Career Assurance and Guidance

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Chardeemacdennis60

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All,

I apologize in advance if I am beating a dead horse but I wanted some experienced perspective and advice on this career as it currently stands. I am currently an M2 that is very interested and excited to pursue the specialty. Prior to medical school, I worked for about five years as an ICU nurse and fell in love with anesthesiology. I will leave out why I pursued medicine instead of CRNA but would be happy to discuss with anyone that is curious. I am not trying to offend anyone with this post, just searching for honest advice and reassurance (or not).

I am currently apprehensive about this career path and feel like we are in a volatile and uncertain period regarding politics and trajectory. It is impossible to escape the political dynamic of the field and it is speculated ad nauseam amongst my classmates and online forums. I have no regrets about pursuing medicine yet I often worry that this career (anesthesiology) will vanish before I have a chance to practice. Instead of speculating if CRNA's will simply "take over", I have a few questions regarding the current and future dynamics.

Essentially, I do not understand how these careers (MD vs. CRNA) can continue to co-exist in our current climate. How is it sustainable for anesthesiologists to earn a living when the political and financial paradigm increasingly favors the use of CRNA's? How is it possible that MD’s continue to demand their current salaries when legislation (i.e. medicare reimbursements) essentially draws an equivalence between the two fields? When the majority of states have already "opted-out" of supervision, and medicare continues to slash rates, why would any health system continue to pay double for an MD? To be brutally honest, the economics of the profession make absolutely no sense to me from a sustainability standpoint. Hoping someone that knows more can offer some input on the topic.
 
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In short, the comprehensive financial package between CRNAs and Physicians has shrank. Once you account for mandatory breaks, overtime, and lack of participation in anything besides punching the clock and sitting the stool, a CRNA is not much cheaper than a physician. With physicians you pay more, but get way more bang for your buck. On top of that, physicians are simply more knowledgable clinicians by virtue of their training and can thus avert and or bail out nurses from some very bad situations.

Then there is the lawsuit situation. The cost savings from cutting out physicians and going soley with nurses across several years gets wiped out in one successful lawsuit. You better believe it that attorneys are focused in on tying CRNAs to hospitals and thus going after those bottom lines. Thats the kind of stuff that drives changes. Need proof? Look at the other thread regarding the 23 Million dollar jury verdict against the Texas CRNA. That one lawsuit likely wiped out 10 years of cost savings for doing the managed care model compared to physician only practice. I digress.
 
Chardeemacdennis60 said:
I am currently apprehensive about this career path and feel like we are in a volatile and uncertain period regarding politics and trajectory. It is impossible to escape the political dynamic of the field and it is speculated ad nauseam amongst my classmates and online forums. I have no regrets about pursuing medicine yet I often worry that this career (anesthesiology) will vanish before I have a chance to practice. Instead of speculating if CRNA's will simply "take over", I have a few questions regarding the current and future dynamics.

Essentially, I do not understand how these careers (MDA vs. CRNA) can continue to co-exist in our current climate. How is it sustainable for anesthesiologists to earn a living when the political and financial paradigm increasingly favors the use of CRNA's? How is it possible that MDA's continue to demand their current salaries when legislation (i.e. medicare reimbursements) essentially draws an equivalence between the two fields? When the majority of states have already "opted-out" of supervision, and medicare continues to slash rates, why would any health system continue to pay double for an MDA?
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First of all, anesthesiologists do not get paid double to a nurse anesthetist.

Secondly, my training as a physician and as a anesthesiologist gives me a unique set of knowledge and expertise, and I use this to get people out of trouble not infrequently. I troubleshoot anesthetic problems on a near daily basis. I have honed a set of skills that allow me to take care of almost anything I see. But I recognize my limitations and when something is over my depth I consult the assistance of other anesthesiologists. I find solutions in situations where a bad outcome can end up costing the hospital system millions of dollars.

Third, I don't bitch about working more than 40 hours a week and I don't demand time-and-a-half when I exceed that.

Hospitals that recognize the true costs of a nurse anesthetist recognize the great value of having an anesthesiologist.

To be brutally honest, the economics of the profession make absolutely no sense to me from a sustainability standpoint.
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When we are talking about the lives of people it should never be boiled down to an argument of economics. In the history of industries, when people are simply seen as numbers on a spreadsheet, horrible things have been done in the name of saving a buck.
 
