggidy, nimbus and 6 others like this.
  12. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay 10+ Year Member

    1,800
    1,994
    Aug 10, 2007
    Closer to Mexico
    I would definitely still recommend it if you can get a job with a good PP, or if you are academically minded. This will require a good degree of flexibility on your part with regards to location, and also require that you go to a solid program with a strong alumni network, and that you prove to not be a donkey (both personally and clinically). Who knows what will happen 5 years from now with the continued metastasis of AMC's, but this is why geographic flexibility is key.

    I have to chuckle when you say "current doom and gloom" because that has been ubiquitous on this forum since the beginning over 10 years ago.

    I will say that if I didn't read this forum, I would have little clue as to the horrors that affect this specialty in other parts of the country. My practice still operates like they all should.
     
    payme2, rakotomazoto and Nivens like this.
  13. Dejavu

    Dejavu ASA Member 10+ Year Member

    450
    63
    May 17, 2007
    Minnesota
    SaltyFog said this discussion has been going on for 10 years. I will get nothing but feces for saying this from certain members here, but I have listened to these very words and concerns for 42 years.
     
  14. Man o War

    Man o War 2+ Year Member

    664
    583
    Apr 13, 2015
    Decades of hand wringing over CRNAs/money/work load since I was in residency...if SDN was around back then it would have read exactly like it does today. If anything, CRNAs have gotten weaker. Their standards have slipped. And I feel I'm still fairly compensated for the work I do.
     
  15. algosdoc

    algosdoc algosdoc 10+ Year Member

    3,370
    795
    May 3, 2005
    Florida
    I love what I do in anesthesiology, but only because I have carved out a niche that allows me to rotate to different locations (avoiding local politics and boredom due to regimentation), leave after 8 hours of work (am not chained to an anesthesia machine until death), no nights, no weekends, and do not take call. It wouldn't work for most anesthesiologists because there is no guarantee of employment as a locums, but I have had only two unscheduled days off since November 2016. I sleep at home every night, and have limited travel, but live in a major metro area. Life is good.
     
  16. GA8314

    GA8314 Regaining my sanity 2+ Year Member

    473
    305
    Jun 3, 2014
    A busy practice is kind of like an assembly line of cases to be done. Some acute, some bread and butter. But, day in and day out, as an anesthesiologist, the long haul of it all is that the work needs to get done. Cases need to flow. You have the ability, through your skills/time management etc., to provide safe, comfortable SERVICE to your patients, and a safe, fast, clean anesthetic and SERVICE to the surgeons and administration.

    It's a service specialty. Part of that service requires great skill in the traditional sense. Other parts require hustle, interpersonal skills, and a get it done attitude. Then, mix all of those things into one case or a whole day. But, in the end, we are a service specialty.

    Some like and are o.k. with this and others probably don't and aren't. I would caution, however, that even the surgical subspecialties are being looked upon by the public as commodities. Perhaps you won't (as I don't) see this in the near future with administration and the way the surgeons are treated (often as premaddona's), but the public is starting to see surgeons as commodities and with much less "awe" than perhaps in the past.

    Again, I'm happy with my choice and would do it again. But, medicine is changing. Be good at what you do, and work hard to move cases along with a smile, and you will be sought after. Just my opinion....
     
    Twiggidy, pgg and nimbus like this.
  17. rakotomazoto

    rakotomazoto ASA Member 7+ Year Member

    147
    105
    Aug 25, 2009
    Los Angeles, CA
    Just a resident here, but a happy one. I agree with Nivens, your baseline personality plays a strong role in your satisfaction. I still believe that I would be overall pretty happy if I had matched into another specialty. Or if I had pursued another career that had nothing to do with medicine at all. My life would certainly be different, but there are many roads to a happy life. Don't chase happiness through your career or by trying to narrowly define your options by thinking about what the best specialty is going to be in 5 years.

