Choosing Anesthesiology

[osumc2015]

I'm in my second year and I'm coming around to the idea that anesthesiology may be the best fit amongst a few different specialties. I spent last summer doing research with an anesthesiology group and I liked a lot of what I saw:

Great variety of cases
No clinic
No follow-up/chronic care
Cool skill set and knowledge base
Immediacy of managing a case
Not too much diagnosis

As much as I liked the field, the hours that the residents and attendings worked were intimidating. Many would arrive at the hospital at 5:30/6 in the morning and not leave until 6 in the evening or later. Most people I encountered worked weekends regularly and took frequent call. I was working at a large academic hospital in a mid-size city in the Midwest and I'm not sure how reflective this type of schedule is for other anesthesiologists both during residency and after.

I'm wondering how much my aversion to long hours should factor into my decision about specialties. I understand that later in one's career it may be possible to choose jobs that are more flexible in terms of hours, but for now I will have a significant debt load and my flexibility immediately after residency in terms of finding a job may be more limited. From my experience, the anesthesiologists I encountered were working hours similar to surgeons, and I'm not sure I'm willing to commit to that type of lifestyle for the next decade.

Can anyone comment on how the hours/lifestyle in anesthesiology impacted their decision to enter the field? There are several other areas in medicine that I like slightly less, but seem to offer a much better work-life balance. I've tried reading through other threads on this topic, but I had a hard time finding much discussion on this particular issue. Any input would be great. Thanks

---

Members don't see this ad.

 

[bala1]

There are several other areas in medicine that I like slightly less, but seem to offer a much better work-life balance.

Which ones do you like slightly less?

 

[osumc2015]

PM&R, Ophthalmology, Allergy & Immunology.

I'm aware that these are vastly different fields, but each has its appeals. I'm not passionate about any field and honestly probably would not be in medical school if I could make the choice over again. That said, I'm stuck with the decision and anesthesiology seems to be the best fit in terms of what I'm looking to get out of my job in the near future.

 

[kindasorta]

Another thing you should ask yourself if you're considering Anesthesiology: do you like Sudoku and crossword puzzles?

 

[bala1]

PM&R, Ophthalmology, Allergy & Immunology.

I'm aware that these are vastly different fields, but each has its appeals. I'm not passionate about any field and honestly probably would not be in medical school if I could make the choice over again. That said, I'm stuck with the decision and anesthesiology seems to be the best fit in terms of what I'm looking to get out of my job in the near future.

Allergy i hear is tough to get into but a good lifestyle FOR SURE. 30 hour weeks. NIce. Pm and R as well has a good lifestyle. and optho probably not as easy as the first two but better than anesthesia.

Anesthesia is having problems. If you go through the forum i have listed a lot of those problems. If you work at a hospital call is frequent, and the likelihood of you getting called and having to get out of bed and go do something is high if you do get called . Never can you take care of it over the phone. You are working on someone elses schedule. And the hours are not part time either. they are long as you mentioned You are in between an alive patient and death constantly. Every single patient you have to think about the possibility of something you did that can cause their death. Every one of them. SO its not necessarily the most laid back profession even though it appears that way.most anesthesiologists including myself usually have an un easy feeling during the course of the day regardless of confidence level, which mine is very high btw. Working with crnas and managing a few of them can make the day tick by very very slowly. Very difficult to work with. Dealing with OR gossip is another painful aspect of the job.
I can go on and on. The actual practice is fun, sure, but it certainly does not feel like a lifestyle specialty and the fact that everyone is in your pocket and marginalizing what you do does not help.

 

[osumc2015]

Allergy i hear is tough to get into but a good lifestyle FOR SURE. 30 hour weeks. NIce. Pm and R as well has a good lifestyle. and optho probably not as easy as the first two but better than anesthesia.

Anesthesia is having problems. If you go through the forum i have listed a lot of those problems. If you work at a hospital call is frequent, and the likelihood of you getting called and having to get out of bed and go do something is high if you do get called . Never can you take care of it over the phone. You are working on someone elses schedule. And the hours are not part time either. they are long as you mentioned You are in between an alive patient and death constantly. Every single patient you have to think about the possibility of something you did that can cause their death. Every one of them. SO its not necessarily the most laid back profession even though it appears that way.most anesthesiologists including myself usually have an un easy feeling during the course of the day regardless of confidence level, which mine is very high btw. Working with crnas and managing a few of them can make the day tick by very very slowly. Very difficult to work with. Dealing with OR gossip is another painful aspect of the job.
I can go on and on. The actual practice is fun, sure, but it certainly does not feel like a lifestyle specialty and the fact that everyone is in your pocket and marginalizing what you do does not help.

Thanks for the perspective, I really appreciate the input

 

[Noegrus]

The question you should ask is, do I want great variety, great responsibility, intellectual challenges, a quickly moving, challenging job (anesthesiology) or do I want to drag myself to work and do the same procedures over and over and over and over and over again for about 20+ years, with most patients bouncing back to see you again because of non-compliance (ophtho, A&I), or you really, really like slow rehab of people with central/peripheral nervous system injuries. At the end what you choose should depend on your temperament. You get paid for the amount of work you have done. One can always go to an ambulatory care ctr and have 8hr days. It is always the same choice - you can do ent and make a killing by putting tubes all day long, or you can do h&n cancer and deal with some of the most complicated reconstructions imaginable. What does your gut say?

 

[B-Bone]

This field and the jobs available are so varied that I think any single characterization is really meaningless. Some people do 100% cardiac trainwrecks, some people do nothing but butt scopes all day. Others do 50/50 general OR and ICU or 100% pain. As far as call, some people don't take any. I know people that take q3 call at all times (except when on vacation every third week = 17 weeks/year). I have a pretty average job where I take call about once a week when I'm not on vacation and work probably 50 hrs/week average. Now that may be 108 hrs one week (a few weeks ago) and 25 hours another, but overall it's really not that bad. You say you don't want to work crazy hours, but you have significant debt load. You're not going to pay that debt off quickly without WORKING for it, in whatever field you choose. I think your best bet is to pick what you like, and work really hard the first few years to pay off that debt. That will likely be easier in anesthesiology (due to relatively higher reimbursement) than in the other fields you've listed. Also consider that it's pretty easy to change jobs in anesthesia after a few years, as opposed to some specialty where you have to develop a patient base and get referrals to build a practice. Anyway, just food for thought.