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Your concerns exist in many fields of medicine. Many pediatric/family medicine clinics are almost entirely run by NP’s. There are NP’s and PA’s covering wards and ICU’s (mostly at night). Years ago ER docs could earn a decent salary working in urgent care, now I can’t even tell you the last time I saw a doc in an urgent care. Also, hospitals are not paying double for an anesthesiologist, often the pay gap quickly disappears when you start factoring in total hours. I work with anesthesiologists that were being told they wouldn’t have jobs in the mid 80’s, yet here we are. Go into a field you enjoy, you’ll be happier in the long run
 
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I practice in a supervisor role. I can tell you that all the CRNAs value having a good anesthesiologist with them. They call me about medical questions, different types of procedures they haven’t done, and overall being present in emergent or difficult situations. It’s the bum anesthesiologists that are afraid of big cases or just plain are not supportive or present that no one respects and honestly I lose respect for as well. Sitting in their cubicle and never showing up. Sadly, a large majority of anesthesiologists fall into this category. Don’t be like that. Also, as said above, the actual pay gap is shrinking big time. On a per hour basis, it’s definitely closer too. Also, there are just so many cases that need to be done that we don’t even have enough CRNAs or anesthesiologists to even cover ORs, OB, endo, MRI, IR etc. also in addition, anesthesiologists can do fellowships to further their value and expertise. I do MICU and it’s been great doing both. I have friends who split with pain. I have friends who are starting a regional/acute pain team. There are many avenues.
 
Really appreciate all the prompt responses, truly did not intend to offend anyone with my questions or statements. I love what the field of anesthesia offers and find joy studying the relevant medicine. Started chasing this dream when I was a bedside nurse and am thrilled with my decision thus far. Sometimes it is difficult not to become preoccupied with the politics when everyone you mention anesthesia to follows "well aren't you worried about CRNAs?". I did not pursue this career to get rich, I have close family that are CRNA's and I am well aware of the opportunity cost of my decision (hence why I mentioned "double the pay"). Wanted to live a life being an expert at doing something I love.
 
chocomorsel said:
You come here looking for answers but it looks like you only want positive answers. Read your first post and ask yourself why you posed this question in the first place. You will then have the answer to the above question.
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What are you talking about? I am asking them to elaborate, seems fair. Being told to “do ortho” without any context doesn’t answer anything.
 
Chardeemacdennis60 said:
Why are you so against your field?
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It’s okay. But you have much more control over your day to day life in most other specialties. I’m in my mid 50s and still work a lot of nights/weekends/holidays. Many primary care docs and surgical specialists never work during those times.
 
nimbus said:
It’s okay. But you have much more control over your day to day life in most other specialties. I’m in my mid 50s and still work a lot of nights/weekends/holidays. Many primary care docs and surgical specialists never work during those times.
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I can see how that would get old, thanks for the insight. I was pretty interested in Ortho for a minute, but if I did a fellowship I would train until I’m nearly 40. I really just want a job I like and that pays the bills. Currently in between primary care and anesthesia, but I just hate charting and dealing with patients that much. The prestige/respect factor doesn’t really matter to me.
 
nimbus said:
It’s okay. But you have much more control over your day to day life in most other specialties. I’m in my mid 50s and still work a lot of nights/weekends/holidays. Many primary care docs and surgical specialists never work during those times.
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Why not cut back? Do y’all not have any option for senior partners to cut back?
 
You seem to honestly want some answers so I’ll do my best, speaking as an anesthesiologist who loves the actual practice of anesthesia, hates supervising CRNAs, and wishes they’d chosen a different field of medicine.

For all talk of CRNAs taking over since I started in the field, there has been no change that I’ve seen. Zero. But that’s through my eyes. There are attendings here who say their job was replaced by a CRNA. I think it’s exceptionally rare. CRNAs, in my opinion, are very good and comfortable at doing the same thing over and over again. Anytime something odd or complex comes at them, they stumble.

The problem, and it’s a huge problem, is that they often aren’t willing to admit they’re confused or they’re stumbling and need some help. Some of them will, but from what I’ve seen, a lot more of them won’t. I have no problem calling a colleague for help. The ASA, and my training, didn’t instill in me some deluded visions of grandeur that I’d be the god of anesthesia once I finished training. Instead, I view the world as in a continual state of change and that I must always be adaptable and open to learning. The AANA does not hold that view. They’ve changed their name out of pure jealousy of the word anesthesiologist and how the public sees that word. They’ve added a year of training. They instill hostile and militant attitudes in their trainees. They preach independence. I have to ask - does ANY of that seem patient centric? It sure doesn’t to me. It all seems very self centered and self promoting.

