Are these feelings normal? Should I back out while I still can?

[medstudent87]

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I did a 3 week rotation in anesthesia during MS3 and loved it...so much that I decided to pursue it as a career.

Right now, I'm on my sub-I at a different hospital...and I'm having second thoughts. This new hospital has TONS of crnas....TONS....and it really annoys me that these nurses are allowed to do just about everything an MD is.

Is anesthesia really that easy? To me, it seems so complex, but I don't know very much about it right now. Honestly, I get a little jealous when I look over the curtain and see only SURGEONS performing surgery, not advanced practice nurses. I can't comprehend how people that went through nursing school, did a little nursing, and then went through a 3yr CRNA school are now able to perform the same tasks as someone whose education consisted of 4 years of studying chemistry, physics and mathematics, followed by 4 years of intense medical education, followed by 4 years of grueling residency.

Are these feelings reason enough to not pursue anesthesiology, or does everyone feel this way at some point?

Need a little guidance here. Thanks in advance

 

[btbam]

Curious why you say they "certainly weren't top students in high school"?

 

[pgg]

Anesthesia isn't a field for people who need constant external reaffirmation of their self worth. We're supporting characters. In a perfect world, the people who surround us recognize the value and difficulty of what we do. Anesthesia is like refereeing, when done well most people don't realize we're doing anything at all.

I wouldn't let the fact that midlevels are running rampant at one institution dissuade you from the field. Non-doctors will piss you off for the rest of your career no matter what specialty you choose.

Most CRNAs aren't militant, most desire backup, most don't consider their training to be equal to that of anesthesiologists, most aren't bad people. Some do, some are, but those cowboys don't make you any less capable or valuable.

 

[Idiopathic]

I did a 3 week rotation in anesthesia during MS3 and loved it...so much that I decided to pursue it as a career.

Right now, I'm on my sub-I at a different hospital...and I'm having second thoughts. This new hospital has TONS of crnas....TONS....and it really annoys me that these nurses are allowed to do just about everything an MD is.

Is anesthesia really that easy? To me, it seems so complex, but I don't know very much about it right now. Honestly, I get a little jealous when I look over the curtain and see only SURGEONS performing surgery, not "advanced practice" nurses. I can't comprehend how these women (and men) that certainly weren't top students in high school are now able to perform the same tasks as someone whose education consisted of 4 years of studying chemistry, physics and mathematics, followed by 4 years of intense medical education, followed by 4 years of grueling residency.

Are these feelings reason enough to not pursue anesthesiology, or does everyone feel this way at some point? Do CRNAs know their place in the world of private practice (meaning, do they understand that they are NOT equals to anesthesiologists?)

Need a little guidance here. Thanks in advance

first of all, you dont know what kind of intellectual capacity CRNAs have, and you certainly cannot say they werent top students in high school, thats ridiculous. if you dont have a love of physiology/pathophysiology and arent fully invested in the perioperative care of the patient, then maybe you should get out.

the system will be different in 6 years when you are out, but there will always be the need for physician leadership. i think that if you want to do the same job as a CRNA (i.e. B+B cases with little call) you will find lots of competition and a shrinking financial structure. also, if you are basing your decision on whether or not CRNAs "know their role" you will definitely be disappointed. you are fundamentally different from the midlevel provider, but that difference is realized through residency, not medical school, and just BEING a physician is not necessarily enough, because it will be a while before you are as good as/better than a CRNA at delivering anesthesia.

as far as "surgeons performing surgery" go spend seven plus years, run a clinic, do everything you can to recruit patients and then do the same surgery 2-3 days per week on every patient you can while your anesthesia colleagues do a variety of cases and avoid the clinic and 6 month follow ups, plus learn ultrasound/TEE techniques, regional/epidural, advanced airway management, ICU skills, etc.

maybe im feeding the troll, i dont know.

 

[medstudent87]

nah, not a troll. Sry about the nasty comments about CRNAs....I'll get rid of them

 

[DrBB]

I did a 3 week rotation in anesthesia during MS3 and loved it...so much that I decided to pursue it as a career.

Right now, I'm on my sub-I at a different hospital...and I'm having second thoughts. This new hospital has TONS of crnas....TONS....and it really annoys me that these nurses are allowed to do just about everything an MD is.

Is anesthesia really that easy? To me, it seems so complex, but I don't know very much about it right now. Honestly, I get a little jealous when I look over the curtain and see only SURGEONS performing surgery, not advanced practice nurses. I can't comprehend how people that went through nursing school, did a little nursing, and then went through a 3yr CRNA school are now able to perform the same tasks as someone whose education consisted of 4 years of studying chemistry, physics and mathematics, followed by 4 years of intense medical education, followed by 4 years of grueling residency.

Are these feelings reason enough to not pursue anesthesiology, or does everyone feel this way at some point?

