Cardiology vs. Anesthesia

[GolDRoger]

Hi everyone,

MS3 here trying to make a decision on the specialty I'd like to pursue. I'm really between anesthesia vs. cardiology. Have rotated through anesthesia and IM. Honestly, I loved both of these specialties and am having a really hard time deciding. I was mainly all in for anesthesia at first but every single anesthesiologist I've talked to has tried to convince me to do something else - they all had a pretty negative outlook on anesthesia and said if they were a med student today they would not pick it. Here are my thoughts:


Anesthesia pros for me: love the lifestyle and the fact that there's a great amount of break time everyday. loved intubating patients, putting in arterial lines, and overall just thought the procedure diversity was great (nerve blocks and always working with your hands). Obviously they can make a ton of $ and I'm seeing a lot of jobs for 500k+ starting, not to mention residency is just 4 years and I can be banking pretty quickly. I do value lifestyle and money a good amount. I do like the idea of supervision and not having to sit my own cases the whole time.

Anesthesia cons: by the end of the rotation, was pretty bored. I feel like the procedures can get pretty repetitive and you're doing the same thing everyday. kind of hated how they were so nice to the surgeon but the surgeon wasn't necessarily nice to them and treated them like kids at times. don't like the fact that i'll never have my own patients. don't like the fact that there was hints of disrespect towards the anesthesiologists.


Cardiology pros: same thing in terms of money. If i did cardio, would want to do IC or EP for sure, and they seem to make the same amount if not more. love the procedures (stenting, ablations, etc). love the respect that comes with cardiology and the fact that I can have great effects on people's lives. love the heart. i do also love teaching (have been doing teaching/tutoring as a side gig for most of my life) and realize that they are teaching to med students and residents/fellows a ton.

Cardiology cons: super long path... like i said I'd be looking at IC or EP and that's 7-8 years post med school. that is a very long time to me. I've heard lifestyle can be quite rough. Not sure how much midlevels are involved but have heard they are more involved and can be very annoying. The poor outcomes I feel could bother me but not so much that it would make me hate my life or anything. The amount of call (though I hear anesthesia is a lot of call too)


Sorry for the long post but just wanted to hear your guys thoughts. Thank you so much in advance

---

Members don't see this ad.

 

[MifflinDunder]

Do you like clinic?

 

[GolDRoger]

Do you like clinic?

I wouldn't want to be in clinic everyday, unless it's more procedural work in clinic. I do want SOME clinic but more inpatient/hospital work and maybe following up with those patients in clinic. I'd like to be 70 inpatient/30 clinic if that's a possibility

 

[IcedAmericano19]

I will tell you, the lifestyle of an interventional cardiologist is a degree or two worse than the lifestyle of an anthesiologist. It is worse than most surgeons tbh. So you have to factor that in to your thinking.

Now EP lifestyle is not bad. I have rarely seen our EP docs come in weird hours for anything emergent. If patient needs a TVP, icu or ER can throw it in.

As someone doing general cards, I will say the lifestyle is pretty damn good (especially compared to interventional). I do a mix of rounding, clinic, imaging, and low risk procedures like tee cardioverions and rhc. You can also be more invasive and do LHC and pacemakers, depending on the program and your job. So you can still do procedures as a generalist, have a pretty good life. Salary is on par or slightly better than anesthesia. I also don’t have to deal with surgeons other than packaging up their next CABG or SAVR etc. and CTS loves cardiologists and treat us with a lot of respect, maybe because we bring them all their business.

 

[Cardiac Amyloidosis]

Anesthesia for sure. No clinic in basket and no bringing work home makes a huge difference. Plus the 4 vs 7-8 years you mentioned, sounds like a no brainer. Find a hospital where they’re respected and you won’t have to worry about that nonsense you witnessed.

I enjoy cardiology but if I could go back in time I would explore other options that don’t require bringing work home.

 

[MifflinDunder]

Anesthesia for sure. No clinic in basket and no bringing work home makes a huge difference. Plus the 4 vs 7-8 years you mentioned, sounds like a no brainer. Find a hospital where they’re respected and you won’t have to worry about that nonsense you witnessed.

I enjoy cardiology but if I could go back in time I would explore other options that don’t require bringing work home.

Agreed. Thanks to mychart, clinic at this day and age will inevitably spill into your personal time.

@GolDRoger If you're insistent on IM, would recommend GI. They no longer do clinic where I am.

