When I was a resident, I bought into the whole idea of CRNA's taking our jobs and anesthesiologists being out of work because of it. Guess what? CRNA's don't want our jobs. Ask the typical CRNA working in a care team model if they would rather be independent and the vast majority will say NO. Smart CRNA's realize that independent practice sucks to a certain degree: no back-up, no breaks and usually an undesirable location. The very vocal minority of militant CRNA's would make you believe that every CRNA is just waiting, watching over our shoulders, wanting our jobs. Nothing could be further from the truth.
The free market has set the price of an anesthesiologist and that is why we get paid what we get paid. Some are concerned about the ever rising subsidy by hospitals. Lets look at it another way. If anesthesiologists truly ran the OR schedules at a typical hospital and optimized for efficiency (and not surgical convenience), the stipend paid would be a lot less. If anesthesiologists refused to do cases that reimbursed them poorly (but reimbursed the hospital greatly), then the stipend would be even more less. The true "customer" for the private hospital is the surgeon and hospitals need to make them happy. Hospitals aren't stupid. They would not pay a subsidy if they didn't think it was good business sense all the way around.
Do you think pilots are worried about the computer takeover of aviation? The new airplanes basically fly themselves. Has American or United Airlines cut all their pilots loose because of this? No. Because no one in their right mind would get into a plane that wasn't flown by a human. The same is true with anesthesia. No one will place their care in the hands of a robot without immediate human oversight (CRNA or MD, and I'm not talking about someone sitting remotely in a "central core").
Those who have pursued fellowships will definitely have a niche, but those of us who didn't do fellowships will be okay too. A thoughtful board certified anesthesiologist proves their value every single day in medical decision making perioperatively. Although a fellowship helps, you don't need it in order to bring a specialized skill set to the table.
Lets be real here. The economy is in a tight spot which means the job market is in a tight spot. Older partners who wish they could retire are working longer. Private groups have put the brakes on partnership tracks because they don't know what the future holds and also because the market has made people willing to take a strictly employee position. Academic centers are seeing their budgets slashed by state and federal entities and are unable to staff as they would like. Those graduating in 2010 will have a tough time finding a job. This was obviously impossible to predict back in February 2006 when they were making their rank lists. In time, this health care "crisis" will stabilize, the economy will stabilize, people will start to retire again and the job spigots will open up once more.
