Ask an anesthesiologist live!...or here. Whatever.

Burrell College of Osteopathic Medicine
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How vulnerable is the field to the following

-automation and ai
-mid level creep

Thanks in advance!
 
They've tried the automation thing already, and it failed fairly miserably. Outcomes were awful as compared with actual people. There's a lot of art and adaptation to anesthesia that a program won't be able to replicate. I suppose it's possible to more closely approximate human performance with a better program, but I wouldn't count on that creating an employment issue any time soon.

Mid-level scope creep is always a concern but not the gigantic issue many make it out to be, in my opinion. The *vast* majority of CRNAs I've worked with have no interest whatsoever in independent practice, and the few who do want to fly solo have plenty of opportunity to do so in rural communities just outside the city. At least 2 area rural hospitals have tried the independent CRNA route and switched back to docs due to dissatisfaction with service.

There's some exceptionally poor "evidence" floating around that CRNAs provide equivalent care to docs that the vocal minority like to trumpet during legislative hearings. What they leave out is that those studies (3 of them, as I recall, but correct me if more have been done recently) were funded by the AANA and essentially compare the healthy patients having minor surgeries under CRNA direction to docs doing all the crazy nonsense that occurs at major tertiary institutions. It makes for a good story, but their conclusion, however biased, is actually damning to the educated eye. Given equal outcomes, would you go to the guy doing massive blood loss 10-hour cancer chop shop operations or someone specializing in ACL repairs and gallbladder removals?
 
Thanks for doing this thread! I'm going to be starting med school this fall at a DO school. I'm extremely interested in anesthesiology.

What are your recommendations of things I can begin doing during my first year of school to help set me up well to pursue anesthesia? I know with other competitive specialties, research is always recommended. Is that necessary for anesthesia? What are other things PD's like to see on residency applications?
 
Research is always a good idea if you can swing the time, but I'd make sure you're settled into a studying rhythm/routine first before trying to add extras in. Learning the material and mastering your classes is much more important than signing up for a research opportunity you'll have trouble juggling. Research is a plus, especially for competitive programs, but it's definitely not a necessity. Getting involved in some sort of anesthesia interest group or just straight contacting the anesthesia program director at your school would help you get some connections and your foot in the door.

Honestly, tat this point, just having your life in order and setting yourself up for success is the best thing you can do for yourself. Cultivate good active relaxation habits, square away finances and living situation, etc. If everything else in your life is polished, it's going to be way easier to focus on and succeed in school. I did a video on that subject, BTW.
 
Hey man I’m an M1 at UAMS coincidentally just exploring some specialty options at the moment. I’ve been a little set on doing something that has significant impact on patients’ lives in real time and the extremes that I came down to were OBGYN leaning more OB vs. Gen Surg into Critical Care. I’ve sort of lopped off the Gen Surg idea due to lifestyle stuff and I’m not sure I have the right view of the reality of the job day-to-day. I thought OB might be a good choice because patients are generally happy to see you despite some heartbreaking moments, plus there’s a lot of variety. I just thought there’s a good impact there. I’ve tossed around the idea of anesthesia though because it sounds like it would be hands-on with some cerebral aspects together. Plus all the perks just seem like it may make life easier with a family and time outside of work.

Can you touch on the impact you have on your patients? Coming into med school I was leaning EM for variety and occasional adrenaline, but after working in an ED I found that the ratio of lifesaving/patient watching wasn’t as high as I was looking for.
Does anesthesia have a better ratio than EM would you say? Also, can you touch on the stereotype of anesthetists doing crosswords or being bored all the time and how false/true that might be? I’m lining up to shadow hopefully soon so some of this may be better answered in real time for me. Thanks and good to see a UAMS grad having real success.
 
