Can someone tell me why Anesthiology is still so competitive?

[guitarguy23]

I'm seriously wondering. I know little about the specialty, except that malpractice is high and when s*** goes bad it goes BAD. Can someone tell me a little about what makes this specialty so desirable?

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[username456789]

I'm seriously wondering. I know little about the specialty, except that malpractice is high and when s*** goes bad it goes BAD. Can someone tell me a little about what makes this specialty to desirable?

It's really not that competitive . . .

 

[guitarguy23]

That's what I think too! I thought it was big 10-20 years ago, but classmates of mine seem to think it's just as desired as it was. I didn't know if I was just out of the loop and missing something.

 

[JoshSt]

As said previously, it's not a competitive field...

 

[SouthernSurgeon]

The aspects of anesthesia that have historically made it popular are:
-Relatively controlled/predictable schedule
-Less hours in residency than many fields (avg ~50-55 hrs/week once hitting CA years)
-Procedure heavy
-Patient care light (*only have to talk to awake patients for a few minutes before the operation)
-Interesting physiology/pharmacology
-Moments of high intensity/life or death requiring expertise...but only moments of it

The aspects that have led to its decline in popularity:
-CRNAS
-CRNAS
-CRNAS
-Changing practice models (mostly moving from high value private practices with leverage over hospitals to hospital employees with little value)
-Increased residency slots while these other changes were occurring, leading to a misbalance of supply/demand

 

[DermViser]

I'm seriously wondering. I know little about the specialty, except that malpractice is high and when s*** goes bad it goes BAD. Can someone tell me a little about what makes this specialty so desirable?

Um, it isn't "competitive" per se, except maybe at the top programs. Which is great if you like Anesthesiology. That being said - not having your own patients, no pager to carry home afterwards -- priceless. You do get a chance to do Pain medicine (fellowship) --- which is completely outpatient - 9 to 5 based.

 

[PhillyMed777]

I'd recommend going directly to facts and review nrmp charting outcomes online. Latest edition only from 2011. It shows that it is definitely not competitive for your run of the mill U.S. allopathic senior.

 

[Beargryllz]

Money

No call

Those make it incredibly appealing, possibly the most appealing of all

 

[Winged Scapula]

Money

No call

Those make it incredibly appealing, possibly the most appealing of all

There is actually call.

The group I work with has someone on OB call every night and Gen OR call; then there is second call, and third call (in case something else comes in and the first call person is busy). They will also get calls about epidural and PCA management (which is weird to me, so I try and put the kibosh on that largely because I want to be the one managing post op pain).

So they aren't getting calls about a sleep aid for Mrs. Jones in 325B, but their calls generally require coming to the hospital for a case.

 

[DermViser]

There is actually call.

The group I work with has someone on OB call every night and Gen OR call; then there is second call, and third call (in case something else comes in and the first call person is busy). They will also get calls about epidural and PCA management (which is weird to me, so I try and put the kibosh on that largely because I want to be the one managing post op pain).

So they aren't getting calls about a sleep aid for Mrs. Jones in 325B, but their calls generally require coming to the hospital for a case.

Wait, wait!! But it's in the ROAD mnemonic, that can't be true!!! You're just trying to discourage him from applying so you can go for it yourself!

 

[Winged Scapula]

Wait, wait!! But it's in the ROAD mnemonic, that can't be true!!! You're just trying to discourage him from applying so you can go for it yourself!

Did I wander into Pre-Allo?

If I quit surgery and decided to return to residency, I wouldn't choose Anesthesia. I gotta be doing something, otherwise someone's gonna forget to wake me up to turn off the Vec.

 

[DermViser]

Did I wander into Pre-Allo?

If I quit surgery and decided to return to residency, I wouldn't choose Anesthesia. I gotta be doing something, otherwise someone's gonna forget to wake me up to turn off the Vec.

Well playing Soduku on the iPhone takes very nimble hand skills.