 

[secants]

Slightly off topic, but I'm trying to wrap my head around how to increase earning potential in a salaried position. Do most people just take more calls and work weekends/extra shifts/moonlight to get more money? I know it varies by practice scope but lets say for a salaried position at an academic hospital.

I'm an MS3 and like many others, don't really have good grasp of the financial aspect of Medicine yet.

 

[imfrankie]

Slightly off topic, but I'm trying to wrap my head around how to increase earning potential in a salaried position. Do most people just take more calls and work weekends/extra shifts/moonlight to get more money? I know it varies by practice scope but lets say for a salaried position at an academic hospital.

I'm an MS3 and like many others, don't really have good grasp of the financial aspect of Medicine yet.

Some academic places monetize call so you can pick up extra by doing more work. Of course there are also academic places that pay quite well and others comparatively not so well.

 

[bala1]

Some academic places monetize call so you can pick up extra by doing more work. Of course there are also academic places that pay quite well and others comparatively not so well.

why would academic places monetize call when they dont have to?

 

[IlDestriero]

It allows for improved morale by allowing increased flexibility and an opportunity for increased income. It's also fair. Work more, do something extra, etc. you get paid.
We monetize after hours work and specialty calls (transplant, etc.) Some people are happy to work a bit less, others want the opportunity to earn more income by picking up extra shifts, etc.
Improved fairness and morale improve retention. It's all out in the open, no back room deals, and choosing to work less means someone has the opportunity to work more (and get paid for their effort). The faculty like it, and its net neutral on the balance sheet, so it's a big win. The only losers would be the older faculty that arranged "special" deals with the Chief. They're not fair anyway, so who cares.
Most of the faculty jobs I looked at did this one way or another to some degree.

 

[DannyB]

why would academic places monetize call when they dont have to?

Dude, just go away. You have absolutely no idea what you're talking about. This post proves it

 

[doctor712]

It allows for improved morale by allowing increased flexibility and an opportunity for increased income. It's also fair. Work more, do something extra, etc. you get paid.
We monetize after hours work and specialty calls (transplant, etc.) Some people are happy to work a bit less, others want the opportunity to earn more income by picking up extra shifts, etc.
Improved fairness and morale improve retention. It's all out in the open, no back room deals, and choosing to work less means someone has the opportunity to work more (and get paid for their effort). The faculty like it, and its net neutral on the balance sheet, so it's a big win. The only losers would be the older faculty that arranged "special" deals with the Chief. They're not fair anyway, so who cares.
Most of the faculty jobs I looked at did this one way or another to some degree.

Further to ID's point, I know places that monetize up to 5% of total faculty member salary dependent on not only call, but getting excellent resident and medical student reviews!!!! Do they have to? No. Get an MD/MBA as an Anesthesia Chairman and things like this are obvious...

D712

 

[bala1]

Dude, just go away. You have absolutely no idea what you're talking about. This post proves it

ok dude whatever!! Just ten years in practice. What are you a CA1? You just dont like my post. So just say you don't like my post, Don't say i dont know what im talking about. You re a ca1, youve got a long way to go. Hopefully, the market and the state of affairs will be better by the time you graduate. I doubt it but it may be. There is no reason for the academic programs to give their faculty the ability to make more money when they know they dont have to. The only reason they would is if they are having trouble recruiting. BUt the state of affairs now, you leave a job now, you may not find another one that fits your bill for a long while and the programs know that. Are there exceptions? Sure. But by and large the majority of programs pay you a flat salary of 200-275 and that includes x amount of calls. Period.

 

[mikey014]

I'm a 4th year applying to Anesthesia. I loved the field and I felt it has everything I was looking for. On the interview trail I found that it really had the happiest residents compared to the ones I saw on rotations. Actually, a lot of people switch into anesthesia after pursuing other competitive residencies (ObGyn/Surgery/ENT/Ophtho/etc.)

I think everyone above covered everything. But I think the one attending that posted his work schedule has a similar work schedule to what I've heard.

I think I might be at your school. PM me if you have any questions.

 

[IlDestriero]

Well I guess pretty much all of the programs that I looked at must have trouble recruiting, even though they're in desirable cities and pay more than Bala thinks is the norm. Who knew! We have many times more applicants than openings every year. Maybe that has something to do with that unnecessary fair compensation? Retention is high as well.
Perhaps, just maybe, the Chairmen want to be able to recruit the best applicants and retain their best faculty.

 

[bala1]

Well I guess pretty much all of the programs that I looked at must have trouble recruiting, even though they're in desirable cities and pay more than Bala thinks is the norm. Who knew! We have many times more applicants than openings every year. Maybe that has something to do with that unnecessary fair compensation? Retention is high as well.
Perhaps, just maybe, the Chairmen want to be able to recruit the best applicants and retain their best faculty.

Ok we get it, you are making a million dollars a year training residents. The chairman wants to be nice to you because he doesnt want you to leave. CMON dude. These med students are not THAT naive. The system has been treating them like crap for years. Chairman don't care about how residents feel, why all of a sudden will he start caring when you are faculty? IT is counterintuitive and not true.

 

[Silent Cool]

Ok we get it, you are making a million dollars a year training residents. The chairman wants to be nice to you because he doesnt want you to leave. CMON dude. These med students are not THAT naive. The system has been treating them like crap for years. Chairman don't care about how residents feel, why all of a sudden will he start caring when you are faculty? IT is counterintuitive and not true.

Anyway, back to the OP's question.......sheesh...enough with the pissing match already. I'm actually curious to know other people's opinions on the matter.