 

[GolDRoger]

Agreed. Thanks to mychart, clinic at this day and age will inevitably spill into your personal time.

@GolDRoger If you're insistent on IM, would recommend GI. They no longer do clinic where I am.

No way can I do GI… I hate everything about GI unfortunately. I mean do IC / EP do a lot of clinic?

 

[Cardiac Amyloidosis]

From the places I’ve been yes, like 2-3 clinic days/week I think was pretty standard. 2 clinic days a week is enough to be considered a lot in my opinion. Your inbasket willl fill up just off of that.

Maybe there are places where you don’t do much clinic, I don’t know.

 

[ewax]

No way can I do GI… I hate everything about GI unfortunately. I mean do IC / EP do a lot of clinic?

At least for EP, since the majority of procedures are elective and outpatient, you need clinic (probably 2-3×/week fresh out of fellowship, can be less as you build your panel) to feed your lab ablations and devices.

Also will likely need to supervise nurses/mid-levels in long term device clinic.

 

[gutonc]

I wouldn't want to be in clinic everyday, unless it's more procedural work in clinic. I do want SOME clinic but more inpatient/hospital work and maybe following up with those patients in clinic. I'd like to be 70 inpatient/30 clinic if that's a possibility

I'm not in Cards or Anesthesia, so take what I'm about to say with a grain of salt.

There is no way that you know, at this point in your career, as an M3, what you would ultimately like your career to be and whether or not you like clinic or inpatient more. Even as a 3rd year fellow (in Oncology), I was seriously debating a fully inpatient position because I "hated clinic". Now the only time I go to the hospital is when I need to walk through it to get from my outpatient clinic to somewhere else on campus. I don't take call I don't see inpatients (except on a social basis) and I could not be happier.

YMMV of course, and it's not impossible that what you think you want today is exactly what you're going to want in 5-10 years when you finally get there, but it's more likely that it's not.

I do think you've got the pros/cons pretty nicely worked out in your list. I will say that one more pro to "cards" (but really to IM --> cards) is that there are a lot more escape routes for IM trained docs than there are for anesthesia trained. You can bail on cards and go a dozen different routes (fellowship or not) after finishing an IM residency compared to anesthesia where you're basically limited to pain, CCM or a more specialized anesthesia fellowship if you don't love anesthesia once you're done with residency.

 

[IM_to_ortho_hopeful]

Agreed. Thanks to mychart, clinic at this day and age will inevitably spill into your personal time.

@GolDRoger If you're insistent on IM, would recommend GI. They no longer do clinic where I am.

Just work somewhere without epic lol. Allscripts is #1 EMR for me now

 

[IM_to_ortho_hopeful]

I'm not in Cards or Anesthesia, so take what I'm about to say with a grain of salt.

There is no way that you know, at this point in your career, as an M3, what you would ultimately like your career to be and whether or not you like clinic or inpatient more. Even as a 3rd year fellow (in Oncology), I was seriously debating a fully inpatient position because I "hated clinic". Now the only time I go to the hospital is when I need to walk through it to get from my outpatient clinic to somewhere else on campus. I don't take call I don't see inpatients (except on a social basis) and I could not be happier.

YMMV of course, and it's not impossible that what you think you want today is exactly what you're going to want in 5-10 years when you finally get there, but it's more likely that it's not.

I do think you've got the pros/cons pretty nicely worked out in your list. I will say that one more pro to "cards" (but really to IM --> cards) is that there are a lot more escape routes for IM trained docs than there are for anesthesia trained. You can bail on cards and go a dozen different routes (fellowship or not) after finishing an IM residency compared to anesthesia where you're basically limited to pain, CCM or a more specialized anesthesia fellowship if you don't love anesthesia once you're done with residency.

I disagree with gut onc’s last point. Do not go into IM with the intention of escaping from IM, or you’ll end up like me. I’m an internist trying to become an orthochad. You must like IM to want to do IM, I unfortunately hated IM but had to do it anyway.

 

[gutonc]

I disagree with gut onc’s last point. Do not go into IM with the intention of escaping from IM, or you’ll end up like me. I’m an internist trying to become an orthochad. You must like IM to want to do IM, I unfortunately hated IM but had to do it anyway.