Need a little guidance here. Thanks in advance

I'm also a 4th year med student and am currently doing my anesthesia elective. I love the physio and pharm behind anesthesia, and truly find the work to be interesting. However, I do have some of the same concerns as you do. I'm really worried about the future of the field since CRNAs are becoming more and more prevalent and often can do the job as good as MDs can for less pay.

I liked other rotations during my M3 year (such as internal medicine) and might end up going into that just because I know that there will never be a shortage of jobs in that field. With anesthesiology, it may be difficult to find a good job in the ideal location that you would like by the time we are done (in 5 years). Honestly, I think its terrible that we have to make a decision regarding what specialty we want to do by September. Wish they would change that and go back to the 1 year mandatory internship that they used to have before formally applying to a specific specialty.

 

[gasattack3]

first of all, you dont know what kind of intellectual capacity CRNAs have, and you certainly cannot say they werent top students in high school, thats ridiculous. if you dont have a love of physiology/pathophysiology and arent fully invested in the perioperative care of the patient, then maybe you should get out.

the system will be different in 6 years when you are out, but there will always be the need for physician leadership. i think that if you want to do the same job as a CRNA (i.e. B+B cases with little call) you will find lots of competition and a shrinking financial structure. also, if you are basing your decision on whether or not CRNAs "know their role" you will definitely be disappointed. you are fundamentally different from the midlevel provider, but that difference is realized through residency, not medical school, and just BEING a physician is not necessarily enough, because it will be a while before you are as good as/better than a CRNA at delivering anesthesia.

as far as "surgeons performing surgery" go spend seven plus years, run a clinic, do everything you can to recruit patients and then do the same surgery 2-3 days per week on every patient you can while your anesthesia colleagues do a variety of cases and avoid the clinic and 6 month follow ups, plus learn ultrasound/TEE techniques, regional/epidural, advanced airway management, ICU skills, etc.

maybe im feeding the troll, i dont know.

I agree with the entire post, but especially the bold. This is so true.

 

[medstudent87]

I'm also a 4th year med student and am currently doing my anesthesia elective. I love the physio and pharm behind anesthesia, and truly find the work to be interesting. However, I do have some of the same concerns as you do. I'm really worried about the future of the field since CRNAs are becoming more and more prevalent and often can do the job as good as MDs can for less pay.

I liked other rotations during my M3 year (such as internal medicine) and might end up going into that just because I know that there will never be a shortage of jobs in that field. With anesthesiology, it may be difficult to find a good job in the ideal location that you would like by the time we are done (in 5 years). Honestly, I think its terrible that we have to make a decision regarding what specialty we want to do by September. Wish they would change that and go back to the 1 year mandatory internship that they used to have before formally applying to a specific specialty.

Are these valid concerns for a med student to be thinking about? I feel like whenever I ask an attending about this issue in person, they never seem concerned (both academic and private docs). Then I come on SDN and its like the field is about to implode.

 

[BLADEMDA]

I did a 3 week rotation in anesthesia during MS3 and loved it...so much that I decided to pursue it as a career.

Right now, I'm on my sub-I at a different hospital...and I'm having second thoughts. This new hospital has TONS of crnas....TONS....and it really annoys me that these nurses are allowed to do just about everything an MD is.

Is anesthesia really that easy? To me, it seems so complex, but I don't know very much about it right now. Honestly, I get a little jealous when I look over the curtain and see only SURGEONS performing surgery, not advanced practice nurses. I can't comprehend how people that went through nursing school, did a little nursing, and then went through a 3yr CRNA school are now able to perform the same tasks as someone whose education consisted of 4 years of studying chemistry, physics and mathematics, followed by 4 years of intense medical education, followed by 4 years of grueling residency.

Are these feelings reason enough to not pursue anesthesiology, or does everyone feel this way at some point?

Need a little guidance here. Thanks in advance

CRNAs in training do 28 months right now on average. In the near future (or right now for the US Army program) CRNA training is 36 months long but they get a DNP as the terminal degree. DNAP- Doctor of Nurse Anesthesia Practice which according to the AANA is EQUIVALENT to a Physician Anesthesiologist is all aspects of care.

 

[DrBB]

Are these valid concerns for a med student to be thinking about? I feel like whenever I ask an attending about this issue in person, they never seem concerned (both academic and private docs). Then I come on SDN and its like the field is about to implode.

I think they're definitely valid. I don't know about the docs you work with but the ones I'm currently working with on my rotation expressed concern for the field. There are more and more residency spots opening up with the amount of anesthesia jobs remaining constant or even decreasing due to CRNAs. Big cities (where I want to be) have gotten saturated with anesthesiologists and pay is not as high as if it were out in a smaller town. It's gotten more and more competitive to get a good job in a big city. Plus, I think it's crazy that CRNAs get paid 200k for the amount of training they have.