 

[gasattack3]

I'm in my second year and I'm coming around to the idea that anesthesiology may be the best fit amongst a few different specialties. I spent last summer doing research with an anesthesiology group and I liked a lot of what I saw:

Great variety of cases
No clinic
No follow-up/chronic care
Cool skill set and knowledge base
Immediacy of managing a case
Not too much diagnosis

As much as I liked the field, the hours that the residents and attendings worked were intimidating. Many would arrive at the hospital at 5:30/6 in the morning and not leave until 6 in the evening or later. Most people I encountered worked weekends regularly and took frequent call. I was working at a large academic hospital in a mid-size city in the Midwest and I'm not sure how reflective this type of schedule is for other anesthesiologists both during residency and after.

I'm wondering how much my aversion to long hours should factor into my decision about specialties. I understand that later in one's career it may be possible to choose jobs that are more flexible in terms of hours, but for now I will have a significant debt load and my flexibility immediately after residency in terms of finding a job may be more limited. From my experience, the anesthesiologists I encountered were working hours similar to surgeons, and I'm not sure I'm willing to commit to that type of lifestyle for the next decade.

Can anyone comment on how the hours/lifestyle in anesthesiology impacted their decision to enter the field? There are several other areas in medicine that I like slightly less, but seem to offer a much better work-life balance. I've tried reading through other threads on this topic, but I had a hard time finding much discussion on this particular issue. Any input would be great. Thanks

As a resident, you can find worse hours to be sure. Also as a resident, in any specialty, you just have to accept that you'll be working lots (and often odd i.e. holidays etc.) of hours.

Some PP group attendings probably work MORE hours than your average anesthesiology residency. Obviously, the compensation is hugely different, but keep that in mind. On the flip side, I'm sure you can find, as others have mentioned, a cush job in a surgicenter or endo suite (not sure our future is sustainable in endo suites but what do I know).

Highly variable. But, I really would not expect to make money in this field without working a lot of hours, having a good deal of stress and responsibility, and taking a good amount of call. Again, like others have stated, what you end up doing AFTER residency could be highly variable.

I can say that mid-way through my CA2 year in a fast paced, high volume, level I trauma hospital with lots of high acuity cases (can you avoid those these days???), this field is NOT for people looking for the easy route. There are WAY less stressful fields, in residency and out of residency.

That being said, again, if you're going to make money in medicine you need to work hard for it. Seems that would be obvious but it's worth stating/reiterating, I think.

I love the field for the crazy acuity we see. For the fast paced nature of it. Sure, some cases are "boring", but if you work at a decent sized hospital and take call, I'm positive you will have enough "excitement" to keep you stimulated in this field.

I think med students and residents even (less so for sure) perhaps can underappreciate what it's like as an attending in this specialty. Challenges will present themselves regularly, and often they are unanticipated (the examples are too numerous to list). Can you get through residency if you're not an assertive type? Not a go-getter? Someone more meek and mild? Yeah, I think you can. Your attendings will just baby-sit you more as that aspect of your personality becomes known to, well, all. You'll get through your difficult subspecialty months. You'll get through your call nights. You can probably even try (with reasonable success) to avoid larger cases, or just never volunteer for them/let others do them..... Probably, though, those types would be destined to lower acuity jobs in PP OR those are the attendings that nobody really likes working with since they are no help or freak out when things go bad.

BUT, to be good, don't think this field doesn't take some serious intesitnal fortitude.

Just some thoughts after coming off of some very challenging cases in which everything didn't go super smoothly or as planned (do they ever?? LOL). It's fun though, if you dig that type of thing.

 

[IlDestriero]

I'm wondering how much my aversion to long hours should factor into my decision about specialties. I understand that later in one's career it may be possible to choose jobs that are more flexible in terms of hours, but for now I will have a significant debt load and my flexibility immediately after residency in terms of finding a job may be more limited. From my experience, the anesthesiologists I encountered were working hours similar to surgeons, and I'm not sure I'm willing to commit to that type of lifestyle for the next decade.

Can anyone comment on how the hours/lifestyle in anesthesiology impacted their decision to enter the field? There are several other areas in mGgedicine that I like slightly less, but seem to offer a much better work-life balance. I've tried reading through other threads on this topic, but I had a hard time finding much discussion on this particular issue. Any input would be great. Thanks

One of the advantages of anesthesia is the diversity of jobs that you can find if you go looking and are flexible on where you live.
Want to work in an ASC 7-4 M-F or a gig that gets you out by 3? It's there.
Eat what you kill work like a dog and grab that loot. You're good.
Split a position with another part time MD. You can find one if you look long and hard.
Do your own cases, teach residents and fellows, research, bust your hump covering 4 rooms with CRNAs. Whatever you want.
6 weeks vacation, 12 weeks, more? One call a week, one a month, none?
Frequent high acuity cases, hearts, transplant, none? Whatever you want.
One fairly universal truth, even in academics, is that the more you work, the more that the job pays. You could start out at a high dollar job working hard and pay down your debt and then move to a position with a better lifestyle. The world is your oyster, unless you're severely geographically limited.
Residency +/- fellowship will probably be 60-80 hours wherever you go, there's no way around that. You also work when the surgeons work. That's the job.

 

[gasattack3]

One of the advantages of anesthesia is the diversity of jobs that you can find if you go looking and are flexible on where you live.
Want to work in an ASC 7-4 M-F or a gig that gets you out by 3? It's there.
Eat what you kill work like a dog and grab that loot. You're good.
Split a position with another part time MD. You can find one if you look long and hard.
Do your own cases, teach residents and fellows, research, bust your hump covering 4 rooms with CRNAs. Whatever you want.
6 weeks vacation, 12 weeks, more?
One fairly universal truth, even in academics, is that the more you work, the more that the job pays. You could start out at a high dollar job working hard and pay down your debt and then move to a position with a better lifestyle. The world is your oyster, unless you're severely geographically limited.
Residency +/- fellowship will probably be 60-80 hours wherever you go, there's no way around that. You also work when the surgeons work. That's the job.