Will all of the continual AANA nonsense help their cause? I have no idea. I can tell you with certainty though that it harms patients.

The problem with anesthesia is that regardless of technological and pharmaceutical advances, problems in the OR continue to occur. If something happens on your 3,000th anesthetic, and it’s something you’ve never seen before, and if you can’t figure it out quickly then the patient will see real serious harm and potentially die, and there’s no one you can call for help, then that’s a real problem. And yet, that’s exactly anesthesia. An extra year of training won’t solve that for the CRNA. A name change won’t help that problem. The only thing that may help the patient in that situation is a clever mind and a mindset developed long before, which says that trouble is always there waiting to rear its ugly head and we must always remain humble and vigilant.

An equally large problem with anesthesia is all of the complete and total boredom between the moments of terror. And this is what allows supervising anesthesiologists to hide away, never show their face, never perform an actual anesthetic, become wholly and totally dependent on a CRNA, and become a disgrace to this field.

Another problem with this field is that everyone seems to always look for the exit door. When I say everyone, it’s definitely a stretch, but it’s rare that I see an anesthesiologist who actively looks and wants to finish a case they started when relief arrives. That is absolutely nonexistent with CRNAs, who due to nursing culture and training, maintain a shiftwork and clock punching mentality.

Will CRNAs continue their march for desired independence? Yes they will. Will they find continued success? Yes, but it’s a battle of a thousand cuts. Has the CRNA affected my personal ability to find happiness in this field? Yes it has. I would be fine to never supervise another CRNA, as much as I like most of them. Yet MD only work mostly exists on the west coast, and certainly not in my area.

There is a part of me that feels they SHOULD be independent. It’s what the AANA tells everyone, even those not listening. And I have little to no desire to work with people with bad attitudes and hostility. I’d much prefer to do the work myself in pleasant peace. If they are in fact so great, then fine, let them go do their work and I’ll do mine. There appears plenty of work to go around.

Finally, the biggest problem for me with anesthesia is the lack of innovation. It simply doesn’t really change much, for better or worse. I enjoy anesthesia because I like working with my hands and doing procedures. And I greatly enjoy my interactions with patients. But were I to choose again, I’d give some surgical fields a harder look, and perhaps cardiology. There is just a lot more innovation and advancements going on in those fields that I think would strike my interest a bit more. I simply get bored too often in anesthesia. If you ever wonder where the advancements in medicine are occurring, then figure out where the reps are and who’s eating all the food they bring to the hospital. As far as I can tell that’s not anesthesia. Ever.

In the end I think anesthesia is fine. Are CRNAs a problem? Yeah, they are. But for me they aren’t a problem for the reasons you’ve brought forth, though over time those reasons may be justified.

I can tell you with certainty though that if the idea of working with CRNAs and the mentality they bring forth bothers you, and you think you’ll have trouble ignoring it, and MD only isn’t an option for your desired area when you have to make a choice, then just find a different field. Because it’s not worth it. Good luck.
 
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nimbus said:
It’s okay. But you have much more control over your day to day life in most other specialties. I’m in my mid 50s and still work a lot of nights/weekends/holidays. Many primary care docs and surgical specialists never work during those times.
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I don’t know about that…. A lot of other specialities bring a ton of work home with them - charts to finish, eternal phone calls to respond to, lingering doubt over whether they made the right decisions, and ongoing stress to see more and more patients and build a patient roster. We don’t deal with any of that, which is a great form of work-life control.

A beautiful thing in anesthesia is that when you’re done you’re done…. And at least our job for better or worse is time bounded shift work.

A major downside, as you highlighted, is the amount of call and often inappropriate expectations that go along with it. I think we are woefully under compensated for call - especially if you compare us to surgical fields that often get paid a ton for call without doing much actual work (eg neurosurgery). If call was well paid then we’d see a bunch of people eager to do it, and that is rarely the case in anesthesiology.
 
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kidthor said:
I don’t know about that…. A lot of other specialities bring a ton of work home with them - charts to finish, eternal phone calls to respond to, lingering doubt over whether they made the right decisions, and ongoing stress to see more and more patients and build a patient roster. We don’t deal with any of that, which is a great form of work-life control.