To be clear, I wasn't suggesting going IM to escape it. I was stating that, if you get to the end (or the middle) of the road in training for an IM based subspecialty and decide that isn't actually what you want to do, it's much easier to pivot to something else (in IM) than it is to exit to a completely different specialty, which is what you're trying to do. You didn't have to do IM, that was a choice you made.

 

[cards67]

70:30 is possible but I wouldn't bank on it. More likely 50:50 or even less. Every specialty gets monotonous, you have to be interested in the bread and butter. IC lifestyle can be rough, EP not so much. Salary ceiling in IC/EP is probably higher, but if you choose academics that could change things. IC/EP can always cut back on procedures in the future and still make good money. Midlevels aren't a concern in cards. Owning patients has its perks and cardiology holds a lot of power in hospitals.

Also gotta agree with gutonc, what you think and feel now could very well change when you're an attending. I really enjoyed inpatient and strongly considered HF, but now I really appreciate my boring, predicable 8-5 M-F clinic schedule. Clinic has its cons but I never bring work home.

 

[IM_to_ortho_hopeful]

To be clear, I wasn't suggesting going IM to escape it. I was stating that, if you get to the end (or the middle) of the road in training for an IM based subspecialty and decide that isn't actually what you want to do, it's much easier to pivot to something else (in IM) than it is to exit to a completely different specialty, which is what you're trying to do. You didn't have to do IM, that was a choice you made.

While you’re right I didn’t have to do IM… to be fair someone who does not match into their desired specialty should probably finish whatever their SOAP/backup is… in the moment you’re afraid and find yourself backed up into a corner. You have to face the horrors of becoming an internist vs. Not being employed and not being able to do much with your medical degree. It’s a horrible position to be in, that is difficult to understand unless you’re in it. I would never fault someone who soaped, just a part of the game. I would also never encourage someone to go into IM unless they are truly interested in it, because frankly 95% of the specialty is algorithmic and mid levels can do almost the entirety of the work. Midlevels + AI is the future of IM. I say that as an internist. The subspecialties are safe for now. Anesthesia is not at risk of a huge change in labor forces unless someone can invent a propofol that does not cause respiratory compromise. CRNAs are also helpful to anesthesia job protection, it is much more difficult to create a CRNA than an NP.

 

[timpview]

If you do IC, you get to do anesthesia on the sickest patients that many of them (anesthesiologists) wouldn’t touch. Best/worst of both worlds.

 

[yungbucc]

Couple of more cons for anesthesia: For the high paying jobs you’re interested in you have to wake up early most days of your career (get to hospital around 6:30), work a fairly consistent number of nights and weekends in house. In gen cards (6 year path, good job market and plenty of money, no need to do IC or EP imo) the hours can be more normal person hours, and there’s plenty of large groups where call is infrequent and done from home. Also, just imo from having SO/friends in anesthesia, doing only general anesthesia has downward pressure on their salaries from CRNA. CRNAs making >250-300k easily now, and they’re opening schools like crazy. Obviously they’re not physicians, but talk to any anesthesiologist who isn’t BSing and they will definitely say presence of CRNAs can limit negotiating power. Job market is hot right now, but things may look different in 6-8 years when ~2000 more CRNAs are being pumped out each year. Safer to do a fellowship in anesthesia and have specialty training to market. That’s debatable just telling you what others have been advised. 5 years for anesthesia/fellowship and 6 years for gen cards, and I also would say gen cards has higher salaries.

 

[MifflinDunder]

Agreed I would also recommend OP to revisit the I like supervising CRNAs idea. I’ve never heard the same from an Anesthesiologist. Sounds like you’re just taking on more liability.

 

[LoudBark]

While you’re right I didn’t have to do IM… to be fair someone who does not match into their desired specialty should probably finish whatever their SOAP/backup is… in the moment you’re afraid and find yourself backed up into a corner. You have to face the horrors of becoming an internist vs. Not being employed and not being able to do much with your medical degree. It’s a horrible position to be in, that is difficult to understand unless you’re in it. I would never fault someone who soaped, just a part of the game. I would also never encourage someone to go into IM unless they are truly interested in it, because frankly 95% of the specialty is algorithmic and mid levels can do almost the entirety of the work. Midlevels + AI is the future of IM. I say that as an internist. The subspecialties are safe for now. Anesthesia is not at risk of a huge change in labor forces unless someone can invent a propofol that does not cause respiratory compromise. CRNAs are also helpful to anesthesia job protection, it is much more difficult to create a CRNA than an NP.