 

[BLADEMDA]

One of the advantages of anesthesia is the diversity of jobs that you can find if you go looking and are flexible on where you live.
Want to work in an ASC 7-4 M-F or a gig that gets you out by 3? It's there.
Eat what you kill work like a dog and grab that loot. You're good.
Split a position with another part time MD. You can find one if you look long and hard.
Do your own cases, teach residents and fellows, research, bust your hump covering 4 rooms with CRNAs. Whatever you want.
6 weeks vacation, 12 weeks, more? One call a week, one a month, none?
Frequent high acuity cases, hearts, transplant, none? Whatever you want.
One fairly universal truth, even in academics, is that the more you work, the more that the job pays. You could start out at a high dollar job working hard and pay down your debt and then move to a position with a better lifestyle. The world is your oyster, unless you're severely geographically limited.
Residency +/- fellowship will probably be 60-80 hours wherever you go, there's no way around that. You also work when the surgeons work. That's the job.

For those that want an ER type of job working for a management company or a hospital at around $300K this specialty is fine.

For others who want to maximize their time and productivity based on skill and business savy this fied is a poor choice. In the end, most of you have little business experience and no real world understanding of medicine/economics so you will choose to do what you want anyway.

Just remember in the past 36 months more practices have sold out to management companies or folded up to become hospital employees that at any other time in the history of the specialty. I see that trend continuing for the next 5 years until the few remaining private practices are the exception rather than the norm.

 

[EtherBunny]

For those that want an ER type of job working for a management company or a hospital at around $300K this specialty is fine.

For others who want to maximize their time and productivity based on skill and business savy this fied is a poor choice. In the end, most of you have little business experience and no real world understanding of medicine/economics so you will choose to do what you want anyway.

Just remember in the past 36 months more practices have sold out to management companies or folded up to become hospital employees that at any other time in the history of the specialty. I see that trend continuing for the next 5 years until the few remaining private practices are the exception rather than the norm.

The rising tide of hospital employment at the expense of private practices is a disturbing trend. I'm definitely opposed to this model of practice for a variety of reasons (which I won't go into now). However, I'm not convinced that this model of care is sustainable in the long term.

The fundamental problem is that hospitals are becoming the equivalent of large corporations. In effect, hospital systems are creating monopolies, and the cost of health care in these markets is rising as a result. The mechanism of this rise in cost is simple: large hospital systems, by virtue of their disproportionate market share, have more leverage with third party payers than physicians in solo or small group practices when it comes to negotiating fee schedules. Hence the ridiculous difference in price for procedures that are performed at hospitals (e.g., transforaminal steroid injections) as opposed to ASCs or private offices.

I can't imagine that patients and physicians will continue to support these mega-hospitals, when the overall result is lower pay for physicians, higher insurance premiums for patients, and no positive change in the overall quality of care.

Hospital employment isn't good for physicians and it isn't good for patients. I don't see this model sticking around for very long.

 

[bala1]

As a resident, you can find worse hours to be sure. Also as a resident, in any specialty, you just have to accept that you'll be working lots (and often odd i.e. holidays etc.) of hours.

Some PP group attendings probably work MORE hours than your average anesthesiology residency. Obviously, the compensation is hugely different, but keep that in mind. On the flip side, I'm sure you can find, as others have mentioned, a cush job in a surgicenter or endo suite (not sure our future is sustainable in endo suites but what do I know).

Highly variable. But, I really would not expect to make money in this field without working a lot of hours, having a good deal of stress and responsibility, and taking a good amount of call. Again, like others have stated, what you end up doing AFTER residency could be highly variable.

I can say that mid-way through my CA2 year in a fast paced, high volume, level I trauma hospital with lots of high acuity cases (can you avoid those these days???), this field is NOT for people looking for the easy route. There are WAY less stressful fields, in residency and out of residency.

That being said, again, if you're going to make money in medicine you need to work hard for it. Seems that would be obvious but it's worth stating/reiterating, I think.

I love the field for the crazy acuity we see. For the fast paced nature of it. Sure, some cases are "boring", but if you work at a decent sized hospital and take call, I'm positive you will have enough "excitement" to keep you stimulated in this field.

I think med students and residents even (less so for sure) perhaps can underappreciate what it's like as an attending in this specialty. Challenges will present themselves regularly, and often they are unanticipated (the examples are too numerous to list). Can you get through residency if you're not an assertive type? Not a go-getter? Someone more meek and mild? Yeah, I think you can. Your attendings will just baby-sit you more as that aspect of your personality becomes known to, well, all. You'll get through your difficult subspecialty months. You'll get through your call nights. You can probably even try (with reasonable success) to avoid larger cases, or just never volunteer for them/let others do them..... Probably, though, those types would be destined to lower acuity jobs in PP OR those are the attendings that nobody really likes working with since they are no help or freak out when things go bad.

BUT, to be good, don't think this field doesn't take some serious intesitnal fortitude.

Just some thoughts after coming off of some very challenging cases in which everything didn't go super smoothly or as planned (do they ever?? LOL). It's fun though, if you dig that type of thing.

Finally Someone who paid his brain bill!!! and a resident no less

 

[bala1]

One of the advantages of anesthesia is the diversity of jobs that you can find if you go looking and are flexible on where you live.
Want to work in an ASC 7-4 M-F or a gig that gets you out by 3? It's there.
Eat what you kill work like a dog and grab that loot. You're good.
Split a position with another part time MD. You can find one if you look long and hard.
Do your own cases, teach residents and fellows, research, bust your hump covering 4 rooms with CRNAs. Whatever you want.
6 weeks vacation, 12 weeks, more? One call a week, one a month, none?
Frequent high acuity cases, hearts, transplant, none? Whatever you want.
One fairly universal truth, even in academics, is that the more you work, the more that the job pays. You could start out at a high dollar job working hard and pay down your debt and then move to a position with a better lifestyle. The world is your oyster, unless you're severely geographically limited.
Residency +/- fellowship will probably be 60-80 hours wherever you go, there's no way around that. You also work when the surgeons work. That's the job.