It's interesting that you cite OB as a specialty with variety. I'd actually argue it's one of the specialties with the narrowest scope. You only have a few procedures that you do, and most of your patients are healthy young women, unless you really lean into the GYN side of things. Your schedule will also be rubbish unless you land yourself a gig at a small institution that avoids high-risk patients and plans most of its deliveries. Babies don't care much for schedules, it turns out. It's true, though, that most people are happy to see you, at least at some point during your interaction and give you a lot of credit and warm fuzzy feelings for delivering their kids.

Anesthesia doesn't exactly have the cushiest schedule either, though. You're very much at the mercy of the OR, and emergencies that keep you stuck at work happen often. You're also likely to be on call and working through the night at times. You can mitigate that by working at a surgicenter, but you trade off a fair bit of salary for the pleasure.

As for making a big difference, anesthesia is high on the list, but patients usually don't know - much less care - what you do for them. If it's recognition you're looking for, this isn't usually the place to get it. Nerve blocks and labor epidurals are good bang for your buck in that regard, but most everything else goes down when your patients are asleep. You're also involved in a whole bunch of futile care for moribund patients, and that can get frustrating or even depressing for some.

When you're in a room managing a case, anesthesia can sometimes be boring. Anesthetics are generally tolerated pretty well, even in really sick patients, so long cases with minimal blood loss often don't require too much work behind the drape. It's when things go haywire and deviate from the expected course that you earn your money. As an attending, you'll be managing multiple ORs, so you get a lot more troubleshooting than you do if you just roll with 1 room at a time. Days I would characterize as "boring" happen extremely rarely, but my group operates really lean and produces roughly double the national median RVUs per doc. Your mileage may vary.

Overall, I would definitely say that anesthesia is more satisfying than what I see the ER docs doing. You're a swiss army knife and are often the endgame for many emergencies. You don't have anyone to turf patients to, so you just do whatever you can and need to sort out the problems you encounter. It's nice to be the ultimate authority on things like airways, lines, some critical care issues, etc.
 
MilkmanAl said:
It's interesting that you cite OB as a specialty with variety. I'd actually argue it's one of the specialties with the narrowest scope. You only have a few procedures that you do, and most of your patients are healthy young women, unless you really lean into the GYN side of things. Your schedule will also be rubbish unless you land yourself a gig at a small institution that avoids high-risk patients and plans most of its deliveries. Babies don't care much for schedules, it turns out. It's true, though, that most people are happy to see you, at least at some point during your interaction and give you a lot of credit and warm fuzzy feelings for delivering their kids.

Anesthesia doesn't exactly have the cushiest schedule either, though. You're very much at the mercy of the OR, and emergencies that keep you stuck at work happen often. You're also likely to be on call and working through the night at times. You can mitigate that by working at a surgicenter, but you trade off a fair bit of salary for the pleasure.

As for making a big difference, anesthesia is high on the list, but patients usually don't know - much less care - what you do for them. If it's recognition you're looking for, this isn't usually the place to get it. Nerve blocks and labor epidurals are good bang for your buck in that regard, but most everything else goes down when your patients are asleep. You're also involved in a whole bunch of futile care for moribund patients, and that can get frustrating or even depressing for some.

When you're in a room managing a case, anesthesia can sometimes be boring. Anesthetics are generally tolerated pretty well, even in really sick patients, so long cases with minimal blood loss often don't require too much work behind the drape. It's when things go haywire and deviate from the expected course that you earn your money. As an attending, you'll be managing multiple ORs, so you get a lot more troubleshooting than you do if you just roll with 1 room at a time. Days I would characterize as "boring" happen extremely rarely, but my group operates really lean and produces roughly double the national median RVUs per doc. Your mileage may vary.