So are you are an outpatient internist or hospitalist right now trying to apply for the match in orthopedics? Now that is interesting.

 

[CCM-MD]

Cardiology for sure. Significantly lower midlevel encroachment threat. Big money maker for the hospital in terms of facility fees versus a big cost to the hospital as an anesthesiologist. Organ system expert. Lots of options from procedural to imaging in terms of subspecialties. Cardiovascular disease isn’t going away.

EM used to be just as hot as anesthesia is right now, look at where it’s at now. If I was you I wouldn’t touch anesthesia, EM, hospitalist, critical care or radiology with a 10 foot pole.

Edited to add hospitalist

 

[MifflinDunder]

Cardiology for sure. Significantly lower midlevel encroachment threat. Big money maker for the hospital in terms of facility fees versus a big cost to the hospital as an anesthesiologist. Organ system expert. Lots of options from procedural to imaging in terms of subspecialties. Cardiovascular disease isn’t going away.

EM used to be just as hot as anesthesia is right now, look at where it’s at now. If I was you I wouldn’t touch anesthesia, EM, critical care or radiology with a 10 foot pole.

Aren't you CCM though. What IM fellowships do you think are worth it?

 

[slowthai]

Cardiology for sure. Significantly lower midlevel encroachment threat. Big money maker for the hospital in terms of facility fees versus a big cost to the hospital as an anesthesiologist. Organ system expert. Lots of options from procedural to imaging in terms of subspecialties. Cardiovascular disease isn’t going away.

EM used to be just as hot as anesthesia is right now, look at where it’s at now. If I was you I wouldn’t touch anesthesia, EM, critical care or radiology with a 10 foot pole.

Why radiology?

 

[chessknt]

Aren't you CCM though. What IM fellowships do you think are worth it?

You don't understand how the business of medicine works until it is too late but the main take home point is you want to own equipment so you can collect facility fees. The entire system is rigged against doctors (it is why part A reimbursement always goes up and part B reimbursement always goes down, or at best, sideways) so the more you can resemble a hospital the better off financially you will be. Heme/onc does this by selling and infusing chemo to their patients. GI does is by owning ASC/scoping equipment. Cardiology does it by owning imaging/stress testing equipment (and in some cases cath labs).

Anesthesia, pulm, rheum, CCM, endo, ID, nephro (all the HD centers are owned by private equity) dont get to own anything and it is why under the current system you should avoid them. Ownership is the only thing of value in our society and the only thing protected under our current reimbursement system. Anesthesia will collapse eventually the same way hospitalist/CCM will collapse--there is no ownership and part B billing is crap. Supply/demand economics don't apply in medicine--it doesnt matter if you are the only rheumatologist in the state, the government says you get $28/unit and that your consults are worth 4 units. Private insurance says you can either be in network and take 110% of medicare or be out of network. Your staff costs go up every year so you either work more, get paid less, or give up and work for a hospital which will systemically undervalue you using the stark laws they wrote. Or you can try to balance bill people our of network and they they get upset and refuse to pay because why should they have to pay you so much when you only saw them for 10 minutes?!?!?

 

[GolDRoger]

Thank you to everyone for your replies… based on what you all are saying in regards to the power with hospital, ownership, etc, I think I’m going to go with cards and finalize

 

[GolDRoger]

Couple of more cons for anesthesia: For the high paying jobs you’re interested in you have to wake up early most days of your career (get to hospital around 6:30), work a fairly consistent number of nights and weekends in house. In gen cards (6 year path, good job market and plenty of money, no need to do IC or EP imo) the hours can be more normal person hours, and there’s plenty of large groups where call is infrequent and done from home. Also, just imo from having SO/friends in anesthesia, doing only general anesthesia has downward pressure on their salaries from CRNA. CRNAs making >250-300k easily now, and they’re opening schools like crazy. Obviously they’re not physicians, but talk to any anesthesiologist who isn’t BSing and they will definitely say presence of CRNAs can limit negotiating power. Job market is hot right now, but things may look different in 6-8 years when ~2000 more CRNAs are being pumped out each year. Safer to do a fellowship in anesthesia and have specialty training to market. That’s debatable just telling you what others have been advised. 5 years for anesthesia/fellowship and 6 years for gen cards, and I also would say gen cards has higher salaries.