I hate to sound like im busting your balls but how many jobs have you actually looked for? It is not as easy as you think. True, all those kind of positions are available at some point in time but not all at once and certainly not anywhere near each other geographically . What im driving at is YOU ARE NOT IN CONTROL of how and when you work, someone else is.Ive been doing 1099 coverage for 10 years. ive done it all. Ive done my own cases in level one trauma centers.. sick sick patients and nobody to relieve you EVER. ive done supervision type work, Ive done all endo work for a full year. No days off sedating endos in a basement office with propofol and no sux. It is NOT CUSH. But in all scenarios they were never part time, I never had any choices of my days off.ive done hospital endo work which is worse than office endo because everyone is ****ing bleeding. Don't think you can have it the way you want as if you are a famous ent surgeon. cuz thats not the way it works in anesthesia.

 

[IlDestriero]

one of the advantages of anesthesia is the diversity of jobs that you can find if you go looking and are flexible on where you live...
The world is your oyster, unless you're severely geographically limited...
You also work when the surgeons work. That's the job.

See above. Geographic flexibility is so important that I noted it twice.
All of those arrangements are available all the time somewhere, with the exception of the half time job share. But, I've seen that as well more than once.
To answer your question, I've interviewed 4 times over ~15 years of doing anesthesia and looked at a dozen or more jobs each time. The majority of the jobs that I've looked at were not advertised anywhere. I've also been contacted about at least 6 positions over the last 2 years alone, and I don't mean recruiter cold calls, and looked onto several more that I heard were looking that sounded interesting. The advantage I have is some freedom of geographic limitations. Of course, I would not work in many, many places, and have several strong preferences. My wife has a significant career as well, so that's also in play, more now than before. But she has a very marketable skill set and could/has moved when it suited us. You need to go to meetings, keep in touch with old colleagues, work your contacts, alumni network, etc. People are always expanding, moving, retiring, etc. Nobody uses gas work. It's on you to keep your finger on the pulse. I like my job, it's fair, the location suits my family and is considered desirable, but I'm always interested in what else is out there. I would move for the right opportunity.
If you have to take sub optimal, no sux shady basement jobs, you either are a masochist, severely geographically limited to a desirable area (SoCal/LA?) or have black marks on your record limiting your options, or all three. I'll tell you the same thing I've told many others, bide your time, buff your CV, line up a couple references, start calling everywhere you want to live, and get a better job. Unless you really like it, but your constantly down on anesthesia, so I doubt it.
With a decade of various jobs under your belt you should have the skill set to easily get a job before any resident on the market. And they all get jobs. Even the weak ones.

 

[bala1]

With a decade of various jobs under your belt you should have the skill set to easily get a job before any resident on the market. And they all get jobs. Even the weak ones.

I take what is available for 1099 work. I don't do w-2. Never will. So I end up working at messed up places. But they are all messed up. Academic jobs are probably cush but they dont pay anything. If i recall you are a peds cardiac guy. Of course you will get phone calls more than a reg ole general guy. I have no black marks against me and as brash as i come across on sdn ive never had a problem and people love working with me because i am competent. BUt, I ask questions, and once those questions start to reveal the scam that people are running they probably would be more interested in the new grad. Of course. THey are not boarded yet and thats a reason to take them for a ride they thing . Be careful guys. You think i have a grim outlook? yes i do. I have seen people's intentions. You think your chairman gives a rats arse about you? Think again.

 

[deleted126335]

See above. Geographic flexibility is so important that I noted it twice.
All of those arrangements are available all the time somewhere, with the exception of the half time job share. But, I've seen that as well more than once.
To answer your question, I've interviewed 4 times over ~15 years of doing anesthesia and looked at a dozen or more jobs each time. The majority of the jobs that I've looked at were not advertised anywhere. I've also been contacted about at least 6 positions over the last 2 years alone, and I don't mean recruiter cold calls, and looked onto several more that I heard were looking that sounded interesting. The advantage I have is some freedom of geographic limitations. Of course, I would not work in many, many places, and have several strong preferences. My wife has a significant career as well, so that's also in play, more now than before. But she has a very marketable skill set and could/has moved when it suited us. You need to go to meetings, keep in touch with old colleagues, work your contacts, alumni network, etc. People are always expanding, moving, retiring, etc. Nobody uses gas work. It's on you to keep your finger on the pulse. I like my job, it's fair, the location suits my family and is considered desirable, but I'm always interested in what else is out there. I would move for the right opportunity.
If you have to take sub optimal, no sux shady basement jobs, you either are a masochist, severely geographically limited to a desirable area (SoCal/LA?) or have black marks on your record limiting your options, or all three. I'll tell you the same thing I've told many others, bide your time, buff your CV, line up a couple references, start calling everywhere you want to live, and get a better job. Unless you really like it, but your constantly down on anesthesia, so I doubt it.
With a decade of various jobs under your belt you should have the skill set to easily get a job before any resident on the market. And they all get jobs. Even the weak ones.

Agree with most. Especially geographic flexibility. At some point we all believed that we are entitled to live in the metro area that we want and that it should have positions that are comparable to BFE. It is just not the case. In fairness though the pickings have been a lot easier up until about 2-3 yers ago.

 

[Airzonk]

As a very unhappy CA2 anesthesia resident i can tell you this is a dead field. Go into ortho or neuro spine spine and you will have the world at your fingertips. If you enjoy freezing in a room for hours on end often forgotten about and with so very little respect then anesthesia is awesome. No relief, no real didactics, no outside world to speak of then anesthesia is amazing. Do you save a life every now and then of course. Are you an accessory to a surgeon's murder absolutely. Will attending life be any better? Absolutely not. There are so many other fields of medicine where you may be able to appreciate life. Clearly money is not everything and in our field and in the future may well be nothing. 250,000 in loans for a job CRNA's do, good luck. What an aweful job. I dream of leaving everyday. I can tell you Peds may be ok. Cardiac tough and the CT surgeons horrible. Transplant stressful with not much reward other than the chief of transplant surgery being ridiculous. Regional maybe some success there. Pain, who knows. OB, very rewarding somewhat stable but again those few VERY aweful OB/GYN's who clearly should have not been physicians or stuck to somewthing basic in medschool will haunt you forever. I should say something positive so here goes. ICU, who does a fellowship for less pay than you make currently? Probably smart people who know it will pay better it the future, be more rewarding and get you out of monkey general OR. You could be considered a very good glorified paramedic and you are going to be much better than an emergency medicine physician in so many ways. The dinosaurs of anesthesia (those who SOLD US OUT) are slowly leaving replaced by a much more motivated much smarter younger crowd. CRNA's in some states (my current state) are mostly irrelevant and do the very very mudane procedural rooms. Things may get better but probably will not. You will have valuable skills and will often be called upon to do them granted you don't become complacent. In the end i'm pretty sure I will not be able to repay my loans and will have to default or live as a pauper. We are the new middle class. I have an EU passport and am willing to accept middle class but I suspect most will not.