 

[Silent Cool]

Did I wander into Pre-Allo?

If I quit surgery and decided to return to residency, I wouldn't choose Anesthesia. I gotta be doing something, otherwise someone's gonna forget to wake me up to turn off the Vec.

Out of curiosity, what field would you most likely choose?

 

[Silent Cool]

Well playing Soduku on the iPhone takes very nimble hand skills.

The OR is a great place to catch up on current events!

 

[Winged Scapula]

Out of curiosity, what field would you most likely choose?

Probably Psych (or Derm, then I could still do little procedures in the office).

 

[Back 5]

Probably Psych (or Derm, then I could still do little procedures in the office).

That would be very interesting, going from Surgery to Psych.

 

[GadRads]

Probably Psych (or Derm, then I could still do little procedures in the office).

Why psych in particular? Don't really care for Derm.

 

[Winged Scapula]

That would be very interesting, going from Surgery to Psych.

It's apparently not that unusual. Probably because we've spent many years working with the mentally ill amongst our colleagues. LOL

Plus I have a graduate degree in psychology so I've always found that very interesting.

 

[DermViser]

Why psych in particular? Don't really care for Derm.

I take it you're new to SDN...

 

[notbobtrustme]

Gas looks like so much fun. While on gyne, all I saw the gas-man do was knock dudes out and then go dick around on his Ipad. I'm sure residency is a bitch, but his gig right now is pretty goddamn sweet, especially when you control what cases you want. Not everyone has to do 80 y/o OSA, BMI 50 open heart surgery cases. If all you have to do were epidurals and gyne-knockouts, you'd have the most chill setup ever.

 

[Kahreek]

Did I wander into Pre-Allo?

If I quit surgery and decided to return to residency, I wouldn't choose Anesthesia. I gotta be doing something, otherwise someone's gonna forget to wake me up to turn off the Vec.

what would you do if you had to do another residency?

 

[Kahreek]

Well playing Soduku on the iPhone takes very nimble hand skills.

i heard there was a anesthesiologist so proficient with his hands from playing sodoku in the tiny iphone screen, than everytime the vascular surgeon had to do micro anasthomosis he was called.

 

[Kahreek]

Probably Psych (or Derm, then I could still do little procedures in the office).

dermviser just jumped out of his chair when he heard derm. He is proud.

 

[Flamen04]

Probably Psych (or Derm, then I could still do little procedures in the office).

It's not that uncommon at all! 5 of the psych resident I've worked with were past surgeons...

 

[Dires]

The anesthesia discussion boards have freaked me out. Discuss.

 

[SouthernSurgeon]

Gas looks like so much fun. While on gyne, all I saw the gas-man do was knock dudes out and then go dick around on his Ipad. I'm sure residency is a bitch, but his gig right now is pretty goddamn sweet, especially when you control what cases you want. Not everyone has to do 80 y/o OSA, BMI 50 open heart surgery cases. If all you have to do were epidurals and gyne-knockouts, you'd have the most chill setup ever.

Anesthesiologists at my place are cracking down hardcore on iPad/phone use for non-professional use during cases. There was a high profile malpractice case recently where the plaintiffs lawyer used time stamped posts on FB to show that a doc was posting during the case

 

[Bryan O’Blivion]

It isn't. There are a lot of positions in a lot of residency programs distributed throughout a wide geographical region. The data from Charting Outcomes indicates that average Step scores for a successful match in Anesthesia are comparable/less than the national average for US medical students. Being average is fine for an applicant, which by definition, makes it not competitive.

The job market is currently saturated, not likely to dramatically improve, and the field is subject to the misperception that it is easy and over compensated. Mid level practitioners are taking proportionately more and more bread and butter work, so there is that.

If you want money, go for a surgical specialty, IR, or interventional cards.
If you want lifestyle, PM&R, psych, maybe +/- EM.
Money and lifestyle, ophthalmology, derm.