Overall, I would definitely say that anesthesia is more satisfying than what I see the ER docs doing. You're a swiss army knife and are often the endgame for many emergencies. You don't have anyone to turf patients to, so you just do whatever you can and need to sort out the problems you encounter. It's nice to be the ultimate authority on things like airways, lines, some critical care issues, etc.
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I see what you’re saying with an OB narrow scope. I was looking at it from a generalist view with clinic, a little surgery, and L&D. Plus just the mixed bag of medicine and procedures. But for leaning into OB more, I see where it narrows steeply.
As an attending, what does your day look like as you’ve mentioned moving between different rooms? Are you essentially supervising the anesthesia across the OR and then step in when things go unexpectedly? Do you find that you’re watching after multiple ORs more than managing an individual case, or is that something that your group rotates on? Which do you enjoy more?
 
cjmurph14 said:
I see what you’re saying with an OB narrow scope. I was looking at it from a generalist view with clinic, a little surgery, and L&D. Plus just the mixed bag of medicine and procedures. But for leaning into OB more, I see where it narrows steeply.
As an attending, what does your day look like as you’ve mentioned moving between different rooms? Are you essentially supervising the anesthesia across the OR and then step in when things go unexpectedly? Do you find that you’re watching after multiple ORs more than managing an individual case, or is that something that your group rotates on? Which do you enjoy more?
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We rotate through jobs, but on a given day, we have 2 people in the OR managing 4 rooms each, one assigned to OB, one assigned at a surgery center, and one person doing a heart 1:1 with an anesthetist, if necessary. We try to be available for induction of and emergence from anesthesia for every patient and check in on cases every 30-45 min or so. That's not always possible - 0730 first start has you in 4 cases starting simultaneously, for instance - but you can usually pull it off. Most of my job is personnel management and OR schedule wrangling with some minor medical troubleshooting thrown in.

Occasionally, you'll have a big case that you have to pay rapt attention to, in which case your partners can pick up some slack for you. That's part of the gig and not a big deal. I like that I get a chance to use the skills I learned in residency, but it's nice that level of intensity isn't the norm. I definitely prefer cruising along doing easy cases on healthy since it's easier and is where we make most of our money, but again, a difficult case every now and then is nice for staying sharp.
 
Can you succinctly in bulletpoints recap this video for me. I cant listen to this guy. He was all wrong about ask an anesthesiologist live. He prob is wrong about this. I cannot listen.
 
The match sounds like it was a murderfest. I'll be talking about that live tomorrow night at 8-10 Central time. It'd be awesome if those of you who went through it could provide some first-hand insight as to why things look so brutal this year. See you then!

Edit: Live now. Come chat!
 
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Yeah, match was rough for sure

I'm blessed to have matched well, but I certainly didn't get my top choice!
 
Ganon said:
Yeah, match was rough for sure

I'm blessed to have matched well, but I certainly didn't get my top choice!
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Congrats on matching! Match rates were down, especially for competitive specialties, but it sounds like falling far through rank lists was the real killer this year. I guess we'll have to wait to see the data on that to know for sure, but it *sounds* like a disproportionate sample of people who matched did so way down their lists.

Also, WTF is up with anesthesia over the past couple years? There are almost twice as many applicants as there were when I applied, all vying for about 100 more spots. Insanity.
 
Dr. Anonymouss said:
Any ideas for me on this?

forums.studentdoctor.net

Anesthesiology subspecialty pay??

Hello, looking for more information regarding average salary for anesthesiologists by subspecialty. I am more so talking about pain medicine and anesthesiologists with fellowship training. Thanks
forums.studentdoctor.net forums.studentdoctor.net
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Absolutely. Check out GasWork.com for current anesthesia job offerings. It obviously doesn't have ALL listings, but you'll at least get an idea for what you can make regionally.

I think you'll find that the benefit of doing fellowship is more to make yourself more employable and desirable than it is to actually get a bigger paycheck. I mean, you'll probably make a little more with, say, cardiac or pediatric training, but it won't be a world of difference. Pain is a bit of a wild card since you can potentially get involved in a really busy practice and pull down huge money, but there's also seemingly perpetual talk amongst the feds about slashing pain procedure reimbursement. Buyer beware.
 
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For anyone interested in discussing the RaDonda Vaught case and what that means for us as far as malpractice and liability are concerned, I'll be delving into it tonight at 8 Central.
 