This is one of the main reasons I was leaning towards cards

 

[Full Metal IC]

My recommendation is anesthesiology +/- cardiac fellowship. Ticks most of your boxes, just 1 more year of training after anesthesia. Job market right now and income potential are fantastic. Lifestyle way better than IC. Remember that most specialties become repetitive after you've done it for a few years so repetitiveness should not really be a deterrant IMO. IC is an exception to this because of how much constant R&D there is on the industry side, but if you're debating anesthesia vs. IC the former is more lifestyle-friendly. We would all burn out after a few years if there wasn't some degree of repetitiveness. My friends who went into cardiac anesthesia are very satisfied.

 

[timpview]

You don't understand how the business of medicine works until it is too late but the main take home point is you want to own equipment so you can collect facility fees. The entire system is rigged against doctors (it is why part A reimbursement always goes up and part B reimbursement always goes down, or at best, sideways) so the more you can resemble a hospital the better off financially you will be. Heme/onc does this by selling and infusing chemo to their patients. GI does is by owning ASC/scoping equipment. Cardiology does it by owning imaging/stress testing equipment (and in some cases cath labs).

Anesthesia, pulm, rheum, CCM, endo, ID, nephro (all the HD centers are owned by private equity) dont get to own anything and it is why under the current system you should avoid them. Ownership is the only thing of value in our society and the only thing protected under our current reimbursement system. Anesthesia will collapse eventually the same way hospitalist/CCM will collapse--there is no ownership and part B billing is crap. Supply/demand economics don't apply in medicine--it doesnt matter if you are the only rheumatologist in the state, the government says you get $28/unit and that your consults are worth 4 units. Private insurance says you can either be in network and take 110% of medicare or be out of network. Your staff costs go up every year so you either work more, get paid less, or give up and work for a hospital which will systemically undervalue you using the stark laws they wrote. Or you can try to balance bill people our of network and they they get upset and refuse to pay because why should they have to pay you so much when you only saw them for 10 minutes?!?!?

Kind of.

Private practice cards hasn’t recovered and very few are capturing or truly benefiting from facility fees with imaging.. and freestanding cath labs haven’t really come back as well (yet) and really are more complicated than scope mills or ASCs

Cardiology is being “subsidized” through hospital employment though our leverage is higher than most/nearly all… but employment is still employment.

But agree with many of your other points.

 

[gutonc]

My recommendation is anesthesiology +/- cardiac fellowship. Ticks most of your boxes, just 1 more year of training after anesthesia. Job market right now and income potential are fantastic. Lifestyle way better than IC. Remember that most specialties become repetitive after you've done it for a few years so repetitiveness should not really be a deterrant IMO. IC is an exception to this because of how much constant R&D there is on the industry side, but if you're debating anesthesia vs. IC the former is more lifestyle-friendly. We would all burn out after a few years if there wasn't some degree of repetitiveness. My friends who went into cardiac anesthesia are very satisfied.

The bolded is critical for all med students to understand, regardless of what they're planning to go into. We know it's fun to have a different shiny thing to chase after every day when you're a student and learning, and your ability to pay your mortgage doesn't depend on how well you can manage all of those things. But for many (most?) of us, there comes a time when a predictable schedule with minimal craziness/excitement, and the opportunity to wrap things up and go home at a reasonable hour, is the goal.

We know it seems like the people out there doing the Whipples and the TAVRs and the intubations and resuscitations are doing the "cool stuff" while the IM and FM docs in their clinics are just sitting around talking and typing. But trust me that the 4th Whipple of the week and the 32nd TAVR this month are just as routine as the 20th DM/HTN/HLD patient of the day and in the end, the only thing that matters is that you can do the routine stuff day in and day out (like literally every other job on the planet) and still be happy.

 

[IM_to_ortho_hopeful]

Kind of.

Private practice cards hasn’t recovered and very few are capturing or truly benefiting from facility fees with imaging.. and freestanding cath labs haven’t really come back as well (yet) and really are more complicated than scope mills or ASCs

Cardiology is being “subsidized” through hospital employment though our leverage is higher than most/nearly all… but employment is still employment.

But agree with many of your other points.

I heard cardiology is trying to break into ASC/OBL more. How does this work? Would you need a good PACU and critical care unit nearby for the patients that’s are cathed? Or is it mostly for PAD patients?