Don't get me wrong, I might still go into anesthesia after I finish my soul searching. I just think that there are a lot of valid concerns for the future. Despite midlevels taking over in many medical fields, I don't think that fields such as IM will be as affected just because the demand for primary care/IM subspecialists is going to be very high.

 

[WESTDOC1]

anesthesiology average starting salary is 300,000 according to medscape salary report. I am an MS IV going to apply for the field. It is absolutely rewarding both financially and intellectually. GO to medscape and look at the average salaries. I honestly think that is a lot of money for anyone no matter how much debt you're in! =)

Just my 2 cents.

 

[Endee]

It's all about where you work. We are full ACT and I feel like all of our physicians are duly respected as the leader of that team. I try to involve whichever doctor is supervising me in the case as much as possible/practical, including trying to brief/debrief before and after complicated cases and calling to keep him or her abreast of critical changes, blood loss/transfusion needs, etc. I think most of our anesthetists do the same, although a couple of doctors have noted to me that the AAs do it more diligently, because of our training I guess.

It's nice every now and again to have a room with ASA 1's having simple procedures where you don't need help, but for all of our super sick people and people having major surgeries, the culture in our group is to call the anesthesiologist in and get them involved as soon as possible. That's what the ACT model is meant for, right?

It's all local.

 

[WESTDOC1]

With all due respect, I feel like some older physicians are uneasy in general because they are witnessing a tremendous upheaval of how medical practice is going to be conducted. Change is hard to accept and adapt to, especially when you are used to be absolute masters of your domain. The field of Anesthesia will change, it is up to us future physicians to revamp it, make it better, more effective and more lucrative. Anesthesia will never go away.

 

[WESTDOC1]

Be the change you want to see -Ghandhi

=)

Keep your head up guys. Follow your dreams...and for all the future anesthesiologists gluck with a future of healing people dream haha (literally)

 

[saratoga733]

With all due respect, I feel like some older physicians are uneasy in general because they are witnessing a tremendous upheaval of how medical practice is going to be conducted. Change is hard to accept and adapt to, especially when you are used to be absolute masters of your domain. The field of Anesthesia will change, it is up to us future physicians to revamp it, make it better, more effective and more lucrative. Anesthesia will never go away.

WESTDOC1 good positive attitude. Blade please stop scaring the newbies. If I had listened to you back in '05 I wouldn't have entered this wonderful specialty. I enjoy great professional satisfaction and get compensated handsomely for it. WESTDOC1, there are jobs paying > 2X more than the salary you quoted from medscape if you have the drive to make yourself stand out from the pack. Money talk aside, I would gladly do this job for a lot less. Think about it, once MDs and nurses salaries start converging-- why would anyone hire them over us?? Doing more, compensated less? Yes, it's the way of the future in medicine regardless of specialty-- just talk to the radiologists, orthopedic surgeons, etc. Honestly guys, how many anesthesiologists do you see on the unemployment line in ANY of the opt out states??

 

[henrylee]

http://www.medscape.com/viewarticle/766667

anyone else concern with this?

 

[BLADEMDA]

WESTDOC1 good positive attitude. Blade please stop scaring the newbies. If I had listened to you back in '05 I wouldn't have entered this wonderful specialty. I enjoy great professional satisfaction and get compensated handsomely for it. WESTDOC1, there are jobs paying > 2X more than the salary you quoted from medscape if you have the drive to make yourself stand out from the pack. Money talk aside, I would gladly do this job for a lot less. Think about it, once MDs and nurses salaries start converging-- why would anyone hire them over us?? Doing more, compensated less? Yes, it's the way of the future in medicine regardless of specialty-- just talk to the radiologists, orthopedic surgeons, etc. Honestly guys, how many anesthesiologists do you see on the unemployment line in ANY of the opt out states??

1. I wasn't posting on SDN prior to 2006/07
2. I'm not "scaring" anyone. I'm telling the truth as I see it.
3. NOWHERE have I ever posted Anesthesiologists would earn less than $250K.
Instead, I post that a fellowship is useful for future career enhancement and job security.
4. All of Medicine will take a hit with Obamacare but those Doctors viewed as "less necessary under the ACO Model" may be at risk of even a larger salary reduction.
5. I'm glad you will do this job for "a lot less" because Obamacare is likely to make that a reality.
6. If ObamaCAre wasn't enough to deal with we have the AANA problem. Only Family practice and us have advanced Nurses stating EQUIVALENCE with Physicians at the legislative level.

 

[WESTDOC1]

and emergency physicians and some GENERAL internal physicians....
But, you're right blade. My posts were not meant to undermine anything you've said. And yes on the legislative level CRNAs are most definitely equal and are a powerful force. Recent policitics have shown that no one really gives a rat's ass about the quality of health care as long as some form of healthcare is present, so it is very likely that CRNAs and MDAs will compete for the same jobs including transplants and cardiac. I have not seen a CRNA do transplants and cardiac as of yet in the academic setting. I have seen them do GB and obstetric stuff.
I think surgery is the only real field that is safe from midlevels, for now. Unless they open up "schools of orthopedics."