On the other hand: Pretty portable, relatively controllable schedule, useful skill set, interesting drugs/equipment, no clinic. LOTS of international opportunities. In high demand in global health. Also, very interesting research opportunities that may have implications beyond medicine.

It isn't a competitive field for US seniors. That has some up and downs. EDIT: One good aspect is that if you are a competitive applicant, you get greater choice in your residency. That makes interview season relatively less expensive, and a lot more fun. If you are a less competitive applicant, it means you get a good chance of getting in somewhere without aplying to every program on the continent, or doing something less than fun, like a research year.

 

[BestDoctorEver]

.....

 

[dadaddadaBATMAN]

Probably Psych (or Derm, then I could still do little procedures in the office).

Why not EM? Some procedures, get to label, buff and turf the psych patients.....don't wanna deal with the BS?

 

[KnuxNole]

There is actually call.

The group I work with has someone on OB call every night and Gen OR call; then there is second call, and third call (in case something else comes in and the first call person is busy). They will also get calls about epidural and PCA management (which is weird to me, so I try and put the kibosh on that largely because I want to be the one managing post op pain).

So they aren't getting calls about a sleep aid for Mrs. Jones in 325B, but their calls generally require coming to the hospital for a case.

Or coming to the hospital to intubate a crashing patient too!

 

[KnuxNole]

Gas looks like so much fun. While on gyne, all I saw the gas-man do was knock dudes out and then go dick around on his Ipad. I'm sure residency is a bitch, but his gig right now is pretty goddamn sweet, especially when you control what cases you want. Not everyone has to do 80 y/o OSA, BMI 50 open heart surgery cases. If all you have to do were epidurals and gyne-knockouts, you'd have the most chill setup ever.

Wait, he was knocking out DUDES in GYN?

 

[Winged Scapula]

Why not EM? Some procedures, get to label, buff and turf the psych patients.....don't wanna deal with the BS?

Ewww...not even if it was the only choice.

The point you're missing is that I am intrigued by the psych patients (thought disordered ones, not the borderline sot depressed housewives) and want to "deal" with them and know what happens.

Besides despite what EM claims, there isn't enough "procedures" in most of EM to keep a surgeon happy.

 

[Winged Scapula]

Or coming to the hospital to intubate a crashing patient too!

Gee I would hope that if a patient is crashing someone else could intubate before an anesthesiologist drove in from home.

 

[Dral]

Ewww...not even if it was the only choice.

The point you're missing is that I am intrigued by the psych patients (thought disordered ones, not the borderline sot depressed housewives) and want to "deal" with them and know what happens.

Besides despite what EM claims, there isn't enough "procedures" in most of EM to keep a surgeon happy.

We actually have a PsyD who co-attends Derm clinic twice a week for us. Derm deals with an ok amount of psych issues...both caused by skin conditions and vice versa.

I don't have a psych degree, but I think that stuff is interesting as well.

 

[235009]

It isn't. There are a lot of positions in a lot of residency programs distributed throughout a wide geographical region. The data from Charting Outcomes indicates that average Step scores for a successful match in Anesthesia are comparable/less than the national average for US medical students. Being average is fine for an applicant, which by definition, makes it not competitive.

Keep in mind also that the data is from four matches ago and since then average step 1 scores have increased while anesthesia has continued it's descent into unpopularity. See 2013 match where 60+ spots went unfilled.

 

[KnuxNole]

Gee I would hope that if a patient is crashing someone else could intubate before an anesthesiologist drove in from home.

True, the emergency medicine physician could swing by the ICU...or an in house hospitalist. I get nervous with CCU patients crashing...thankfully my call nights have been benign, but it's only 1.5 months of overnight experience...if they need an emergent airway, I need to call my sleeping attending at home, or the gas attending at home. Or call the ED to consult them for help D:

 

[DermViser]

Anesthesiologists at my place are cracking down hardcore on iPad/phone use for non-professional use during cases. There was a high profile malpractice case recently where the plaintiffs lawyer used time stamped posts on FB to show that a doc was posting during the case

 

[DermViser]

dermviser just jumped out of his chair when he heard derm. He is proud.