 

[timpview]

I heard cardiology is trying to break into ASC/OBL more. How does this work? Would you need a good PACU and critical care unit nearby for the patients that’s are cathed? Or is it mostly for PAD patients?

The ASC/OBL is actually driven more by peripheral interventions and now EP (pacers, icd, even loops). Elective pci volume is stagnant to down trending (as appropriate due to indications) as well as the obvious higher risk of complications in that realm, especially with higher calcification in today’s world. That obviously doesn’t stop everyone but it does for some. I mean I would never get an elective PCI in such a place.

I still think the main thing impeding obl growth is just the hassle and upfront risk. It could all be wipes away with a stroke of a pen like it was in 2009??.. and costs have obviously skyrocketed.

Employment provides enough money for most (700-900k) that they’re willing to put up with the annoyance of employment vs risking more. Now obviously a lot of variations of this and joint ventures even with employed docs… but if incomes for employed docs went drastically down then you would see a lot more trying to get really creative in the obl world.

 

[GolDRoger]

The bolded is critical for all med students to understand, regardless of what they're planning to go into. We know it's fun to have a different shiny thing to chase after every day when you're a student and learning, and your ability to pay your mortgage doesn't depend on how well you can manage all of those things. But for many (most?) of us, there comes a time when a predictable schedule with minimal craziness/excitement, and the opportunity to wrap things up and go home at a reasonable hour, is the goal.

We know it seems like the people out there doing the Whipples and the TAVRs and the intubations and resuscitations are doing the "cool stuff" while the IM and FM docs in their clinics are just sitting around talking and typing. But trust me that the 4th Whipple of the week and the 32nd TAVR this month are just as routine as the 20th DM/HTN/HLD patient of the day and in the end, the only thing that matters is that you can do the routine stuff day in and day out (like literally every other job on the planet) and still be happy.

I hear you, and as a married man with a kid on the way, can completely understand that. After looking into it some more I believe I’m set on general / EP

 

[GolDRoger]

My recommendation is anesthesiology +/- cardiac fellowship. Ticks most of your boxes, just 1 more year of training after anesthesia. Job market right now and income potential are fantastic. Lifestyle way better than IC. Remember that most specialties become repetitive after you've done it for a few years so repetitiveness should not really be a deterrant IMO. IC is an exception to this because of how much constant R&D there is on the industry side, but if you're debating anesthesia vs. IC the former is more lifestyle-friendly. We would all burn out after a few years if there wasn't some degree of repetitiveness. My friends who went into cardiac anesthesia are very satisfied.

I hear you on the repetitiveness aspect. After considering it some more I believe I am set on cards however. Just want to be in a more future proof specialty with good procedure variety, able to be a boss, etc.

 

[hopefulraddaddypls]

Cardiology for sure. Significantly lower midlevel encroachment threat. Big money maker for the hospital in terms of facility fees versus a big cost to the hospital as an anesthesiologist. Organ system expert. Lots of options from procedural to imaging in terms of subspecialties. Cardiovascular disease isn’t going away.

EM used to be just as hot as anesthesia is right now, look at where it’s at now. If I was you I wouldn’t touch anesthesia, EM, hospitalist, critical care or radiology with a 10 foot pole.

Edited to add hospitalist

Love how its always non radiologists saying this, lol

 

[Sapien3]

I hear you, and as a married man with a kid on the way, can completely understand that. After looking into it some more I believe I’m set on general / EP

Good luck!
Cannot agree w/ so many pro-card comments.
I am general Card + Imaging. I am busier than EP and IC where I work. Specially with clinic, and imaging. Am the only advanced imager where I work. My co-workers, EP, IC and CTS value my opinion when it comes to some complex patients and imaging. I did not appreciate the edge it gave me until I started working at a place where most are older physician and are not uptodate.

Reasons I did not do IC- STEMI calls; and EP- got to do procedures to justify low clinic volume.