    Life is too short and there are far better and simpler ways to find joy than to work yourself to death chasing the "perfect" job. There is meaning in hard work, but it seems like medicine has a way of driving people to the extreme and as a result, you see all of the discussion about burnout and physician suicide rates, etc, etc. I cannot speak for others, but I have found some degree of balance and happiness so far, but that has as much to do with what I have done outside the hospital. My wife and kids consume pretty much all of my "free time" but being a dad and a father adds a deep sense of meaning to my life and I actually think it makes me a much better physician. Just as you want to diversify your financial investments, don't throw all of your emotional resources into the "career" bin. Spread yourself around and keep on exercising or painting or fishing or surfing or going to church or whatever it is that connects you to the rest of the world outside of medicine.

    Anesthesiology will not change your personality for better or worse. No one knows what the future of medicine will be exactly like 5 years from now, just like no one 5 years ago knew who would win the last presidential election. Short of the world ending (which is also a possibility...), the patients will still be there in 5 years and they will still want someone to keep them safe and comfortable while they have surgery. If you think that is your role, go for it.

    However, if a bunch of strangers can talk you into or out of this decision, then you haven't done your homework. There is no perfect specialty, every one has pros and cons. Choosing a specialty is more subjective than some people like to believe, so make sure you know yourself and consider how well you might do as a consultant who is providing a service for someone else's patient. Anesthesiology is a great fit for some, but not ideal for everyone. Good luck in making your decision.
     
  18. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor 7+ Year Member

    5,098
    3,955
    Oct 17, 2007
    The problem for medical students is that they don't get the full image until they are well into residency, if not already attendings. There is this romanticized version of anesthesiology that one experiences during an elective, because the residents are afraid to complain, because the attendings won't share their insights with a greenhorn medical student who may turn around and report them to somebody, and frankly because most medical students are too darn stupid to notice even what's under their noses.

    Back when I was a fellow, I told a medical student a number of my previous experiences as an anesthesiology attending. She looked at me with big incredulous eyes, then continued working on applying for her absolutely idyllic idea of anesthesiology residency. We'll probably see her bitching here in a year or two. But that was a lesson for me not to share my impressions with anybody who's not prepared to receive them ever again. I will confirm their experiences if asked, but I will not tell them anything negative on my own; I am sure many other attendings do the same. It's just not worth the headache, especially if I am the only one who tells things as they are. The students will think that they heard 5 positive experiences vs just a negative one and will conclude that the problem is with the latter person, not that the former ones lied to them (even if just by omission). American culture does not appreciate bad news or criticism, or candor, unless it's packed in PC euphemisms (e.g. people don't say they are having a bad day, they say they are doing OK instead of well).
     
    Last edited: Aug 29, 2017
  19. Pharmado

    Pharmado PharmaDo 5+ Year Member

    140
    97
    Mar 5, 2012
    Texas
    I think most people who legitimately enjoy anesthesia can find a practice where they are happy. The question is whether or not they are willing to go to a place with a practice they will enjoy. There are pockets of the country as previously described where the jobs are simply not good. If you HAVE to live on the East coast, you may consider a different field. If you are free to move where ever the best job takes you, there are plenty of jobs to fit everyone's personality. I wanted to go to Tennessee but found a wasteland of AMC's and other undesirable jobs. There probably are good jobs there, but I didn't find them. Instead I chose a job with a practice I believed suited my personality. So far I'm very happy with my choice and I really enjoy my job. OP needs to decide what is most important and make a decision based on that. Anesthesia is a great field, but not all of the jobs are good ones. Unfortunately the poor jobs are increasing and the good ones are decreasing, especially in "desirable" urban areas.
     
    SaltyDog and FFP like this.
  20. rakotomazoto

    rakotomazoto ASA Member 7+ Year Member

    147
    105
    Aug 25, 2009
    Los Angeles, CA
    I agree that medical students don't usually get the whole picture, myself included. I made a decision based on the limited data at my disposal and fortunately, so far so good. But life is always like that, we make lots of major decisions without complete information. I have also had some discussions with medical students who were missing the big picture and just hearing what they wanted to hear rather than what I was trying to tell them. It is frustrating and I wish I was better at conveying the good and bad of anesthesiology and helping people apply that information to themselves and their strengths and weaknesses.
     