MilkmanAl said:
For anyone interested in discussing the RaDonda Vaught case and what that means for us as far as malpractice and liability are concerned, I'll be delving into it tonight at 8 Central.
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ooo I haven't heard about this. Ill have to read into it. Any good starting articles you recommend?
 
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MilkmanAl said:
For anyone interested in discussing the RaDonda Vaught case and what that means for us as far as malpractice and liability are concerned, I'll be delving into it tonight at 8 Central.
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Did you happen to record this? I'm very interested to hear your thoughts on it!
 
MilkmanAl said:
They've tried the automation thing already, and it failed fairly miserably. Outcomes were awful as compared with actual people. There's a lot of art and adaptation to anesthesia that a program won't be able to replicate. I suppose it's possible to more closely approximate human performance with a better program, but I wouldn't count on that creating an employment issue any time soon.

Mid-level scope creep is always a concern but not the gigantic issue many make it out to be, in my opinion. The *vast* majority of CRNAs I've worked with have no interest whatsoever in independent practice, and the few who do want to fly solo have plenty of opportunity to do so in rural communities just outside the city. At least 2 area rural hospitals have tried the independent CRNA route and switched back to docs due to dissatisfaction with service.

There's some exceptionally poor "evidence" floating around that CRNAs provide equivalent care to docs that the vocal minority like to trumpet during legislative hearings. What they leave out is that those studies (3 of them, as I recall, but correct me if more have been done recently) were funded by the AANA and essentially compare the healthy patients having minor surgeries under CRNA direction to docs doing all the crazy nonsense that occurs at major tertiary institutions. It makes for a good story, but their conclusion, however biased, is actually damning to the educated eye. Given equal outcomes, would you go to the guy doing massive blood loss 10-hour cancer chop shop operations or someone specializing in ACL repairs and gallbladder removals?
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I think you are minimizing the scope creep issue because I DO think it IS a major issue and will become more of an issue in the future. This will put a lot of downward pressure on the salaries and the opportunities will not be as plentiful. This is the trend. I do not see it reversing unless the ASA starts doing drastic things which I do not foresee. There certainly will be opportunities available, but who knows what kind of opportunities
 
Agree to disagree, I guess. As I've said before, my experience is that hospitals that try the CRNA-only route revert back to solo physician practice with fair frequency. Good luck getting docs to work for less than we already do. Worst-case scenario is that big hospitals across the country buy into midlevel independence wholesale, in which case they'll figure out pretty fast that the "equal outcomes" claims the AANA trumpets aren't quite on the mark. If it's evident in small rural hospitals, you know bigger outfits are well aware of the risks.

It's possible the climate on this issue is worse elsewhere. We just don't have issues with uppity CRNAs locally, as far as I'm aware. They're too busy trying to prevent AAs from getting licensed in Kansas.
 
MilkmanAl said:
Agree to disagree, I guess. As I've said before, my experience is that hospitals that try the CRNA-only route revert back to solo physician practice with fair frequency. Good luck getting docs to work for less than we already do. Worst-case scenario is that big hospitals across the country buy into midlevel independence wholesale, in which case they'll figure out pretty fast that the "equal outcomes" claims the AANA trumpets aren't quite on the mark. If it's evident in small rural hospitals, you know bigger outfits are well aware of the risks.

It's possible the climate on this issue is worse elsewhere. We just don't have issues with uppity CRNAs locally, as far as I'm aware. They're too busy trying to prevent AAs from getting licensed in Kansas.
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Is kansas the next state to get AAs?
 
OptionOffense said:
Is kansas the next state to get AAs?
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Not sure if it'll be the next one, but they're set up pretty squarely for that to happen. AAs are currently allowed provisionally for COVID relief, and they're pushing hard to make that provision permanent. It seems pretty tough to keep them boxed out for long, at this point.
 