 

[Etorphine]

interested in gas at one point, but all it took was one particularly challenging, critically ill pt to realize that I liked the idea of dealing with life or death decisions, but not actually doing it. I like excitement, but not anywhere near that level. I have lots of respect for people in the field, especially the ones that are good at on-the-fly decision-making.

 

[Bryan O’Blivion]

Keep in mind also that the data is from four matches ago and since then average step 1 scores have increased while anesthesia has continued it's descent into unpopularity. See 2013 match where 60+ spots went unfilled.

Indeed, this is correct. I was going to add something like that, but wanted to keep my comment brief, as I was headed to work. It will probably remain so for the next few foreseeable cycles. If you are a US MD student who wants to pursue a career in anesthesia, the odds are good. If you are seeking to impress friends and strangers with the exclusive nature of your medical specialty, it probably is not for you.

A good way to look at the field is to consider it a 5 year residency, as a fellowship is becoming a common career step.

 

[Impromptu]

Anesthesiology is still an excellent field. The popularity is cyclical. Current issues include possibilities of declining reimbursement (like bundled payments), AMCs, CRNAs, malpractice, hospital administration, egotistical surgeons, worsening patients. We love to talk about doom and gloom.

Even with those issues, anesthesiologists will still make more than most other specialties. It is the highest paying field that an "average" medical student can get into. The savvy among you might start to realize that it doesn't make much sense to burn your life away competing against the uber-competitive medical students for the orthopedics or dermatology residencies when you can get into an awesome and high paying residency like anesthesiology.

I knew many medical students who went for the competitive residencies simply because they were competitive. It was as if their self worth could only be satiated by beating others. It didn't matter if they really liked the field or not. It didn't matter if that field was truly difficult or not. They just had to beat others.

Do you really think it takes an above average medical student to be a good dermatologist? If given the chance an average medical student could do well in nearly any field. There are other factors in play that determine competitiveness of a specialty. So, since most of you are near average medical students, and about half of you are a bit below average, why not go into a field that pays more?

A few corrections to previous posters.

Hours: I diligently logged all my hours during residency and was typically 65-90 hours/week, with the average being in the 70s. Now in private practice I have yet to break 100 hours in a week, but I still work 75-95 hours/week. Q5 1st call (24 hours in house), and covering about 1/2 of the weekends (1st or 2nd call). While on call OB needs me all the time for epidurals, redoses, emergency c-sections. ER and the rest of the hospital call all the time for help with IVs. Surgery center jobs are the low hanging fruit that is being gobbled up by the AMCs. I wouldn't stake my career on getting one of those and still making lots of money or having high job satisfaction.

Schedule: There is no predictable schedule. You go home once all the cases are done, including all the add-ons. You will typically have 1-2 slow surgeons each day, throwing a monkey wrench into the schedule, delaying other surgeons. And you are the peace keeper.

Patients: When in charge I have to know everything about the 35 patients scheduled for surgery that day, as well as all the ancillary spots, do all the in-house pre-ops, see the patients in our pre-op clinic, and the OB patients. Imagine completing up to 50 detailed H&Ps each day, deciding for each patient whether or not they are ready for the procedure, and what the best anesthetic technique is. I have to trust that my nurse anesthetists will then carry out my vision for that patient (difficult trusting others). When I am in the operating room myself I get to know the patients more intimately than anyone else.

Intensity: Every moment under anesthesia is intense. We just make it look easy. If you doubt it, watch a new CA-1 in his/her first case.

In conclusion, anesthesiology is still an excellent field. You will have high satisfaction. You can make more money than most other specialties. It has issues. Obamacare may or may not ravage it. No one can currently predict the future. My guess is I will continue to be happy I chose this field.