EP, IC and CTS all love their Gen Card to manage their complex patients 🙂

 

[anaphyrelaxed]

Couple of more cons for anesthesia: For the high paying jobs you’re interested in you have to wake up early most days of your career (get to hospital around 6:30), work a fairly consistent number of nights and weekends in house. In gen cards (6 year path, good job market and plenty of money, no need to do IC or EP imo) the hours can be more normal person hours, and there’s plenty of large groups where call is infrequent and done from home. Also, just imo from having SO/friends in anesthesia, doing only general anesthesia has downward pressure on their salaries from CRNA. CRNAs making >250-300k easily now, and they’re opening schools like crazy. Obviously they’re not physicians, but talk to any anesthesiologist who isn’t BSing and they will definitely say presence of CRNAs can limit negotiating power. Job market is hot right now, but things may look different in 6-8 years when ~2000 more CRNAs are being pumped out each year. Safer to do a fellowship in anesthesia and have specialty training to market. That’s debatable just telling you what others have been advised. 5 years for anesthesia/fellowship and 6 years for gen cards, and I also would say gen cards has higher salaries.

I remember sharing the elevator with an anesthesia attending at 5:40 AM almost every morning when I would show up to the wards as a med student.

Waking up that early for the rest of my life is what convinced me to avoid anesthesia. For as much as med students say they hate clinic, I love having an 8-5, no nights, no inpatients (in allergy), and every weekend/holiday off.

 

[dozitgetchahi]

Just work somewhere without epic lol. Allscripts is #1 EMR for me now

Allscripts is one of the worst EMRs I’ve ever had the displeasure of using.

 

[IM_to_ortho_hopeful]

Allscripts is one of the worst EMRs I’ve ever had the displeasure of using.

Yeah but no inbox bro who cares how useful the EMR is if you don’t need to deal with dumb **** outside of work

 

[dozitgetchahi]

Yeah but no inbox bro who cares how useful the EMR is if you don’t need to deal with dumb **** outside of work

You’ll still be dealing with those tasks, even if there is no inbox. I worked for a hospital that had a crappy outdated EMR (Centricity) before. Instead of dealing with these tasks electronically, I had a full physical inbox of paperwork that had to be addressed daily. That was even more painful than a full electronic inbox.

 

[MifflinDunder]

You’ll still be dealing with those tasks, even if there is no inbox. I worked for a hospital that had a crappy outdated EMR (Centricity) before. Instead of dealing with these tasks electronically, I had a full physical inbox of paperwork that had to be addressed daily. That was even more painful than a full electronic inbox.

I don't know I'll take this over mychart. It leaves you open to every single thought the patient is having qHourly. I'm Oncology and get asked to explain scans as soon as they hit my inbox. One time I made the mistake of waiting it out 48 hours to set a precedent. The patient sent multiple messages and called the front, and I ultimately got an earful for being too late.

 

[dozitgetchahi]

I don't know I'll take this over mychart. It leaves you open to every single thought the patient is having qHourly. I'm Oncology and get asked to explain scans as soon as they hit my inbox. One time I made the mistake of waiting it out 48 hours to set a precedent. The patient sent multiple messages and called the front, and I ultimately got an earful for being too late.

Set boundaries and make things happen at appointments. If your admin isn’t ok with that, change jobs.

 

[shouldigomd]

A lot of the pro's and con's you describe are very culture / location dependent. You can choose how hard you want to work to a certain degree as either an anesthesiologist or cardiologist. Cardiology and its subspecialties offers a lot more variety and options than anesthesia so if you are on the fence it makes more sense. Cardiology also involves a lot of clinic so if that isn't your thing .... might be a deal breaker. I am an IC and saw 32 in clinic today and wanted to cry.

 

[The kitchen sink]

You don't understand how the business of medicine works until it is too late but the main take home point is you want to own equipment so you can collect facility fees. The entire system is rigged against doctors (it is why part A reimbursement always goes up and part B reimbursement always goes down, or at best, sideways) so the more you can resemble a hospital the better off financially you will be. Heme/onc does this by selling and infusing chemo to their patients. GI does is by owning ASC/scoping equipment. Cardiology does it by owning imaging/stress testing equipment (and in some cases cath labs).

Anesthesia, pulm, rheum, CCM, endo, ID, nephro (all the HD centers are owned by private equity) dont get to own anything and it is why under the current system you should avoid them. Ownership is the only thing of value in our society and the only thing protected under our current reimbursement system. Anesthesia will collapse eventually the same way hospitalist/CCM will collapse--there is no ownership and part B billing is crap. Supply/demand economics don't apply in medicine--it doesnt matter if you are the only rheumatologist in the state, the government says you get $28/unit and that your consults are worth 4 units. Private insurance says you can either be in network and take 110% of medicare or be out of network. Your staff costs go up every year so you either work more, get paid less, or give up and work for a hospital which will systemically undervalue you using the stark laws they wrote. Or you can try to balance bill people our of network and they they get upset and refuse to pay because why should they have to pay you so much when you only saw them for 10 minutes?!?!?