MilkmanAl said:
Not sure if it'll be the next one, but they're set up pretty squarely for that to happen. AAs are currently allowed provisionally for COVID relief, and they're pushing hard to make that provision permanent. It seems pretty tough to keep them boxed out for long, at this point.
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Let us know what we can do to help that along. I still think you are not on mark as to under estimating the malignancy of the AANA and their ability to marginalize physicians via politics.
 
For anyone wanting a bird's-eye view of what my daily life is like, here's a quick go at summing 14 years of medical training and experience up in 11 minutes.
 
@MilkmanAl
Small world, current rising M3 at UAMS. Anesthesiology has actually jumped to the top of my interests lately. Coming into school, I was pretty set on primary care either by Family Med or Med-Peds, just hadn't ironed out how important inpatient focus was for me. I worked in a small ER before med school as a tech, and between that experience and getting more hospital exposure, I really liked the idea of being a swiss army knife.

After reading more into anesthesiology, it has really grabbed my attention. I really like the idea of going the critical care route, and was wondering if you could elaborate what this path looks like? What are a few examples of how the schedule of a critical care anesthesiologist would look like? I'm not sure if I would want to do academic medicine, so would a more community style hospital be feasible? What do you think the chances would be to work as a hospitalist in a small rural hospital from time to time as a CCM anesthesiologist, or even in a small rural ER if I had that itch? That's what entices me about Family Medicine, the ability to work as a hospitalist or in the ER. I just also really love physiology/pharm and the thought of thinking about multiple organ systems, as well as the plethora of procedures that anesthesiologists do.

Hoping that 3rd year gives me a good idea. Building on that, what are some things that can help matching anesthesia? I know grades and Step 2 will play an important factor as well as LORs. I haven't gotten into any research and really don't desire to, and would be perfectly happy matching at UAMS.
 
Critical care is pretty cool! It requires an extra year of fellowship after training, so the additional commitment isn't as damning as some other fellowship tracks. You get to care longitudinally for the sickest people in the hospital, and if I do say so myself, anesthesiologists make the best intensivists due to how much time we spend training to manage catastrophes. The more long-term, maintenance care is what the fellowship is good for.

Unfortunately, if you're looking to avoid academic practice, your options may be limited. At least in my area, anesthesia-led ICUs basically don't exist outside of large tertiary care centers. In fact, I don't know of any, other than the two major academic institutions in town. Maybe that's different elsewhere and someone else can weigh in accordingly? My hospital would support a dedicated ICU team, but they're just now transitioning to that and are using pulm docs. You might be able to wrangle a tele ICU position, as I think that's what more remote, smaller locations are moving toward these days.

Also a bummer is that you're probably going to take a pay hit to focus on critical care. (That would likely not be the case for telehealth, but I digress.) When there are pulmonologists available to work for $300k-350k, it's tough for hospitals - especially smaller ones - to justify the cost differential to pay you anesthesia money. You might find a group somewhere that rotates people through the ICU and the OR as part of their contract with the hospital, so the pay doesn't suffer, but again, I don't know of any places locally that function that way.

Matching is going to be a strange beast from here on out. Anesthesia has been absurdly competitive in the last 2 matches compared to how it was historically. With Step 2 presumably being the new Step 1 in terms of sorting competitiveness, that'll absolutely be critical to score well on, as you say. Research is always a plus to your app, but if you're content to match in the Midwest or mid south, I'm going to wager that you're fine without it, changes in specialty competitiveness notwithstanding. Otherwise, just button up your app the best you can. Knock out good clinical grades, get decent letters, prep smartly for your interviews, and apply broadly. Oh, and tell them I sent you! That'll get you matched, for sure.
 
For those of you getting ready to start med school, you might find the stream I did last Wednesday with the MCAT Reddit useful. It's long, but hopefully interesting!
 