  21. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

    10,515
    4,362
    Dec 14, 2005
    Home Again
    I still enjoy my days and don't dread going to work. I would choose anesthesia again. I'm not sure if I'd do medicine again ... but within medicine, anesthesia is right for me.

    I have a high degree of confidence that for the duration of my career, I'll be able to find a good work environment, with acceptable income and time off. I am however, geographically flexible and not especially attracted to large coastal cities. I'm also currently an "employee" in the 2nd least efficient system in the USA, earning something like 25th %ile MGMA wages, so some of the things that are egregiously intolerable for others are just Tuesday for me. Others might argue that I'm just indoctrinated and brainwashed to accept being a cog in an indifferent machine, and that I'm not setting the bar high enough; my counter argument is that I just have ... perspective.
     
    el mero mero, nimbus and FFP like this.
  22. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor 7+ Year Member

    5,098
    3,955
    Oct 17, 2007
    Besides all the generics posted above and in many other threads, in order to help you, tell us more about yourself (personality, favorite subjects and rotations, things you excel at, priorities in life, other specialties you are interested in, hobbies etc.).
     
  23. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

    16,009
    2,340
    Apr 22, 2007
    Southeast
    All I Can say is that in one of the largest states in the USA there are maybe 5 independent practices which have not been sold or taken over by AMCs. Anyone who doesn't recognize this is a substantial change from 10 years ago is clearly ignorant.

    I see no signs of the "slow down" of AMC take-overs on the horizon. If anything, the trend is accelerating at a rapid pace. This means a current med student will likely never be a "partner" in a real private practice but rather an employee of an AMC, hospital or academic center. The fortunate few who seek employment out West or in the Midwest have the best chance of financial success going forward.

    If I was entering a field of medicine today I would avoid specialties where 50% of the graduates are forced to become employees of a large organization. Instead, I would look for the opportunity to have my own practice; but, that's just me.

    The job/work is not the issue. The politics of this field is pretty bad and the former number one threat to the field is now number 2. So, I disagree that the issues this field faces are the same ones from 10 years ago.

    On a positive note you will always have a job with a crappy 401K plan working for the "man" until you are age 70.

    Best of luck.
     
    Last edited: Aug 30, 2017
    Leinie and el mero mero like this.
  24. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    575
    341
    Jan 13, 2015
    i probably wouldn't....but not for the gloom and doom reasons typically mentioned here


    *actually....see below*
     
    Last edited: Aug 30, 2017
  25. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    575
    341
    Jan 13, 2015
    The on thing medicine has on just about every other career is: Job Security

    You'd be hard pressed to find a more secure career. You graduate med school, you complete a residency (maybe a fellowship), you will find a job and for the most part if you don't screw up you will keep the job. I think that goes for most specialties.

    In my previous post I said I probably wouldn't, I take that back, I would look hard at some other fields that interested me first before choosing my current career, but this is all in hindsight and knowing things now that I didn't know then. I personally don't fall for the doom and gloom because for the most part we'll always make 6 figures and in the end "a job is nothing but work". It's the politics that bother me in this field and that's something you'll have to really interview alot of attendings to find out about. Maybe it's just my gig in particular, but I have a feeling it isn't just here.

    So my better answer is "maybe"
     
    nimbus and pgg like this.
  26. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    575
    341
    Jan 13, 2015
    100
     
  27. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

    10,515
    4,362
    Dec 14, 2005
    Home Again
    Truth.

    Oh, come on ... the only reason that even the doom & gloom anesthesiologists won't be able to retire in their 50s is if they're idiots with their income or can't retire without a private jet.


    "Annual income twenty pounds, annual expenditure nineteen nineteen and six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery." Except in our line of work, even in the AMC era, we're starting with a lot more than 20 pounds ...