 

[username456789]

The savvy among you might start to realize that it doesn't make much sense to burn your life away competing against the uber-competitive medical students for the orthopedics or dermatology residencies when you can get into an awesome and high paying residency like anesthesiology.

The even savvier among them might start to realize that life is so much more than the 2-3 years of medical school you would "burn" to obtain these coveted spots.

 

[Baller MD]

Hours: I diligently logged all my hours during residency and was typically 65-90 hours/week, with the average being in the 70s. Now in private practice I have yet to break 100 hours in a week, but I still work 75-95 hours/week. Q5 1st call (24 hours in house), and covering about 1/2 of the weekends (1st or 2nd call). While on call OB needs me all the time for epidurals, redoses, emergency c-sections. ER and the rest of the hospital call all the time for help with IVs. Surgery center jobs are the low hanging fruit that is being gobbled up by the AMCs. I wouldn't stake my career on getting one of those and still making lots of money or having high job satisfaction.

In conclusion, anesthesiology is still an excellent field. You will have high satisfaction. You can make more money than most other specialties. It has issues. Obamacare may or may not ravage it. No one can currently predict the future. My guess is I will continue to be happy I chose this field.

If you're going to work that many hours per week, you better be making more than most other specialties.

 

[circulus vitios]

If you're going to work that many hours per week, you better be making more than most other specialties.

I wonder what it's like on a dollar per hour basis. Kind of depressing to be in your mid 30s and beyond and still working 75+ hours a week.

 

[DermViser]

The even savvier among them might start to realize that life is so much more than the 2-3 years of medical school you would "burn" to obtain these coveted spots.

I've never gotten the logic, why is the four years of med school "burning" it away, but a tiring and exhausting 4 years of residency isn't?

 

[NontradCA]

Gee I would hope that if a patient is crashing someone else could intubate before an anesthesiologist drove in from home.

When I was a new hospital corpsman on the L & D ward (no NICU/Peds specialists at our hospital) baby was breached and the resident had a lot of trouble delivering. Well, part of my job (glorified LPN) was to do the initial stimulation and make sure the laryngoscope was ready. It was.

The resident was with mom and baby was unresponsive. Well after telling both the RN and resident this, the RN came over and said she was not going to intubate and asked if I wanted to try (wtf). I didn't try, because I didn't know how- never trained at all. The RN paged gas guy from home- a CRNA mind you.

He arrived in about 5 mins, and by that time I was really bagging and trying my best to get a response; the baby was responsive. Baby was clearly cyanotic but breathing and he attempted to intubate an failed. Well we gave O2 a little longer and baby ended up fine, but needless to say it was a ****ty situation. Also, turned out guy was a CRNA.

As an aside, I've also been in a situation (at the same hospital) where a stroke patient was coding on our 8 bed ICU and the RN locked herself in the bathroom, leaving me alone with him. He died.

 

[notbobtrustme]

Do you really think it takes an above average medical student to be a good dermatologist? If given the chance an average medical student could do well in nearly any field. There are other factors in play that determine competitiveness of a specialty. So, since most of you are near average medical students, and about half of you are a bit below average, why not go into a field that pays more?

This is a very good statement. The people replacing your mom's and dad's knees today were bottom of the barrel med students. The doctors biopsying that mole were bottom of the barrel med students. It's only recently that these specialties because the purview of the top students. 20 years ago, only garbage students went into Derm. You think the field changed that much in 20 years that it now requires people who score in the top 5% on boards and be in the top 10% of their class to do Derm? **** no, it's still pretty much the same as it used to be. The only thing that changed was factors surrounding Derm. The same goes for every specialty. The way medical education is setup, any med student can become a competent provider in any specialty. That's the whole point of the residency system here. You learn what you need to learn in order to practice.