 

[doctor712]

CRNAs in training do 28 months right now on average. In the near future (or right now for the US Army program) CRNA training is 36 months long but they get a DNP as the terminal degree. DNAP- Doctor of Nurse Anesthesia Practice which according to the AANA is EQUIVALENT to a Physician Anesthesiologist is all aspects of care.

Then maybe these DNAPs would be happy to take the full verbal boards upon completion of said "equivalent" training? Just a thought. Perhaps AANA should be offered this idea to demonstrate, "equivalency".

🙄

D712

 

[WESTDOC1]

Look at it from their perspective. Medicine is a business and politics cares about CHEAP not Great health care. If they are able to offer cheaper alternatives, people will listen. We doctors/future doctors can be as great as we want, but reality is no one cares for amazing cowboys anymore. Study the system and make it efficient. That will make you valuable.

 

[BLADEMDA]

Look at it from their perspective. Medicine is a business and politics cares about CHEAP not Great health care. If they are able to offer cheaper alternatives, people will listen. We doctors/future doctors can be as great as we want, but reality is no one cares for amazing cowboys anymore. Study the system and make it efficient. That will make you valuable.

COST-EFFECTIVE
SAFE
NO DIFFERENCE IN OUTCOME
MEANS GOOD ENOUGH under Obamacare.

 

[partydoc]

Then maybe these DNAPs would be happy to take the full verbal boards upon completion of said "equivalent" training? Just a thought. Perhaps AANA should be offered this idea to demonstrate, "equivalency".

🙄

D712

There's that same argument with allowing DNP's to take step 3. I don't think they should be allowed to.

If they pass the "equivalency training" do they get board certified then?

 

[BLADEMDA]

There's that same argument with allowing DNP's to take step 3. I don't think they should be allowed to.

If they pass the "equivalency training" do they get board certified then?

AANA says they alread did "equivalency training" at DA U next to you.

 

[partydoc]

AANA says they alread did "equivalency training" at DA U next to you.

Sorry, I mean to change that. I meant equivalency exams.

 

[WESTDOC1]

Could not agree more. That is why the veteren physicians are so upset by it. I have met so many middle aged to semi retired physicians who I have been awe with, not only because of their intellectual prowess, but because of how dedicated they are to patient care, follow-up and positive outcomes. Although personalities are sometimes malignant, their dedication has my utmost respect

Compared this to some of the younger physicians i have worked with "fresh out of residency. They are not as dedicated and focus their care on seeing as many patients as quickly as possible. This is apparant in what they expect from their students. I have found that the newer ones value efficiency/organization and older ones value knowledge and intuition.

This is of course a blanket statement. I am commenting on trends. Society has demanded this from physicians and physicians are responding. Once hospital mortality rates go up, maybe the trend will switch. Until then enjoy the fact that every field of health care is like becoming the EM (put a bandaid on it and see ya later).

 

[WESTDOC1]

And for you scrutinizing readers out there. Do not get the idea that I dont care about patient-care.
I went to medical school, because i enjoy medicine, the science of it and the delivery of it. I do not enjoy dealing with social issues like placement of the patient, affordability of medicines, and all the other ridiculous social issues that are put on a doctor's shoulder that should be dealt with my case/social workers. For this reason, I am choosing a field that is medically challenging and doesnt have to deal with all the BS. I could care less about the patient when he leaves the hospital, but ill be damned if i deliver any health care that is subpar while the patient is in my hands.

 

[dubfarmer]

I too am a fourth year strongly considering anesthesia but after some conversations with private practice guys and reading the discussions on this board it went from done deal to gun shy.

For guys like blade with the more pessimistic views of the future (which I tend to agree with)... bottom line... if you were a 4th year with ~250k of debt would you go into anesthesia?

“Who's up, who's down since 2010? "Decreased reimbursement" is the overall buzz-phrase, yet a minority of specialties saw modest gains. The biggest income increases were in ophthalmology (+9%), pediatrics (+5%), nephrology (+4%), oncology (+4%), and rheumatology (+4%). The largest declines were in general surgery (-12%), orthopedic surgery (-10%), radiology (-10%), and neurology (-8%).”

Even with the present and future predicted troubles with anesthesia I just don't see anything from the other specialties that make me go wow I'd be a fool not do that.

 

[Tedebear]

Actually my friend that is an anesthesiologist (who respects CRNAs) told me Anesthesiology requires 36 months of training ie PGY2-PGY4 to actually be competent and practice Anesthesiology. 4 years of Undergrad does nothing toward actual practical knowledge in the field. Nor does medical school and internship. They are prerequisites but true practical learning occurs during anesthesiology residency.

Therefore if you break it down

36 months of Anesthesiology residency is not much more than 28 months of CRNA training.