A beautiful thing in anesthesia is that when you’re done you’re done…. And at least our job for better or worse is time bounded shift work.

A major downside, as you highlighted, is the amount of call and often inappropriate expectations that go along with it. I think we are woefully under compensated for call - especially if you compare us to surgical fields that often get paid a ton for call without doing much actual work (eg neurosurgery). If call was well paid then we’d see a bunch of people eager to do it, and that is rarely the case in anesthesiology.
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I think overall lack of patient ownership has been and will be a net downside going forward. Hospitals are falling over each other trying to recruit spine surgeons or structural cardiologists who bring in pts getting procedures that have insane facility fees.

On the other hand, hospitals look at anesthesia (and rads, ER) the same way they look at the cafeteria. A recurring pain in the ass expense to be minimized in any way possible.
 
Southpaw said:
.

Finally, the biggest problem for me with anesthesia is the lack of innovation. It simply doesn’t really change much, for better or worse. I enjoy anesthesia because I like working with my hands and doing procedures. And I greatly enjoy my interactions with patients. But were I to choose again, I’d give some surgical fields a harder look, and perhaps cardiology. There is just a lot more innovation and advancements going on in those fields that I think would strike my interest a bit more. I simply get bored too often in anesthesia. If you ever wonder where the advancements in medicine are occurring, then figure out where the reps are and who’s eating all the food they bring to the hospital. As far as I can tell that’s not anesthesia. Ever..
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I agree with pretty much everything you said but this part was especially spot on. I'm 5 years out but I still try to keep up on literature, podcasts, videos, the "what's new" section of UTD, etc, but you know what the topics I look at are almost never about? Anything related to general anesthesia. And it's not just because I'm CCM trained and because cardiac anesthesia is a fair amount of my practice.

Critical care medicine has landmark papers still coming out every year. The mortality of so many critical illnesses remains so bad that money still pours into research and pharmacologic/technologic development. To be good at CCM one has to keep up on the literature related to all the organ systems. Critical care echocardiography / vexus / POCUS, i.e. a truer understanding of wtf "volume status" means, is still in its nascent stages. And eCPR/ECMO is about to become a thing, at least in major metros.

And from the CT surgery / cardiology side, there's been as many advances in the last 15 years as there was in the previous 50 before that. Echocardiography and multimodality imaging are still advancing at a rapid pace. A bazillion people are going to need convergent or total surgical MAZEs. CABG (esp total arterial grafting) is going to be here to stay for a long time. There are like ten different types of transcatheter total mitral valve replacements in various development. The 1yr survival of a durable VAD (HMIII) just recently hit the same survival as heart transplant, not to mention there's multiple total artificial hearts in early trials. Ad infinitum.

OTOH, in general anesthesia we got...sugammadex (a decade after the Europeans). Precedex is overused for just being ok. Remimazolam...which no one will use even after waiting years for it to become affordable. There's still no TCI in the US. There's no new groundbreaking non-narcotic analgesics. BIS monitors are a joke. There's no new (cost effective) volatile anesthetics. There's a PENG block, ESP block, and 10 other fluff blocks which are maybe more effective than nothing. And video laryngoscopes are almost two decades old.
 
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given what you are looking for, the field of anesthesia is still a good one, that being relative to all the others for the reasons discussed above. You can find a good, well paying job and if you watch your spending / lifestyle and shut out most of the medical/political noise, it can be a recipe for as stable a profession as one could hope for. I'm personally grateful for choosing it and there is no perfect specialty or position.
 
vector2 said:
I agree with pretty much everything you said but this part was especially spot on. I'm 5 years out but I still trying to keep up on literature, podcasts, videos, the "what's new" section of UTD, etc, but you know what the topics I look at are almost never about? Anything related to general anesthesia. And it's not just because I'm CCM trained and because cardiac anesthesia is a fair amount of my practice.

Critical care medicine has landmark papers still coming out every year. The mortality of so many critical illnesses remains so bad that money still pours into research and pharmacologic/technologic development. To be good at CCM one has to keep up on the literature related to all the organ systems. Critical care echocardiography / vexus / POCUS, i.e. a truer understanding of wtf "volume status" means, is still in its nascent stages. And eCPR/ECMO is about to become a thing, at least in major metros.