 

[Airzonk]

Sorry, but I should respond to the posters questions regarding hours. I was a surgical resident before anesthesia and I can tell you my hours are worse I just don't report them as so. On cardiac I wake up 4:30am and arrive by 5:15 to set up my room in NYC our hospital does not employ techs qualified to set up the 4 line transducer set, zero them properly have an adequate TEE in the room or the basic "cardiac set up". I am a nurse in every regard. I make the drugs. Check the maching. enable the TEE machine and enter the patient data. I set up the basic intubation equipment, make sure no cables are touching the floor etc.., etc.., On peds make all the Baer tralls for like 7 to 8 cases all the drugs etc.,,. Did more endo in my first years than a CRNA in an endoscopy center. Set up everything no "techs" there. I wont refer to them as techs anymore other than people that show up and do not much. What else general OR's 8am start 630am didactics up at 530 am, miss didactics because the techs are not helpful. Get reprimanded for miss important 630am conference??? while i set up because surgeon wants block in by 0700. I could go on but anesthesia sucks and puts on a huge front in so many ways in this regard. BTW surgeons will always win. Have fun with anesthesia residency. Disclaimer does not apply to attendings who went through this and don't care anymore and will not change the culture.

 

[p30doc]

Wow.



What program are you at?

 

[Airzonk]

A "good program" good luck interviewing

 

[C5toC9]

Most depressing post I've read in a while

 

[San Marzano]

A "good program" good luck interviewing

It looks like you didn't match into your program as an M4 but rather secured a position while doing a prelim surgery year, based on your post history. Just curious as to why you ended up in that situation?

 

[IlDestriero]

Sounds like your program sucks. Too bad. They're not all that bad.
Our techs set up everything fine. But can't touch the meds. wouldn't want them to.
It gets better. You're not too far in to quit and do something else

 

[Airzonk]

typical reply

 

[pgg]

Airzonk, all residencies suck, and it sounds like yours sucks a lot more than most.

typical reply

That doesn't make anything he wrote untrue. If you're determined to be miserable, you'll succeed.

 

[Consigliere]

Airzonk is RIGHT ON with his comments. I wish I could hire that kid when he finished, but I think he'll move on to something else.

My man, we'd sit around and bitch about the sorry, sad state that anesthesia is in like I do with one of my buddies. No joke - damn near every day we talk about just how much this field blows. Every day I wake up, scream "F-UCK!!" so loudly that they hear me on Mars, then give myself the usual "you can do this, you can get through the day" self affirming speech on the way to work. Not everyone feels this way but a helluva lot do. The rarified few on SDN who "love anesthesia" are the exception rather than the norm. In the real world and not the fantasy land of SDN you'll see that most anesthesiologists DESPISE their job.

Kudos for recognizing this and having the guts to post it here! That's just the cat's as-s, brah. You got nuts and I'm sorry to see that you've had the misfortune of choosing such a punked out speciality. I'd say "well, at least you'll make a lot of money" but that would be yet another lie.

 

[Per4mer8]

Misery loves company....

I myself have met perhaps 2 unhappy anesthesiologists. Compare that to (anecdotally) much higher %'s (50+%??) of hospitalists, surgeons, EM docs.....

 

[chudat]

definitely one of the more depressing posts I read in a while, hope everything goes well for you.

 

[deleted126335]

Sorry, but I should respond to the posters questions regarding hours. I was a surgical resident before anesthesia and I can tell you my hours are worse I just don't report them as so. On cardiac I wake up 4:30am and arrive by 5:15 to set up my room in NYC our hospital does not employ techs qualified to set up the 4 line transducer set, zero them properly have an adequate TEE in the room or the basic "cardiac set up". I am a nurse in every regard. I make the drugs. Check the maching. enable the TEE machine and enter the patient data. I set up the basic intubation equipment, make sure no cables are touching the floor etc.., etc.., On peds make all the Baer tralls for like 7 to 8 cases all the drugs etc.,,. Did more endo in my first years than a CRNA in an endoscopy center. Set up everything no "techs" there. I wont refer to them as techs anymore other than people that show up and do not much. What else general OR's 8am start 630am didactics up at 530 am, miss didactics because the techs are not helpful. Get reprimanded for miss important 630am conference??? while i set up because surgeon wants block in by 0700. I could go on but anesthesia sucks and puts on a huge front in so many ways in this regard. BTW surgeons will always win. Have fun with anesthesia residency. Disclaimer does not apply to attendings who went through this and don't care anymore and will not change the culture.

That describes the tougher rotations on my residency as well 25 years ago. We got up extra early on the days we had early am didactics.

The difference is that I really enjoyed the good things about the specialty and was optimistic about my future. Anesthesia still promised a good life if you were capable, followed all the rules and worked hard. That promise no longer exists.

Also it's winter and dark and you are just at the halfway point of your training. Some of your attendings do care but are powerless to affect change for you or for themselves.

Good luck.

 

[EtherBunny]

Airzonk really isn't that far off base. Anesthesiology isn't a great choice for graduating medical students these days. 10 years from now? Maybe. But right now, things aren't looking very good for the specialty as a whole.

The midlevel encroachment issue gets worse every year (more states opting out, despite the best efforts of the ASA to oppose this legislation. Now CMS will pay CRNAs who practice interventional pain the same amount as a fellowship trained pain doctor, which is ridiculous but true. All MD practices are losing their contracts with some institutions in favor of all CRNA groups, especially in low acuity settings such as ASCs).

Hospital subsidies for anesthesiologists are being phased out which will translate into a significant reduction in compensation for many anesthesiologists.