All the training to get to Anesthesiology residency is useless as a practicing Anesthesiologist. Training occurs during residency.

 

[doctor712]

There's that same argument with allowing DNP's to take step 3. I don't think they should be allowed to.

If they pass the "equivalency training" do they get board certified then?

I was being somewhat sarcastic. Expecting that the overwhelming majority are not nearly (insert percentage here) as a Medical Doctor. Be it a Neurologist or Anesthesiologist. I make no distinction there.

D712

 

[doctor712]

Actually my friend that is an anesthesiologist (who respects CRNAs) told me Anesthesiology requires 36 months of training ie PGY2-PGY4 to actually be competent and practice Anesthesiology. 4 years of Undergrad does nothing toward actual practical knowledge in the field. Nor does medical school and internship. They are prerequisites but true practical learning occurs during anesthesiology residency.

Therefore if you break it down

36 months of Anesthesiology residency is not much more than 28 months of CRNA training.

All the training to get to Anesthesiology residency is useless as a practicing Anesthesiologist. Training occurs during residency.

this could open up an entirely new debate (favoring the MD side of things)...but I'm too tired right now...

D712

 

[Osteoimperfecta]

COST-EFFECTIVE
SAFE
NO DIFFERENCE IN OUTCOME
MEANS GOOD ENOUGH under Obamacare.

Which is why if he wins in November, we are all screwed big time. SCREWED!!

 

[Dermpath]

1. I wasn't posting on SDN prior to 2006/07
2. I'm not "scaring" anyone. I'm telling the truth as I see it.
3. NOWHERE have I ever posted Anesthesiologists would earn less than $250K.
Instead, I post that a fellowship is useful for future career enhancement and job security.
4. All of Medicine will take a hit with Obamacare but those Doctors viewed as "less necessary under the ACO Model" may be at risk of even a larger salary reduction.
5. I'm glad you will do this job for "a lot less" because Obamacare is likely to make that a reality.
6. If ObamaCAre wasn't enough to deal with we have the AANA problem. Only Family practice and us have advanced Nurses stating EQUIVALENCE with Physicians at the legislative level.

What I find surprising, and I'm not in anesthesia, is that CRNAs make 150-200k or so. That is not really cost savings, and who in the hell decided to pay these people doctor salaries with nursing education? Seriously who came up with that kind of pay!? It's almost to the level of what anesthesiologists make for godness sake, given the call, longer hours, no overtime pay that attendings have. You seem to be a vocal individual, could you please address why these nurses are getting paid so much?!

 

[BLADEMDA]

Actually my friend that is an anesthesiologist (who respects CRNAs) told me Anesthesiology requires 36 months of training ie PGY2-PGY4 to actually be competent and practice Anesthesiology. 4 years of Undergrad does nothing toward actual practical knowledge in the field. Nor does medical school and internship. They are prerequisites but true practical learning occurs during anesthesiology residency.

Therefore if you break it down

36 months of Anesthesiology residency is not much more than 28 months of CRNA training.

All the training to get to Anesthesiology residency is useless as a practicing Anesthesiologist. Training occurs during residency.

More AANA propaganda. All of my education and experience was valuable from MS1-MS4 and especially the PGY 1 year. But, I was trying to become a Doctor then an Anesthesiologist and not a Nurse then an anesthetist.

 

[BLADEMDA]

Actually my friend that is an anesthesiologist (who respects CRNAs) told me Anesthesiology requires 36 months of training ie PGY2-PGY4 to actually be competent and practice Anesthesiology. 4 years of Undergrad does nothing toward actual practical knowledge in the field. Nor does medical school and internship. They are prerequisites but true practical learning occurs during anesthesiology residency.

Therefore if you break it down

36 months of Anesthesiology residency is not much more than 28 months of CRNA training.

All the training to get to Anesthesiology residency is useless as a practicing Anesthesiologist. Training occurs during residency.

CRNAS are Nurses. They think like a Nurse and have the educational background of a nurse. Hence, they belittle medical school, medical knowledge and the internship year. All of it is worthless according to them. Yet, when you ask the militant CRNAs about Pre-CRNA education they stress 3 years of actual critical experience and critical thinking as being very valuable.

To turn a dial you don't need medical school and an intership plus a residncy. But, to evaluate, tune up and care for the ASA4 train wreck you do. The million dolllar question is do you want an anesthesia nurse technician running the show or a Physician Anesthesiologist?

 

[jwk]

Actually my friend that is an anesthesiologist (who respects CRNAs) told me Anesthesiology requires 36 months of training ie PGY2-PGY4 to actually be competent and practice Anesthesiology. 4 years of Undergrad does nothing toward actual practical knowledge in the field. Nor does medical school and internship. They are prerequisites but true practical learning occurs during anesthesiology residency.

Therefore if you break it down

36 months of Anesthesiology residency is not much more than 28 months of CRNA training.