I've been pretty bad about making useful content recently, but if there's something y'all want to know about, I'm all ears. Also, one aspect of medicine that I never, ever got any useful advice on before actually graduating residency was how to job hunt. Sure, we got some vague details, but nobody mentioned what salary we should be looking for, what perks to ask about, etc. Physicians as a whole are awful at business, and we consequently get hosed on contracts all the time. Know your worth! For reference, here's a job a headhunter sent me this morning:
Screenshot_20220708-091459.png
 
Any advice for getting letter of rec from an anesthesiologist? I am getting ready to apply (4th year) and haven't been able to get letters. On my anesthesia rotation i spent most time in the OR with residents. Attending would come in at beginning and end of case and essentially ignore students...
 
It's tough to get a decent relationship as a doc, no doubt, especially if you're in a private practice setting where they're scrambling around, managing 4 rooms at a time. What I did was talk to a couple docs I hit it off with and asked if I could be in their rooms on the reg so I could form a relationship that way. You'll have to be a little persistent and creative to get those letters, but everyone in the field knows that anesthesia letters are a tough thing to come by and will likely accommodate you accordingly.
 
Do you think there are any fellowships within gas that are less susceptible to CRNA encroachment?
 
Fortunately, I think all accredited fellowship paths (read: cardiac, pain, ICU, and peds) are pretty mid-level-proof. There are always going to be anesthetists doing heart and peds cases and a few yahoos who think it's wise to get involved in pain procedures with literally zero training, but being systematically replaced by those people is a long, long way off, if even possible. There's just too much complex stuff going on for a physician to not be involved.
 
MilesDavisTheDoctor said:
What led you to not choosing to do a fellowship?
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I'd initially wanted to do pain, but once I got into it, I discovered that I absolutely hate clinic in general and pain clinic in particular, so that was out. ICU is an extra year to take a pay hit, so no go there. I enjoyed both peds and hearts but not enough to eat the opportunity cost and pigeonhole myself as the peds guy or heart guy. Here I am 6 years later doing lots of peds and hearts, and while I'm technically less employable than someone with a fellowship, most private practice gigs in the area aren't all that concerned with that, as long as you have relevant experience.
 
MilesDavisTheDoctor said:
Is there anything you wish you had known about anesthesia before choosing?
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I suppose it would've been nice to know how dependent my day-to-day life would be on other people. I'm basically stuck until surgeons decide to stop adding on cases. There's no set amount of work to be done or long-term pacing for a project. You just go balls-out every day to clear out as much as you can as efficiently as possible. That's probably more of an issue in private practice than academia, but your day ranges from "hurry up and wait" to manic rushing around to coordinate schedules. You're relied on to evaluate patients for surgery fitness, manage basically everyone's schedule, and triage surgical cases. Even if you block some non-urgent case at 1 AM, you still get a call about it and have to deal with it. That is to say, even if everything goes smoothly, you're down still on the hook to tell everyone what they can do and when.
 
Do you ever find yourself clashing with the CRNA's or AA's over patient care or do you find that your job title is well respected? When I say this I mean it seems like every other doctor, especially surgeons, are well respected and have full autonomy, but they also don't have non-physicians who might consider themselves as equals as in anesthesiology. So I am curious about the dynamics and your experience with this.
 
I've alluded to my positive relationships with anesthetists in the past, and respect - at least outwardly - has been no exception. I don't think I've ever had any issues on that front. I e only had a few instances where anyone even asked me why I was doing or requesting something and maybe one or two times when an anesthetist had me administer a med he wasn't comfortable giving. Respect from other OR staff, namely RNs, has also never been an issue.

On the floor, it's a slightly different issue. Overall, I'd say everyone adheres to the command chain fairly well, but we do definitely get a lot more pushback from, say, OB nurses than from OR folk.
 
MilkmanAl said:
I've alluded to my positive relationships with anesthetists in the past, and respect - at least outwardly - has been no exception. I don't think I've ever had any issues on that front. I e only had a few instances where anyone even asked me why I was doing or requesting something and maybe one or two times when an anesthetist had me administer a med he wasn't comfortable giving. Respect from other OR staff, namely RNs, has also never been an issue.