And from the CT surgery / cardiology side, there's been as many advances in the last 15 years as there was in the previous 50 before that. Echocardiography and multimodality imaging are still advancing at a rapid pace. A bazillion people are going to need convergent or total surgical MAZEs. CABG (esp total arterial grafting) is going to be here to stay for a long time. There are like ten different types of transcatheter total mitral valve replacements in various development. The 1yr survival of a durable VAD (HMIII) just recently hit the same survival as heart transplant, not to mention there's multiple total artificial hearts in early trials. Ad infinitum.

OTOH, in general anesthesia we got...sugammadex (a decade after the Europeans). Precedex is overused for just being ok. Remimazolam...which no one will use even after waiting years for it to become affordable. There's still no TCI in the US. There's no new groundbreaking non-narcotic analgesics. BIS monitors are a joke. There's no new (cost effective) volatile anesthetics. There's a PENG block, ESP block, and 10 other fluff blocks which are maybe more effective than nothing. And video largoscopes are almost two decades old.
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So aspects of cardiac anesthesia have a fair amount of innovation? I have always been interested in the fellowship but have never heard great things about the call schedule, I guess it is all a give and take. I see what you are saying and general anesthesia seems fairly stagnant, thanks expanding on that.
 
BHM1 said:
given what you are looking for, the field of anesthesia is still a good one, that being relative to all the others for the reasons discussed above. You can find a good, well paying job and if you watch your spending / lifestyle and shut out most of the medical/political noise, it can be a recipe for as stable a profession as one could hope for. I'm personally grateful for choosing it and there is no perfect specialty or position.
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I appreciate it. It is sad state of affairs sometimes as a medical student, seems nearly impossible to find a physician that encourages you to pursue their specialty anymore. I would say that more anesthesiologists encourage rather than discourage pursuit of their field which has always been a plus for me. I am pretty honest with myself about my career though, it is always going to be #2 behind my family/personal life - although I know some may take offense to that. I think it is easier to have that mindset in some specialities than others while still being good/passionate about what you do.
 
Chardeemacdennis60 said:
I appreciate it. It is sad state of affairs sometimes as a medical student, seems nearly impossible to find a physician that encourages you to pursue their specialty anymore. I would say that more anesthesiologists encourage rather than discourage pursuit of their field which has always been a plus for me. I am pretty honest with myself about my career though, it is always going to be #2 behind my family/personal life - although I know some may take offense to that. I think it is easier to have that mindset in some specialities than others while still being good/passionate about what you do.
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be sure of it, always

And yes, our specialty enables us to give 100% while at work but not having to carry patient phone calls/office issues, etc with us at home. Sure, other specialty groups are designed where these things are covered but by the very nature of our work it is not a primary issue.
 
Chardeemacdennis60 said:
I appreciate it. It is sad state of affairs sometimes as a medical student, seems nearly impossible to find a physician that encourages you to pursue their specialty anymore. I would say that more anesthesiologists encourage rather than discourage pursuit of their field which has always been a plus for me. I am pretty honest with myself about my career though, it is always going to be #2 behind my family/personal life - although I know some may take offense to that. I think it is easier to have that mindset in some specialities than others while still being good/passionate about what you do.
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For all of the negatives I stated above, I can recommend anesthesia as a field for those who see it for what it is and what it is not. Meaning, you go in eyes wide open. If you are a nurse who went to medical school you're already way ahead of most medical students on understanding the medical field at large and what patient care is really about. You also see what nursing is, and importantly, isn't. I do not try and talk medical students out of going into anesthesia. I simply want them fully knowledgeable about its positives and negatives. I think lack of knowledge of the negatives of our field has led to unhappiness and burnout for many. If you come in knowing all of that, and choose it anyway, I think you're more likely to be a true asset to anesthesiology, to your patients, and most importantly I think it more likely that you'll find yourself happy and fulfilled.
 
Southpaw said:
For all of the negatives I stated above, I can recommend anesthesia as a field for those who see it for what it is and what it is not. Meaning, you go in eyes wide open. If you are a nurse who went to medical school you're already way ahead of most medical students on understanding the medical field at large and what patient care is really about. You also see what nursing is, and importantly, isn't. I do not try and talk medical students out of going into anesthesia. I simply want them fully knowledgeable about its positives and negatives. I think lack of knowledge of the negatives of our field has led to unhappiness and burnout for many. If you come in knowing all of that, and choose it anyway, I think you're more likely to be a true asset to anesthesiology, to your patients, and most importantly I think it more likely that you'll find yourself happy and fulfilled.
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Appreciate your response and perspective. I was very close to applying CRNA when I was a nurse. I can say from shadowing and speaking with many, for personal reasons I would always regret not pursuing medicine and decided to make the change. Outside of the academic environment, we do not get any exposure to anesthesia in medical school. Having a better understanding of the current/future negatives is why I turned to this forum and I appreciate all the honesty.
 