Anesthesiologists don't have very much power and leverage in hospitals because we don't have any patients of our own. We don't bring any business to the hospital. We're essentially facilitators. No patients means no power in this era. Hospitals are very focused on the bottom line and the ORs are the profit centers of hospitals. This is why surgeons have so much power. They have patients and they generate tons of revenue for hospitals. This is not the case for anesthesiologists.

ObamaCare is a potential disaster for the field if Medicare rates for anesthesiology become the norm for private insurers, because Medicare reimbursement for anesthesia is disproportionately abysmal for anesthesia when compared to other medical and surgical services.

The job market for graduating anesthesiologists has contracted significantly, especially when you compare the current job market to that of the early 2000s. Partnership tracks are either protracted or not offered at all. It's very difficult to even find a job in desirable areas in the coasts--even for fellowship trained guys--unless you have connections in those areas. Starting pay has dropped.

I typically advise med students to go into surgical subspecialties. It's a much safer route these days--always will be. Surgical subspecialties are relatively recession proof (with the exception of cosmetic plastics practices) and immune to midlevel encroachment. The job market is wide open for surgeons, even in highly desirable locations. Prestige, high pay, excellent job security, and reasonable hours in private practice. Tough to beat that combo. Anesthesiology doesn't have any of those qualities, except for high pay in certain practice settings.

Buyer beware with anesthesiology.

 

[DannyB]

Sorry, but I should respond to the posters questions regarding hours. I was a surgical resident before anesthesia and I can tell you my hours are worse I just don't report them as so. On cardiac I wake up 4:30am and arrive by 5:15 to set up my room in NYC our hospital does not employ techs qualified to set up the 4 line transducer set, zero them properly have an adequate TEE in the room or the basic "cardiac set up". I am a nurse in every regard. I make the drugs. Check the maching. enable the TEE machine and enter the patient data. I set up the basic intubation equipment, make sure no cables are touching the floor etc.., etc.., On peds make all the Baer tralls for like 7 to 8 cases all the drugs etc.,,. Did more endo in my first years than a CRNA in an endoscopy center. Set up everything no "techs" there. I wont refer to them as techs anymore other than people that show up and do not much. What else general OR's 8am start 630am didactics up at 530 am, miss didactics because the techs are not helpful. Get reprimanded for miss important 630am conference??? while i set up because surgeon wants block in by 0700. I could go on but anesthesia sucks and puts on a huge front in so many ways in this regard. BTW surgeons will always win. Have fun with anesthesia residency. Disclaimer does not apply to attendings who went through this and don't care anymore and will not change the culture.

You're at a crappy program, there's really no way around that

 

[Dwindlin]

Misery loves company....

I myself have met perhaps 2 unhappy anesthesiologists. Compare that to (anecdotally) much higher %'s (50+%??) of hospitalists, surgeons, EM docs.....

This has been my experience as well, and I'm not surrounded by academic anesthesiologists, my school doesn't have an anesthesia program, all the hospitals here are 100% private practice.

 

[Gern Blansten]

On peds make all the Baer tralls for like 7 to 8 cases

Buretrol?

 

[countingdays]

Airzonk really isn't that far off base. Anesthesiology isn't a great choice for graduating medical students these days. 10 years from now? Maybe. But right now, things aren't looking very good for the specialty as a whole.

The midlevel encroachment issue gets worse every year (more states opting out, despite the best efforts of the ASA to oppose this legislation. Now CMS will pay CRNAs who practice interventional pain the same amount as a fellowship trained pain doctor, which is ridiculous but true. All MD practices are losing their contracts with some institutions in favor of all CRNA groups, especially in low acuity settings such as ASCs).

Hospital subsidies for anesthesiologists are being phased out which will translate into a significant reduction in compensation for many anesthesiologists.

Anesthesiologists don't have very much power and leverage in hospitals because we don't have any patients of our own. We don't bring any business to the hospital. We're essentially facilitators. No patients means no power in this era. Hospitals are very focused on the bottom line and the ORs are the profit centers of hospitals. This is why surgeons have so much power. They have patients and they generate tons of revenue for hospitals. This is not the case for anesthesiologists.

ObamaCare is a potential disaster for the field if Medicare rates for anesthesiology become the norm for private insurers, because Medicare reimbursement for anesthesia is disproportionately abysmal for anesthesia when compared to other medical and surgical services.

The job market for graduating anesthesiologists has contracted significantly, especially when you compare the current job market to that of the early 2000s. Partnership tracks are either protracted or not offered at all. It's very difficult to even find a job in desirable areas in the coasts--even for fellowship trained guys--unless you have connections in those areas. Starting pay has dropped.

I typically advise med students to go into surgical subspecialties. It's a much safer route these days--always will be. Surgical subspecialties are relatively recession proof (with the exception of cosmetic plastics practices) and immune to midlevel encroachment. The job market is wide open for surgeons, even in highly desirable locations. Prestige, high pay, excellent job security, and reasonable hours in private practice. Tough to beat that combo. Anesthesiology doesn't have any of those qualities, except for high pay in certain practice settings.

Buyer beware with anesthesiology.

Read this med students

 

[Stellar Clouds]

I typically advise med students to go into surgical subspecialties. It's a much safer route these days--always will be. Surgical subspecialties are relatively recession proof (with the exception of cosmetic plastics practices) and immune to midlevel encroachment. The job market is wide open for surgeons, even in highly desirable locations. Prestige, high pay, excellent job security, and reasonable hours in private practice. Tough to beat that combo. Anesthesiology doesn't have any of those qualities, except for high pay in certain practice settings.

Buyer beware with anesthesiology.

Could you explain to me how a surgeon has better hours than an anesthesiologist?

 

[Surgerizer]

Could you explain to me how a surgeon has better hours than an anesthesiologist?

Residency is brutal for surgical fields across the board, especially for junior surgical residents. No question about that.

Life AFTER residency, however, is a different story. In general, surgical subspecialists can have a reasonable lifestyle after residency. Some examples...