On the floor, it's a slightly different issue. Overall, I'd say everyone adheres to the command chain fairly well, but we do definitely get a lot more pushback from, say, OB nurses than from OR folk.
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Thanks for the helpful insight!
 
I feel like med schools and residencies do an exceptionally bad job at informing you of what your financial future looks like (Because there's no chance in hell you'd go into medicine if they did. Kidding! Sort of...). Here's a really useful site with some rough estimates of what you should expect your income to be. . Academic institutions are exceptionally fond of throwing money at you to lock you down before you find out how much better compensation and quality of life are elsewhere. Don't get hosed by a seemingly big offer before you've explored the market.

 
If anyone is interested, I'll be discussing the merits and pitfalls of careers in private practice vs. academic medicine this evening at 8 Central. Come contribute! Twitch
 
3rd year student here interested in anesthesiology. How do I go about figuring out what residencies to apply to? Like how competitive they are versus how competitive I am?

Also, is there anything you recommend that I should be doing right now to prepare for an anesthesiology match? Kinda clueless in this whole process.
 
Dr. Anonymouss said:
3rd year student here interested in anesthesiology. How do I go about figuring out what residencies to apply to? Like how competitive they are versus how competitive I am?

Also, is there anything you recommend that I should be doing right now to prepare for an anesthesiology match? Kinda clueless in this whole process.
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Dude, I'm so sorry I missed your post. I came back to post the headhunter listing below and caught it. Will edit in some info in a sec.

I've mentioned before the semi-predatory hiring practices academic centers have to keep you on board as staff at a low rate. Students: choose your specialty wisely. Residents: know your worth!

12 month locums need in Colorado 80% supervising no hearts, no OB $320hr $6600/month housing/car stipend Email CV to [email protected] Reply STOP to optout

Edit for anesthesia hopefuls:

Historically, anesthesia has been sort of in the middle as far as competitiveness is concerned, though it seems that it has gotten a lot more competitive over the past few years. See Charting Outcomes data and Main Residency Match Data for more detailed information, but it looks like there are now a solid 50-60% more applicants overall than there are spots, and that's terrifying. Granted, MD seniors still matched fairly well, but the landscape now is a far cry from what it was when I applied, where there were basically an equal number of applicants and spots. That's all to say that competition is a lot stiffer now, but rest assured that there will always be undesirable spots in the Midwest for you to fill.

As always, taking an objective look at how you stack up against the numbers for matched applicants above (236 for Step 1, 248 Step 2, and a couple research experiences, basically) is an obvious first step. If you're substantially below those benchmarks, shore up with additional research, and do your best to murder Step 2. (As an aside, do they report a score for Step 1 anymore, or do they just tell you if you passed or failed?) If you're all set, good for you. If you can't bust into the average range with your Step 2 score, it's still worth applying, but be realistic about your program selection.

In terms of prep, do your best to get involved with anesthesia wherever you can. Interest groups are great for networking. There's probably a state anesthesia society that holds meetings you could go to and meet some of the docs around town. While those are for resident+ typically, I don't think anyone would care if you showed up. I'm assuming you're in the middle of clerkships, so try to get an anesthesia rotation. Also, show up to surgical cases early and try to get some reps on intubations or IV placement or something. Just make yourself known to the anesthesia team however you can, and voice your interest. It's difficult to get early exposure to specialties that aren't primary care, so you're really going to have to advocate for yourself. I found that surgeons were very sympathetic to and supportive of my desire to figure anesthesia out during my surgical rotation, so hopefully you'll have a similar experience.
 
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Do you support someone's decision to go the AA route instead of becoming a board-certified anesthesiologist? This is the route I am currently leaning towards, but am apprehensive about the gaps in training in potentially a high-stress field.
 