Southpaw said:
You seem to honestly want some answers so I’ll do my best, speaking as an anesthesiologist who loves the actual practice of anesthesia, hates supervising CRNAs, and wishes they’d chosen a different field of medicine.

For all talk of CRNAs taking over since I started in the field, there has been no change that I’ve seen. Zero. But that’s through my eyes. There are attendings here who say their job was replaced by a CRNA. I think it’s exceptionally rare. CRNAs, in my opinion, are very good and comfortable at doing the same thing over and over again. Anytime something odd or complex comes at them, they stumble.

The problem, and it’s a huge problem, is that they often aren’t willing to admit they’re confused or they’re stumbling and need some help. Some of them will, but from what I’ve seen, a lot more of them won’t. I have no problem calling a colleague for help. The ASA, and my training, didn’t instill in me some deluded visions of grandeur that I’d be the god of anesthesia once I finished training. Instead, I view the world as in a continual state of change and that I must always be adaptable and open to learning. The AANA does not hold that view. They’ve changed their name out of pure jealousy of the word anesthesiologist and how the public sees that word. They’ve added a year of training. They instill hostile and militant attitudes in their trainees. They preach independence. I have to ask - does ANY of that seem patient centric? It sure doesn’t to me. It all seems very self centered and self promoting.

Will all of the continual AANA nonsense help their cause? I have no idea. I can tell you with certainty though that it harms patients.

The problem with anesthesia is that regardless of technological and pharmaceutical advances, problems in the OR continue to occur. If something happens on your 3,000th anesthetic, and it’s something you’ve never seen before, and if you can’t figure it out quickly then the patient will see real serious harm and potentially die, and there’s no one you can call for help, then that’s a real problem. And yet, that’s exactly anesthesia. An extra year of training won’t solve that for the CRNA. A name change won’t help that problem. The only thing that may help the patient in that situation is a clever mind and a mindset developed long before, which says that trouble is always there waiting to rear its ugly head and we must always remain humble and vigilant.

An equally large problem with anesthesia is all of the complete and total boredom between the moments of terror. And this is what allows supervising anesthesiologists to hide away, never show their face, never perform an actual anesthetic, become wholly and totally dependent on a CRNA, and become a disgrace to this field.

Another problem with this field is that everyone seems to always look for the exit door. When I say everyone, it’s definitely a stretch, but it’s rare that I see an anesthesiologist who actively looks and wants to finish a case they started when relief arrives. That is absolutely nonexistent with CRNAs, who due to nursing culture and training, maintain a shiftwork and clock punching mentality.

Will CRNAs continue their march for desired independence? Yes they will. Will they find continued success? Yes, but it’s a battle of a thousand cuts. Has the CRNA affected my personal ability to find happiness in this field? Yes it has. I would be fine to never supervise another CRNA, as much as I like most of them. Yet MD only work mostly exists on the west coast, and certainly not in my area.

There is a part of me that feels they SHOULD be independent. It’s what the AANA tells everyone, even those not listening. And I have little to no desire to work with people with bad attitudes and hostility. I’d much prefer to do the work myself in pleasant peace. If they are in fact so great, then fine, let them go do their work and I’ll do mine. There appears plenty of work to go around.

Finally, the biggest problem for me with anesthesia is the lack of innovation. It simply doesn’t really change much, for better or worse. I enjoy anesthesia because I like working with my hands and doing procedures. And I greatly enjoy my interactions with patients. But were I to choose again, I’d give some surgical fields a harder look, and perhaps cardiology. There is just a lot more innovation and advancements going on in those fields that I think would strike my interest a bit more. I simply get bored too often in anesthesia. If you ever wonder where the advancements in medicine are occurring, then figure out where the reps are and who’s eating all the food they bring to the hospital. As far as I can tell that’s not anesthesia. Ever.

In the end I think anesthesia is fine. Are CRNAs a problem? Yeah, they are. But for me they aren’t a problem for the reasons you’ve brought forth, though over time those reasons may be justified.