Neurosurgery: I know this sounds crazy, but neurosurgeons can have a pretty good lifestyle after residency if they choose wisely. Neurosurgeons that avoid level 1 trauma centers and focus on spine can have a practice that almost exclusively consists of elective cases. Spine emergencies are relatively rare (spinal cord compression, etc.) so ER call for spine surgeons isn't bad at all. Cranial call, on the other hand, can be an absolute nightmare with subarachnoid bleeds, subdurals, tumors...I know many neurosurgeons in private practice around the country (Washington State, NYC, Los Angeles, Georgia, Michigan) that work roughly 40-55 hours per week with easy call (i.e., being called in from home maybe once per year). Their income ranges from $500,000 to $1,200,000 annually. All of these people have practices that are exclusively (or heavily) spine. One guy in particular just joined Kaiser in California, where he is employed as a spine surgeon. He makes $500,000 annually for 40 hours of work per wek. That's roughly TWICE what an anesthesiologist at Kaiser makes when he/she starts working there, despite the fact that both will work the same number of hours weekly. Neurosurgery has a reputation for being absolutely horrible when it comes to lifestyle, but the reality is that MANY neurosurgeons in private practice have very reasonable schedules. Residency, on the other hand...

Otolaryngology: The average otolaryngologist works ~50 hours per week and pulls over $400K annually. The beauty of this field is that you can tailor your practice to what suits you. If you don't want the headache (and crappy hours) of dealing with head and neck cancer patients, you can focus on bread and butter ENT (tubes, tonsils, etc.) and work 4 1/2 days per week, leaving the OR around 3 PM on your operative days. Facial plastics, otology, laryngology, and sinus subspecialists have FANTASTIC schedules. No emergencies to speak of, good pay, and great job security. The other cool thing about ENT is that older docs can scale back on their operative time as they get closer to retirement and just do clinic stuff, which is very predictable (9-4 every day). I'm sure you've heard the saying "ENT stands for early nights and tennis." This field definitely lends itself to a reasonable lifestyle after residency.

Ophthalmology: Probably the cushest of all surgical subspecialties. These guys--once they have an established practice--can work 4 1/2 days a week with no nights, no weekends, and no ER call. And they can pull in over $400K annually, in many cases over $500K. Not bad for a specialty that has a high impact on patients' quality of life (hard to argue with the overall value of restoring clear vision), low acuity, and low stress.

Plastic surgery: Brutal residency but life after residency can be really sweet. I won't go into the details here, because I'm sure you're well aware of the perks of plastic surgery. These guys have it pretty good after residency.

Other surgical subspecialties with reasonable lifestyles:

Urology
Surgical oncology
Endocrine surgery
Orthopaedics (more variable but there are definitely many orthopaedic surgeons with good hours and crazy high pay)

The truth of the matter is that surgical sub specialists often enjoy higher prestige, higher pay, better hours, more job opportunities, and higher job security than anesthesiologists.

Nothing trumps derm, though.

 

[Stellar Clouds]

Residency is brutal for surgical fields across the board, especially for junior surgical residents. No question about that.

Life AFTER residency, however, is a different story. In general, surgical subspecialists can have a reasonable lifestyle after residency. Some examples...

Neurosurgery: I know this sounds crazy, but neurosurgeons can have a pretty good lifestyle after residency if they choose wisely. Neurosurgeons that avoid level 1 trauma centers and focus on spine can have a practice that almost exclusively consists of elective cases. Spine emergencies are relatively rare (spinal cord compression, etc.) so ER call for spine surgeons isn't bad at all. Cranial call, on the other hand, can be an absolute nightmare with subarachnoid bleeds, subdurals, tumors...I know many neurosurgeons in private practice around the country (Washington State, NYC, Los Angeles, Georgia, Michigan) that work roughly 40-55 hours per week with easy call (i.e., being called in from home maybe once per year). Their income ranges from $500,000 to $1,200,000 annually. All of these people have practices that are exclusively (or heavily) spine. One guy in particular just joined Kaiser in California, where he is employed as a spine surgeon. He makes $500,000 annually for 40 hours of work per wek. That's roughly TWICE what an anesthesiologist at Kaiser makes when he/she starts working there, despite the fact that both will work the same number of hours weekly. Neurosurgery has a reputation for being absolutely horrible when it comes to lifestyle, but the reality is that MANY neurosurgeons in private practice have very reasonable schedules. Residency, on the other hand...

Otolaryngology: The average otolaryngologist works ~50 hours per week and pulls over $400K annually. The beauty of this field is that you can tailor your practice to what suits you. If you don't want the headache (and crappy hours) of dealing with head and neck cancer patients, you can focus on bread and butter ENT (tubes, tonsils, etc.) and work 4 1/2 days per week, leaving the OR around 3 PM on your operative days. Facial plastics, otology, laryngology, and sinus subspecialists have FANTASTIC schedules. No emergencies to speak of, good pay, and great job security. The other cool thing about ENT is that older docs can scale back on their operative time as they get closer to retirement and just do clinic stuff, which is very predictable (9-4 every day). I'm sure you've heard the saying "ENT stands for early nights and tennis." This field definitely lends itself to a reasonable lifestyle after residency.

Ophthalmology: Probably the cushest of all surgical subspecialties. These guys--once they have an established practice--can work 4 1/2 days a week with no nights, no weekends, and no ER call. And they can pull in over $400K annually, in many cases over $500K. Not bad for a specialty that has a high impact on patients' quality of life (hard to argue with the overall value of restoring clear vision), low acuity, and low stress.

Plastic surgery: Brutal residency but life after residency can be really sweet. I won't go into the details here, because I'm sure you're well aware of the perks of plastic surgery. These guys have it pretty good after residency.

Other surgical subspecialties with reasonable lifestyles:

Urology
Surgical oncology
Endocrine surgery
Orthopaedics (more variable but there are definitely many orthopaedic surgeons with good hours and crazy high pay)

The truth of the matter is that surgical sub specialists often enjoy higher prestige, higher pay, better hours, more job opportunities, and higher job security than anesthesiologists.

Nothing trumps derm, though.

Wow...that's very interesting about neurosurgery. I've always been under the impression that they continue to bust their tails off after residency. Thanks for the very detailed post.