Choсolate said:
Do you support someone's decision to go the AA route instead of becoming a board-certified anesthesiologist? This is the route I am currently leaning towards, but am apprehensive about the gaps in training in potentially a high-stress field.
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AA is a freaking amazing career, honestly. I wish I'd known about it in high school. If I had, that might have been the route I chose.

At least at the schools I'm familiar with, new grads are still very green (same level of greenness as new CRNAs, in my experience, just to be clear) but are safe practitioners. Be humble about and aware of your knowledge gaps, read on your own when necessary, and ask questions when something you're unfamiliar and/or uncomfortable with comes up. I would MUCH rather an anesthetist ask me a bunch of questions about a case than reveal they don't know what they're doing once we're deep in the weeds without a plan.

Overall, the time savings the AA route offers over CRNA school makes it a clear winner in that fight, in my mind, since I can't really tell a difference in training quality between the two. As a CRNA, you're spending a couple extra years on useless nursing theory fluff and ICU experience that helps at the very beginning but quickly gets nullified as you gain actual anesthesia experience. As for AA vs MD, you have to evaluate what you want out of your career. If you want to be "the boss" and an expert in your field, MD is the only way. Similarly, if you're all about maximizing income, MD clearly comes out ahead there, too, in the long run. However, the AA route allows you to still pull down a hefty salary (we're looking for people and offering $200k/yr to start for new grads and more with experience. PM me!) with substantially less responsibility and none of the unrelenting bull**** that residency brings to bear. You'll also have a fraction of the debt and be able to get on with your life in your mid 20s instead of early 30s. Furthermore, your hours are more protected, so you'll overall have a much more predictable schedule than you would as a doc. Either way is a solid choice, but cutting out most of the rigors of medical education is a gigantic upside, in my book, especially with how competitive anesthesia has gotten in the match.

One rather big drawback of being an AA is that you're limited to practicing in 18 (I think?) states, which is a deal-breaker for a lot of people, since most of the popular coastal states aren't on the list. If you can stomach those states, then by all means, go for AA school. It's a great profession.
 
For those of you looking into which specialty to choose, here's a copy of the MGMA (salary) data for 2021 by specialty and region.

Maybe I'm just more aware of it these days, but it seems like I've seen more instances than usual of people professing to "do what you're passionate about" or that "after $x, your income doesn't really matter." Let me tell you, lifestyle and income matter. They matter a lot, no matter what your expenditures are. If you live off the grid in a hole in central Kansas, making $1m for the same work as someone making $500k is still remarkably better. Doctors are notoriously awful at business, and it shows in the above self-defeating tropes. Get the most out of your education.

Edit: I posted this on Reddit as well and did not anticipate having to tell people with a medical education to look past the first few pages to get the MGMA data. The first chart is some nonsense survey by Pinnacle. The actual MGMA numbers are in an overwhelming chart that follows. If you're having difficulty seeing the file, you can Google "Pinnacle Health MGMA," and it should be the first non-sponsored result.
 

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Here's some fairly interesting spam I got today regarding physician happiness. It surprising to me how many people describe themselves as unhappy or worse at work, and it makes me think I might have a pretty damn good gig going. This survey also makes me think about the viability of non-medical careers for MDs, which is likely something I'll do a video and/or presentation on in the future.

Physician happiness, in 5 charts

Fewer than half of physicians said they were happy at work in 2022, a significant drop from before the pandemic, according to Medscape's 2023 Physician Lifestyle and Happiness Report. See the trends, charted.
www.advisory.com www.advisory.com


In other news, my financial advisor approached me about appearing on stream, so he'll be doing a live Q&A at some point in the near future when our schedules mesh. I'll keep you guys apprised of that, because he has been extremely helpful to me. He represents Larson Financial, which is a company that only work with physicians as clients, so they're fairly tuned into the weird post-residency jump in salary we experience, the massive student debt loads, etc. For the record, there won't be any money changing hands on either side for this experience. It's purely educational, though I'll say I've been happy with his services and hope he gets some additional business out of the deal.
 
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