I can tell you with certainty though that if the idea of working with CRNAs and the mentality they bring forth bothers you, and you think you’ll have trouble ignoring it, and MD only isn’t an option for your desired area when you have to make a choice, then just find a different field. Because it’s not worth it. Good luck.
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This was a superb summation of the state of the field. Bravo sir or madam.
 
FFP said:
You feel so very secure you feel the need to achieve financial independence as quickly as possible. 😛
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I feel secure in the fact that I'll always be needed and I'll always be able to command a good income (compared to the rest of the world).

I do not feel secure about the future of medicine in general in this country. Lots of things I dislike happening. So it's more of a precaution for if/when the changes in healthcare and medicine are too unpalatable for me to tolerate.
 
abolt18 said:
I feel secure in the fact that I'll always be needed and I'll always be able to command a good income (compared to the rest of the world).

I do not feel secure about the future of medicine in general in this country. Lots of things I dislike happening. So it's more of a precaution for if/when the changes in healthcare and medicine are too unpalatable for me to tolerate.
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I understand. I was just kidding.
 
Chardeemacdennis60 said:
Appreciate your response and perspective. I was very close to applying CRNA when I was a nurse. I can say from shadowing and speaking with many, for personal reasons I would always regret not pursuing medicine and decided to make the change. Outside of the academic environment, we do not get any exposure to anesthesia in medical school. Having a better understanding of the current/future negatives is why I turned to this forum and I appreciate all the honesty.
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the important thing is just being realistic of your expectations and know what you are getting yourself into. if you can do this, anesthesiology is fine.

i would not be worried about your mentioned concerns if you dont care THAT much about salary and just want to pay bills. even if MD gets paid same as CRNA (and its pretty close right now), you can pay bills off a CRNA salary...
 
anbuitachi said:
the important thing is just being realistic of your expectations and know what you are getting yourself into. if you can do this, anesthesiology is fine.

i would not be worried about your mentioned concerns if you dont care THAT much about salary and just want to pay bills. even if MD gets paid same as CRNA (and its pretty close right now), you can pay bills off a CRNA salary...
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Appreciate it. From a financial perspective, my main concern is covering my student debt while being able to support a family. Are the average salaries really that close? Seems like 200+ is the new norm for CRNA while 400+ is relatively normal for MD from what I can see, although I am pretty limited in my knowledge of pay in either fields.
 
Chardeemacdennis60 said:
Appreciate it. From a financial perspective, my main concern is covering my student debt while being able to support a family. Are the average salaries really that close? Seems like 200+ is the new norm for CRNA while 400+ is relatively normal for MD from what I can see, although I am pretty limited in my knowledge of pay in either fields.
Click to expand...
Total salary-wise you're correct. The difference is that the CRNAs are often 36hrs/wk with no call, no weekends, etc, and the anesthesiologist is 50-60hrs a week plus call, holidays, weekends - plus way more expertise and safer care. Per hour for daytime work the pay rates are getting very close.

Whatever the case you should be able to pay debt and support a family. Heck now some people are actually getting PSLF forgiveness, which I thought would never happen. So there's that.
 
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kidthor said:
Total salary-wise you're correct. The difference is that the CRNAs are often 36hrs/wk with no call, no weekends, etc, and the MD is 50-60hrs a week plus call and weekends - plus way more expertise and safer care. Per hour for daytime work the pay rates are getting very close.
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Thanks for clarifying. From a CRNA perspective, in the long term it seems like increasing wages are a double edged sword for their cause. When pay begins to equalize while clinical expertise does not, it seems like this would be a detriment to a CRNA's utility for a health system.
 
Chardeemacdennis60 said:
Thanks for clarifying. From a CRNA perspective, in the long term it seems like increasing wages are a double edged sword for their cause. When pay begins to equalize while clinical expertise does not, it seems like this would be a detriment to a CRNA's utility for a health system.
Click to expand...
Maybe, but they are slightly cheaper as an hourly line item and administrators are unsophisticated. If they look cheaper in some micro sense then that's good enough for many administrators. Most are unable to think big picture. They just function in their little boxes. One place I used to work at had administrators come up with a compensation plan that entirely excluded holidays and weekends because they figured anesthesia stuff didn't happen during those times.

But there's seemingly a shortage of both CRNAs and physicians so there's continued high demand for both.
 
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