    There may be less room for a stable full of Ferraris and ex-wives now compared to the 1980s, but let's not pretend that retiring at 70 with a crappy 401(k) is in the cards for any but the dumbest of us who try to keep up with the Orthopod Joneses.
     
    bigdan, nimbus and GA8314 like this.
  28. GA8314

    GA8314 Regaining my sanity 2+ Year Member

    473
    305
    Jun 3, 2014
    Anecdotal I realize, but employment isn't just going to be more common in our field, as I am aware of quite a few new surgeons and cardiologists taking employment packages with the hospital. So, it's not just us IMO.
     
  29. CommonMan

    CommonMan

    10
    4
    Dec 6, 2016
    When the AMC take over, require a 60 hour work week and pay is less than 150K per year wouldn't the MD's just say no and refuse to take the jobs. CRNA's cannot replace MD's, they lack the expertise. Unless the education and training that MD's go through is just a big scam and a waste of time why do so many here feel like they can be replaced at a drop of a hat. It really is as simple as law of supply and demand.
     
  30. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    575
    341
    Jan 13, 2015
    And that's the point of saying the doom and gloom is kind of silly. No anesthesiologist in the world will work for that and the AMC will eventually fail and lose business. Moreover, if we're graduating residents who would take that job, then we need to re-evaluate who we let into our residency. No desperate resident should be taking those jobs.

    250k? ok, fine. that's similar to some academic jobs. 350k, you're getting towards bad PP job. 150k? they shouldn't get a single response and every existing employee should walk immediately out the door
     
  31. dhb

    dhb Member Lifetime Donor 10+ Year Member

    3,197
    386
    Jul 12, 2006
    Aren't some east coast jobs already close to those figures? Slow erosion will lead you to these numbers and you will always find someone to take those jobs.
     
  32. drdan4

    drdan4

    6
    3
    Jan 5, 2017
    More and more Medicare/Medicaid in hospitals(which reimburses crap).

    More and more Company Model Enslavement at Surgicenters.

    Loser AMCs and Militant CRNAs that will not relent until the only thing MDs do are ASA 3/4, nights/weekends in a collaborative model for marginally more pay.

    A saturated market with increasing residency spots and only FMGs/marginal canditates entering the field.

    Sicker, Fatter , Older increasingly litigious patients. You will work, you will be stressed..and no, you will not get paid.

    Incompetent, Greedy and Spineless leadership that will ensure none of the above will ever improve.

    Of course you should apply! The future has never been brighter!!
     
  33. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay 10+ Year Member

    1,800
    1,994
    Aug 10, 2007
    Closer to Mexico
    No clinic though - so we've got that goin for us.
     
    pgg likes this.
  34. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    575
    341
    Jan 13, 2015
    if you're talking about the 250K then yes because I first hand know an academic institution that pays that and this could be wreckless speculation but I believe NAPA is similar (i could be totally wrong)

    if someone is out there accepting employed positions for less that 200 i personally want to find them and confront them. I dont care how desperate you are, how much you want to live in a certain area, i don't care. I want to personally confront them and tell them to stop devaluing our field
     
    Direct Laryngoscopy likes this.
  35. surfguy84

    surfguy84 5+ Year Member

    515
    185
    Mar 19, 2012
    Not the poster you quoted, but in a similar position and would love your input.

    A bit about me...absolutely positively a work to live type. love traveling, going to music festivals, hanging with friends, being active, surfing, golf. love food and cooking and would some day love to open a little restaurant. very laid back personality. being able to live on the west coast near family and friends is high priority. I place an emphasis on experiences over material things. would love to do international medical work in low income communities/countries.

    For the academic side of things....I am a good student, did well on boards. I love physiology and excel at it. Enjoy being in the OR and would consider surgery if not for the lifestyle. hate endless rounding, despise FM and IM. Interested in psychiatry and EM as well.

    Thanks for your thoughts.
     
  36. Ezekiel2517

    Ezekiel2517 Anesthesiologist 10+ Year Member

    409
    321
    Jan 21, 2005
    CA
    Physician
    Lmao, this sounds like the bio for every EM resident on their program's website. You found your calling son. Make sure you have the obligatory photo of yourself in the jungle or on top of Mt. Everest or with a quirky facial expression that they can use for your bio.
     