Is there anything at all that the other specialities can do to own equipment or gain equity?

 

[chessknt]

Is there anything at all that the other specialities can do to own equipment or gain equity?

I think there are small things but nothing to the scale the big three have which is why they will always be financially inferior. Allergy might be the one exception.

 

[dozitgetchahi]

I think there are small things but nothing to the scale the big three have which is why they will always be financially inferior. Allergy might be the one exception.

I’m a rheumatologist and I made $775k last year at a multispecialty PP. Ask me anything.

 

[onconc]

I think there are small things but nothing to the scale the big three have which is why they will always be financially inferior. Allergy might be the one exception.

What are the big 3 ? Cards, GI and which is the 3rd ?

 

[onconc]

Hi everyone,

MS3 here trying to make a decision on the specialty I'd like to pursue. I'm really between anesthesia vs. cardiology. Have rotated through anesthesia and IM. Honestly, I loved both of these specialties and am having a really hard time deciding. I was mainly all in for anesthesia at first but every single anesthesiologist I've talked to has tried to convince me to do something else - they all had a pretty negative outlook on anesthesia and said if they were a med student today they would not pick it. Here are my thoughts:


Anesthesia pros for me: love the lifestyle and the fact that there's a great amount of break time everyday. loved intubating patients, putting in arterial lines, and overall just thought the procedure diversity was great (nerve blocks and always working with your hands). Obviously they can make a ton of $ and I'm seeing a lot of jobs for 500k+ starting, not to mention residency is just 4 years and I can be banking pretty quickly. I do value lifestyle and money a good amount. I do like the idea of supervision and not having to sit my own cases the whole time.

Anesthesia cons: by the end of the rotation, was pretty bored. I feel like the procedures can get pretty repetitive and you're doing the same thing everyday. kind of hated how they were so nice to the surgeon but the surgeon wasn't necessarily nice to them and treated them like kids at times. don't like the fact that i'll never have my own patients. don't like the fact that there was hints of disrespect towards the anesthesiologists.


Cardiology pros: same thing in terms of money. If i did cardio, would want to do IC or EP for sure, and they seem to make the same amount if not more. love the procedures (stenting, ablations, etc). love the respect that comes with cardiology and the fact that I can have great effects on people's lives. love the heart. i do also love teaching (have been doing teaching/tutoring as a side gig for most of my life) and realize that they are teaching to med students and residents/fellows a ton.

Cardiology cons: super long path... like i said I'd be looking at IC or EP and that's 7-8 years post med school. that is a very long time to me. I've heard lifestyle can be quite rough. Not sure how much midlevels are involved but have heard they are more involved and can be very annoying. The poor outcomes I feel could bother me but not so much that it would make me hate my life or anything. The amount of call (though I hear anesthesia is a lot of call too)


Sorry for the long post but just wanted to hear your guys thoughts. Thank you so much in advance

Anesthesia cons : I heard the nurse anesthetists have militant unions and are encroaching on physician turf. Quite more so than in other sub-specialities

 

[onconc]

I’m a rheumatologist and I made $775k last year at a multispecialty PP. Ask me anything.

Nice!

What is your work structure? I mean is the bulk of this amount coming from direct patient interaction reimbursement? Or does it involve real estate or equipment ownership partnership payments also?

How many hours do you work on an average?

 

[LoudBark]

I’m a rheumatologist and I made $775k last year at a multispecialty PP. Ask me anything.

Sure, you work in a somewhat rural area correct? A rheumatologist in fly over country I assume makes that (no insult to people who live or work there) but I assume a rheumatologist working in a major metropolitan area on either coast or Chicago is in no way going to touch that kind of income and still work reasonable hours?

 

[chessknt]

What are the big 3 ? Cards, GI and which is the 3rd ?

Oncology....

 

[chessknt]

I’m a rheumatologist and I made $775k last year at a multispecialty PP. Ask me anything.

Yea if you set up an infusion center and have a large biologic population you can probably make that happen but significant headwinds for most people I would imagine. I am pulm and am on track to net over 1mm if current projections hold but my situation would be very difficult to replicate and I would never tell someone to go in to pulm and expect that. Cards/onc/gi can make that happen without too much issue in many places however.