 

[Winged Scapula]

Derm and Ortho have been competitive for longer than 20 years: here's some data for Ortho dating back to 1984: http://www.ncbi.nlm.nih.gov/pubmed/24836166 which states it was just as competitive then; IIRC you have to go back to the 60s/early 70s to find easy entry into Ortho. I'm not interested enough to look up Derm; maybe @DermViser can help.

According to the AAOS, the average age of the practicing orthopedic surgeon in the US, is under 50; thus, someone who finished training fairly recently. Hardly someone at the "bottom of their class" replacing grandpa's knee.

 

[DermViser]

Derm and Ortho have been competitive for longer than 20 years: here's some data for Ortho dating back to 1984: http://www.ncbi.nlm.nih.gov/pubmed/24836166

According to the AAOS, the average age of the practicing orthopedic surgeon in the US, is under 50; thus, someone who finished training fairly recently. Hardly someone at the "bottom of their class" replacing grandpa's knee.

Of course not. The 1980s is hardly a long time ago. It was before that - 1960s/1970s.

 

[Psai]

Anesthesiology is still an excellent field. The popularity is cyclical. Current issues include possibilities of declining reimbursement (like bundled payments), AMCs, CRNAs, malpractice, hospital administration, egotistical surgeons, worsening patients. We love to talk about doom and gloom.

Even with those issues, anesthesiologists will still make more than most other specialties. It is the highest paying field that an "average" medical student can get into. The savvy among you might start to realize that it doesn't make much sense to burn your life away competing against the uber-competitive medical students for the orthopedics or dermatology residencies when you can get into an awesome and high paying residency like anesthesiology.

I knew many medical students who went for the competitive residencies simply because they were competitive. It was as if their self worth could only be satiated by beating others. It didn't matter if they really liked the field or not. It didn't matter if that field was truly difficult or not. They just had to beat others.

Do you really think it takes an above average medical student to be a good dermatologist? If given the chance an average medical student could do well in nearly any field. There are other factors in play that determine competitiveness of a specialty. So, since most of you are near average medical students, and about half of you are a bit below average, why not go into a field that pays more?

A few corrections to previous posters.

Hours: I diligently logged all my hours during residency and was typically 65-90 hours/week, with the average being in the 70s. Now in private practice I have yet to break 100 hours in a week, but I still work 75-95 hours/week. Q5 1st call (24 hours in house), and covering about 1/2 of the weekends (1st or 2nd call). While on call OB needs me all the time for epidurals, redoses, emergency c-sections. ER and the rest of the hospital call all the time for help with IVs. Surgery center jobs are the low hanging fruit that is being gobbled up by the AMCs. I wouldn't stake my career on getting one of those and still making lots of money or having high job satisfaction.

Schedule: There is no predictable schedule. You go home once all the cases are done, including all the add-ons. You will typically have 1-2 slow surgeons each day, throwing a monkey wrench into the schedule, delaying other surgeons. And you are the peace keeper.

Patients: When in charge I have to know everything about the 35 patients scheduled for surgery that day, as well as all the ancillary spots, do all the in-house pre-ops, see the patients in our pre-op clinic, and the OB patients. Imagine completing up to 50 detailed H&Ps each day, deciding for each patient whether or not they are ready for the procedure, and what the best anesthetic technique is. I have to trust that my nurse anesthetists will then carry out my vision for that patient (difficult trusting others). When I am in the operating room myself I get to know the patients more intimately than anyone else.

Intensity: Every moment under anesthesia is intense. We just make it look easy. If you doubt it, watch a new CA-1 in his/her first case.

In conclusion, anesthesiology is still an excellent field. You will have high satisfaction. You can make more money than most other specialties. It has issues. Obamacare may or may not ravage it. No one can currently predict the future. My guess is I will continue to be happy I chose this field.

Thank you for this post. I was thinking hard about a surgical subspecialty but gas is what i came to do and I'm pretty sure anesthesia is what I'm going to go into.