All the training to get to Anesthesiology residency is useless as a practicing Anesthesiologist. Training occurs during residency.

Yeah, you tell em cowboy. Who needs all that physiology and pharmacology stuff from medical school? Anatomy? WTF - what possible connection could that have to the practice of anesthesia?

Are you serious?

 

[jwk]

What I find surprising, and I'm not in anesthesia, is that CRNAs make 150-200k or so. That is not really cost savings, and who in the hell decided to pay these people doctor salaries with nursing education? Seriously who came up with that kind of pay!? It's almost to the level of what anesthesiologists make for godness sake, given the call, longer hours, no overtime pay that attendings have. You seem to be a vocal individual, could you please address why these nurses are getting paid so much?!

You won't find many anesthesiologists working for $150-200k. However, there certainly are CRNA's and AA's making that kind of money - although those that do are usually taking call and working a lot of OT, which for some reason you're under the assumption that we don't do. My light weeks are 50 hours, and I have plenty that are pushing 80, and I generally work far more hours each and every week than the docs that are my employers do. I don't apologize to anyone for what I make. I'm an AA, not a CRNA.

Anesthetist salaries and compensation are strictly supply and demand based. More demand = higher pay, more supply = less. It's really that simple. Crappy locations = high demand = higher pay. Desirable locations near big cities / beach = less demand, high supply, and lower pay. Very basic economics - and it holds true with doc positions as well.

 

[Gasworks]

I used to tell med students that the anesthesia ship sailed a good 5 years ago. Now I tell them that the ship is sinking and those of us who thought we could make a good career doing this are scrambling for lifeboats. If you really love the field thats great.. but think about providing 70 hours of critical care a week including nights and weekends for maybe $150k/yr. Personally I'd rather take the last of my savings and open up a couple of dunkin donuts franchises.

Even the most optimistic senior partners in my group are downsizing homes, selling toys, pulling kids out of private school, etc. The future here looks very bleak.

 

[EtherBunny]

I think your concerns are valid and you should definitely factor them into your decisionmaking when you have to decide on a specialty. It should not be the overriding factor, however, because there is so much uncertainty inherent to the situation. The bottom line, despite all the opinions expressed on this forum, is that no one knows what the future holds for this specialty, or any other specialty for that matter. The pressure to reduce medical cost is clearly evident and will not go away--if anything, it will likely intensify over time. The ultimate effects of this pressure on anesthesiology as a specialty are unclear.

It all depends on how the field evolves in response to these pressures. The beauty of being an anesthesiologist is that you're a physician and, therefore, you have a very broad skill set and knowledge base vis-a-vis the the diagnosis and treatment of human disease. Fundamentally, it is this expertise that sets anesthesiologists apart from CRNAs. You have the requisite training to step into an ICU and run the show. You have the knowledge and skills to function as a perioperative hospitalist if necessary. In short, you have a skill set that enables you to take care of patients through the entire continuum of perioperative care. CRNAs, despite all the rhetoric by the AANA, don't have thIs skill set. They certainly don't have the knowledge base regarding human diseases that physicians possess. Moreover, the certainly don't have the same foundation that physicians have diagnosing and treating disease.

I think if the field evolves into a specialty that takes full ownership of perioperative care, anesthesiology will not only survive the changes on the horizon but most likely thrive in the new environment. If the field restricts scope of practice to mostly intraoperative care, we're all going to be in serious trouble. It's time for thecspecialty as a whole to step up to the plate and start using all the knowledge and skills that we acquired to become physicians. This will mean responsibility that extends beyond the operating room and into clinics, hospital floors, and ICUs. It's definitely more painful than passing gas in the ORs, but it's what we were all trained to do.

Just my $.02

 

[Med0123]

I think if the field evolves into a specialty that takes full ownership of perioperative care, anesthesiology will not only survive the changes on the horizon but most likely thrive in the new environment. If the field restricts scope of practice to mostly intraoperative care, we're all going to be in serious trouble. It's time for thecspecialty as a whole to step up to the plate and start using all the knowledge and skills that we acquired to become physicians. This will mean responsibility that extends beyond the operating room and into clinics, hospital floors, and ICUs. It's definitely more painful than passing gas in the ORs, but it's what we were all trained to do.

👍

In Europe (well at least in UK and France), anesthesiology is one of the most (or the most?) respected field of medicine mainly because 95% of ICUs are managed by anesthesiologists.

You guys have the ideal training for that and yet most of ICUs in North America are managed by IM/pulm... DAFUQ?

 

[BLADEMDA]

I did a 3 week rotation in anesthesia during MS3 and loved it...so much that I decided to pursue it as a career.

Right now, I'm on my sub-I at a different hospital...and I'm having second thoughts. This new hospital has TONS of crnas....TONS....and it really annoys me that these nurses are allowed to do just about everything an MD is.