    Psai, AdmiralChz and Leinie like this.
  37. GravelRider

    GravelRider SDN Lifetime Donor Lifetime Donor Gold Donor 2+ Year Member

    1,200
    1,178
    Sep 30, 2014
    NAPA offers >300k. Some major academic institutions on the east coast offer significantly less than 250k. You can make >400k on the east coast, but expect to work for it with a fairly rigorous call load and ~6 weeks vacation (4-6 weeks is typical on east coast, more is a rarity).

    Anesthesia is fun, but the business and politics of it are not fun at the moment. However, the same can be said of most specialties as we continue the march towards the complete takeover of medicine by either big business or big government.

    My advice is to spend less than you earn, develop an escape plan early, and find meaning in your life beyond your career. Also, being able and willing to leave a bad job is your only leverage, so use it (spend less than you earn).
     
    Twiggidy and dr doze like this.
  38. GA8314

    GA8314 Regaining my sanity 2+ Year Member

    473
    305
    Jun 3, 2014
    I'm not a "set the bar low" type of person, but as pertains to our field, I really think that all of us (except for those very close to retirement perhaps, but including residents) need to understand, not that you should be willing to take an underpaid position, but rather that 250k today is the new "six figures". I've heard this before and believe it's true.

    I think anesthesia will provide you with a comfortable living, and while you should shoot for the stars, you need to be o.k. with a comfortable living. One where you should live below your means (this is relative as well as always the way to go no matter the income), knowing that you will be comfortable but not "rich". However, we all know you can be rich in other ways.

    Compared to the rest of the economy (come on, I can't be the only one thanking God I did't do medical sales of ANY kind), we have it pretty good. There's no free lunch and our profession (of medicine in general) has seen it's hay day, but so have many diverse careers.

    Again, this is not a defeatist attitude. If you can be geographically flexible, lucky, and timely, with the right skill set, you can still land a great gig. But, for most, we are going to be more "upper middle class" than anything else. Which, we also all know, is not a bad life.
     
    Twiggidy and pgg like this.
  39. drdan4

    drdan4

    6
    3
    Jan 5, 2017
    Worse - Perioperative Surgical Home.
    More Work. No Money.
     
  40. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

    10,515
    4,362
    Dec 14, 2005
    Home Again
    I ain't doing that. Never.
     
    Twiggidy likes this.
  41. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

    16,009
    2,340
    Apr 22, 2007
    Southeast
    My point about the "crappy 401k plan" was that employed positions deprive the new graduate of the BEST tool out there for growing wealth: tax deferred investing.

    BY being denied a full 401k contribution from their employer the newly minted Anesthesiologist is losing out on more than a million dollars of retirement money. The best way to get wealthy (or at least comfortable) is by saving money and avoiding taxes. The hospitals (to a lesser degree) and the AMCs (almost all of them) make the employee a W-2 instead of a 1099 denying him/her the opportunity to truly obtain wealth via tax deferred investing over 2-3 decades.

    So, this isn't about about Teslas or second homes in Vail Colorado which the AMC employee won't be able to afford, but rather the chance to maximize wealth by using the tax code to the maximum as allowed by law.
     
    mmag likes this.
  42. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

    16,009
    2,340
    Apr 22, 2007
    Southeast
    Look at the chart below and you will see than the maximum contribution for a newly minted Anesthesiologist is $54,000 per year. The employee contributes $18,000 while the employer can contribute up to an additional $36,000 per year. Most AMCs contribute $0-$6,000 per employee depriving that person of a significant sum of money each year; if this is compounded over a 30 year career the result is huge sum of money: most likely in excess of $3 million

    [​IMG]
     
    Last edited: Aug 30, 2017
  43. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

    16,009
    2,340
    Apr 22, 2007
    Southeast
    PGG is correct about the fact that it is what you keep after expenses/living that matters to grow wealth. But, what he doesn't understand or explain well is the tax code is set up to hurt the little guy. Currently, maximizing the 401K ($54,000 per year) is the BEST WAY for any Physician to obtain wealth over 3 decades. Hence, I'd advise against taking jobs which deny you the option of tax deferral unless the compensation reflects this significant hit to your bottom line.