Is anesthesia really that easy? To me, it seems so complex, but I don't know very much about it right now. Honestly, I get a little jealous when I look over the curtain and see only SURGEONS performing surgery, not advanced practice nurses. I can't comprehend how people that went through nursing school, did a little nursing, and then went through a 3yr CRNA school are now able to perform the same tasks as someone whose education consisted of 4 years of studying chemistry, physics and mathematics, followed by 4 years of intense medical education, followed by 4 years of grueling residency.

Are these feelings reason enough to not pursue anesthesiology, or does everyone feel this way at some point?

Need a little guidance here. Thanks in advance

To all the medical students out there who are in their MS-3 or MS-4 year I have a question for you: Based on your grades, STEP score(s) and research where do you stand in terms of MATCHING in the House of MEDICINE?

Please notice I am taking a realistic, pragmatic approach to your career options. This doesn't mean you shouldn't pursue your dreams of a certain specialty but unless your father is going to pull some strings how are you going to match into DERM with average grades and a 200 STEP score? Are you famous or an athlete?

So, what are you actual options for a specialty? Is it Anesthesiology VS Family Practice vs Internal Medicine? Or is Pediatrics vs Family Medicine? Now, if you are within the norm for this specialty what other options do you have available? What do you see yourself doing for the next 30 years of your life?

Some of you out there can Match into any specialty like Optho, Neurosurgery, ENT, etc while others may be more limited in selection.

With the ever increasing number of Medical School graduates competing for a limited number of Residency positions Anesthesiology will remain a fairly competitive match for at least the next few years and, hopefully, for my lifetime. But, the average "matched" applicant in Anesthesiology does NOT compare to Neurosurgery or several other specialties.

 

[BLADEMDA]

"To get by with only 20 apps, you would have to be an excellent candidate. As a D.O., you will still face a few people that still have the stigma that used to be associated. For me, a top D.O. candidate=a top M.D. candidate. Not everyone shares that belief. So you need to be better than the average MD standard. Too me, that means, top quartile of class, better than average USMLE scores (average for anesth has been around 228 and 235 for steps I and II),

Also, you should know that there are many DO students out there this past year who were scoring in the 245-270 range. I think a lot of the schools teach specifically to that exam, just like the Caribbean schools do. Therefore, you see a whole bunch of really high scores. So competition is fierce just among your D.O. colleagues, because there are a bunch of candidates out there. You see some actual reports from people above who had excellent scores and only received invites from 20-30% of the programs they applied to.

If I was an "average" DO student, I would apply broadly. If you are a fourth quartile student, I would also have some contingency plans."


GERN BLANATEN on SDN

 

[darby11]

Most CRNAs aren't militant, most desire backup, most don't consider their training to be equal to that of anesthesiologists, most aren't bad people. Some do, some are, but those cowboys don't make you any less capable or valuable.

hey dude!! what are you saying? Most CRNAS are militant, They all want you r joband consider all anesthesioloigsts SUPERFLUOUS. They are the most difficult bunch of people to direct as they KNOW everything already. its awful i agree with the original poster this IS a reason to steer clear of the field

 

[darby11]

Look at it from their perspective. Medicine is a business and politics cares about CHEAP not Great health care. If they are able to offer cheaper alternatives, people will listen. We doctors/future doctors can be as great as we want, but reality is no one cares for amazing cowboys anymore. Study the system and make it efficient. That will make you valuable.

in a sense you are right. Nobody cares if you are good, just good enough.Which is why I dont understand this whole recertification process, but that is another story. Cheap care you say? Bad outcomes will follow cheap care in spades. Has to happen. You cant lower standards and better care, cant happen.

 

[gasattack3]

Actually my friend that is an anesthesiologist (who respects CRNAs) told me Anesthesiology requires 36 months of training ie PGY2-PGY4 to actually be competent and practice Anesthesiology. 4 years of Undergrad does nothing toward actual practical knowledge in the field. Nor does medical school and internship. They are prerequisites but true practical learning occurs during anesthesiology residency.

Therefore if you break it down

36 months of Anesthesiology residency is not much more than 28 months of CRNA training.

All the training to get to Anesthesiology residency is useless as a practicing Anesthesiologist. Training occurs during residency.

This is BS and your friend needs to acquire a little more self respect and appreciation for his profession.

While it's good to be self critical of our imperfect profession, it's not legitimate to think that some of those concepts are unique to anesthesiology.

I completely underestimated the extent to which MEDICAL SCHOOL is relevant to our profession, and almost across the board. We are amongst the few professions that truly cares for the entirety of the acutely ill (or not so ill) spectrum of patients. Peds, Adults, Geriatrics, Parturients etc etc.

I, personally, had this great feeling that I would be able to "forget" a lot of basic medicine when I began my anesthesiology training...... Big mistake that was, as I'm suprised at how much we really do need to know in this field.

Sure, GIVING anesthesia based upon patterns and protocol is possible with a couple years of anesthesia. But, that's not what anesthesiology is.

 

[gasattack3]

I did a 3 week rotation in anesthesia during MS3 and loved it...so much that I decided to pursue it as a career.

Right now, I'm on my sub-I at a different hospital...and I'm having second thoughts. This new hospital has TONS of crnas....TONS....and it really annoys me that these nurses are allowed to do just about everything an MD is.

Is anesthesia really that easy? To me, it seems so complex, but I don't know very much about it right now. Honestly, I get a little jealous when I look over the curtain and see only SURGEONS performing surgery, not advanced practice nurses. I can't comprehend how people that went through nursing school, did a little nursing, and then went through a 3yr CRNA school are now able to perform the same tasks as someone whose education consisted of 4 years of studying chemistry, physics and mathematics, followed by 4 years of intense medical education, followed by 4 years of grueling residency.

Are these feelings reason enough to not pursue anesthesiology, or does everyone feel this way at some point?

Need a little guidance here. Thanks in advance

Then those anesthesiologists are amongst the swelling ranks whom are their own worst enemies. At my institution, they restrict a CRNA's practice which means no labor epidurals, no spinals, no central lines/access, no peripheral blocks.

Our folks work a little harder, but the CRNA's do not do everything an MD/DO does over here.

Once again, another easy fix to some of the ills of our profession.....

 

[BLADEMDA]

Then those anesthesiologists are amongst the swelling ranks whom are their own worst enemies. At my institution, they restrict a CRNA's practice which means no labor epidurals, no spinals, no central lines/access, no peripheral blocks.

Our folks work a little harder, but the CRNA's do not do everything an MD/DO does over here.

Once again, another easy fix to some of the ills of our profession.....

CRNAs rarely do advanced procedures without intense oversight. This advanced list includes nerve blocks, central lines and diff intubations. Basic skills include spinal and epidurals so most groups allow CRNAs to perform those tasks.

 

[medstudent87]

so, some good news. Turns out only the anesthesiologists at this institution are allowed to do blocks, place central lines, a-lines, etc. Didn't realize this till later this week

 

[gasattack3]

so, some good news. Turns out only the anesthesiologists at this institution are allowed to do blocks, place central lines, a-lines, etc. Didn't realize this till later this week

It's true that you can teach anyone just about any procedure. I knew a cardiology technician (now an intern) who claimed to have placed over 2000 access lines in a cath lab. I believe him and he was a stellar med student, but I digress.

The fact is that for our field to survive we can't keep training CRNA's under the premise that they "need" to have the skills to practice independently. The reality of this, then, is that we shouldn't be teaching them many (if not most) procedures, and this should be implemented on an institutional basis.

You don't see general surgeons teaching mid levels key aspects of their procedures, although this is only partly true as they do teach first assists some very important/critical skills, as well as PA's. I'm sure that this will increase, but the fact is that surgeons have trained periprofessionals to function soley as their assistants, and that's what we should be doing, though I sense that the cat has long been out of the bag. But, we can take small steps to change this situation.

 

[WashMe]

To all the medical students out there who are in their MS-3 or MS-4 year I have a question for you: Based on your grades, STEP score(s) and research where do you stand in terms of MATCHING in the House of MEDICINE?

Please notice I am taking a realistic, pragmatic approach to your career options. This doesn't mean you shouldn't pursue your dreams of a certain specialty but unless your father is going to pull some strings how are you going to match into DERM with average grades and a 200 STEP score? Are you famous or an athlete?

So, what are you actual options for a specialty? Is it Anesthesiology VS Family Practice vs Internal Medicine? Or is Pediatrics vs Family Medicine? Now, if you are within the norm for this specialty what other options do you have available? What do you see yourself doing for the next 30 years of your life?

Some of you out there can Match into any specialty like Optho, Neurosurgery, ENT, etc while others may be more limited in selection.

With the ever increasing number of Medical School graduates competing for a limited number of Residency positions Anesthesiology will remain a fairly competitive match for at least the next few years and, hopefully, for my lifetime. But, the average "matched" applicant in Anesthesiology does NOT compare to Neurosurgery or several other specialties.

😕 I'm not sure what you're trying to say with this post... I'm an MS4 at a highly regarded medical school, ranked in the middle of my class and have a 250's Step I... are you saying I shouldn't do anesthesiology? Are you saying smart medical students, in general, don't do anesthesiology? Are you saying most of us who end up an anesthesiology are not qualified to do other things?

 

[MicroBrewer87]

I'm an MS2 considering Anesthesia and Critical Care, so I don't pretend to know anything about how this works, but I do have a question for the debate going on..

What do other surgeons think about this? Having a patient in the OR on the table crash and looking up to see a nurse at the head of the bed with **** hitting the fan? How do they react to that or what's their feelings about that type of situation?