    Independent groups and 1099 employment allow an individual to use the tax code in a much more efficient manner. Unfortunately, the vast majority of jobs are dead end types with poor retirement plans.


    "However, the truth is that for most physicians, the very best place to invest their next dollar is inside a tax-deferred retirement account such their employer’s 401(k), 403(b), defined benefit/cash balance plan, or even 457(b), and in the case of a self-employed physician, an individual 401(k) or cash balance plan."

    Tax-deferred Retirement Accounts: A Gift from the Government
     
  44. BLADEMDA

    BLADEMDA ASA Member 10+ Year Member

    16,009
    2,340
    Apr 22, 2007
    Southeast
    The problem in Anesthesia is that 90% of the jobs on Gaswork.com are bad jobs so I'm not sure what leverage you really have in this market. I also think that with the increase in the production of Anesthesiologists due to the expansion of residency positions the market won't be getting any better. In fact, as the AMCs fire the extra MDs and replace them with CRNA/AAs the glut will likely get worse.

    Every single CRNA and AA is in demand by management companies as they streamline their 4:1 coverage models across the USA.

    If you must go into this field I firmly believe a fellowship (or even two) is essential to finding a good job and/or being more marketable in this saturated field.
     
  45. Lecithin5

    Lecithin5 2+ Year Member

    46
    13
    Apr 21, 2015
    Pardon my ignorence, but how does a 1099 work in one's favor?
     
  46. Football Pig

    Football Pig

    8
    7
    Aug 31, 2017
    I hope your not serious in stating that "most medical students are too darn stupid" as that seems rather harsh. Grasping the realities of anesthesiology is difficult and that isn't unique to this specialty, understanding the lifestyle outside the educational setting is difficult until you're actually living it.
     
    Twiggidy likes this.
  47. Scotty_G

    Scotty_G Junior Member 10+ Year Member

    327
    37
    Jun 21, 2004
    Northeast
    What blade means is regardless of what type of account you choose for retirement etc you will be able to put the maximum amount allowed which is 54k currently. That is big difference vs putting in let's say half of that every yr working as W2 for AMC. However, you could work as a W2 employee in pp group that doesn't offer partnership (boo that) and still have a good retirement package.
     
  48. Stank811

    Stank811 Junior Member 10+ Year Member

    453
    145
    Aug 26, 2004

    AMC are a joke...which includes NAPA. You are worth more than a million dollars a year supervising 1:4 with 4 weeks of vacation but you are suggesting 300k is a good deal. Please stop with the non sense. I get it you feel you have no other options which is not the case...it is your choice to be devalued but don't try to convince everyone else on this forum the same.

    To the OP I would still recommend anesthesiology as a speciality. I would recommend avoiding any AMC or group that doesn't respect you and be willing to move to find groups or systems that treat you fair.

    There are many mid size to smaller groups that will pay you 350-500k first yr out plus full benifits including 53k into a 401k outside of your salary. You then partner after 2-3 yrs and your salary doubles.
     
    Scotty_G and bashwell like this.
  49. Scotty_G

    Scotty_G Junior Member 10+ Year Member

    327
    37
    Jun 21, 2004
    Northeast
    I agree with Stank :0 However, there are many AMC jobs where it is not 4:1. Some of them are doing your own cases decent amount of time vs 2:1/3:1.
     
  50. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor 7+ Year Member

    5,098
    3,955
    Oct 17, 2007
    I am not talking about lifestyle. I am talking about the interactions between residents and OR staff, or residents and surgeons/surgical residents, or simple things like a doctor pushing a stretcher, or how patients have no friggin' idea that the anesthesiology resident is a physician and ask about "the doctor" etc. There are many subtle things one can pick up just by shadowing for a week or two. and paying attention. There is a lot of naivete among medical students, especially among those who are young and haven't had a different path before. They should realize most places and people do their best to optimize elective experiences, so everything is sugarcoated for them.
     

Share This Page