Choosing Anesthesiology

[gasattack3]

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guys, let's keep this in perspective. sure, our specialty has it's challenges. it will change. some for the worse, and some for the better.

we are a service profession. as such, we cater to our customers (namely surgeons). it's just the way it is. as such, our hours are not ours, per se. if you know this, then you won't be suprised. just as the dude who owns a furniture store isn't suprised he's working weekends and into the holidays.

the bottom line is that our profession gets to do some cools stuff, which is absolutely necessary for others to do THEIR jobs. our skillset is indeed very valuable. don't underestimate this, and we ALL owe it to ourselves and the future of the specialty to find a better way of dealing with CRNA's. Maybe we evaluate different business models or something.

 

[BLADEMDA]

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.

Retina specialists clear $750K and average 40 hours a week. Neurosurgeons can easily earn over $1.5 million if they work 55 hours a week. Don't forget Ortho spine which is usaliy $700K in private practice.

Yes, ENT does earn $400K wth litte call and a far better lifestyle than Anesthesiology. Anesthesiology ends up like ER as an employee of a hospital. ASCs are going to CRNAs or employed Anesthsiologists as well.

 

[Somnus Tuto]

Retina specialists clear $750K and average 40 hours a week. Neurosurgeons can easily earn over $1.5 million if they work 55 hours a week. Don't forget Ortho spine which is usaliy $700K in private practice.

Yes, ENT does earn $400K wth litte call and a far better lifestyle than Anesthesiology. Anesthesiology ends up like ER as an employee of a hospital. ASCs are going to CRNAs or employed Anesthsiologists as well.

And easily 1.5x - 2x that if they're head/Neck, but with a much worse lifestyle

 

[Somnus Tuto]

$$$ factors notwithstanding, I'll choose Anesthesia again any day.

 

[BLADEMDA]

$$$ factors notwithstanding, I'll choose Anesthesia again any day.

Just as some choose ER. Good luck

 

[IlDestriero]

You guys are posting this stuff like it's news. Surgical specialists can make bank, well over $1m/year if you want to bust your hump, limitless if you own your own center, etc.
I could have done anything I wanted, and I did. I like what I do, the diversity of cases, environment, no clinic, applied critical care, no clinic (worth mentioning twice), etc. It's not for everyone. You can't make your own hours, take Wed off, etc. If you want that kind of job you have to go find it and move there. Want you're ego stoked, love letters from happy patients, etc. it ain't gonna happen in gas.
If you're looking for a giant pot of gold, surgical subspecialization was always the answer. Go do that.

 

[wjs010]

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.

where are you located if you dont mind me asking? As I prepare to apply to med school, I often think about what I will be most interested in. I refuse to glorify any specialty, since it would be ignorant to do so, but I do daydream about "how its gonna be"alot. It's interesting to see your post, because I heard gas is the way to go for lifestyle. I have had the fortune of befriending a nearly 60 year old ( but really cool) anethesiologist who I frequently see at the gym. He is a rare case ( i guess) because he seems to love his job. He NEVER talks bad about anesthesiology's current state, or future state for that matter. I even try to nudge him into doing so by bringing up topics like CRNA takeover, medicare, and the impending salary cuts, but no dice. He always tells me that he enjoys his job. Possibly, it is because he works a 2 week off/2 week on call schedule, and he was a working physician at the time that gas docs were making a killing( several years ago right?) Maybe he is the last one of his kind, and the future gas docs will be miserable ..IDK. All I know is, my brother recently finished his surgery residency, and for him, it seemed like 5 years of pure hell. I guess your job is really what you make of it ( or atleast for the most part)...

I hope the guys who hate their job start liking it again somehow.

 

[Stellar Clouds]

You guys are posting this stuff like it's news. Surgical specialists can make bank, well over $1m/year if you want to bust your hump, limitless if you own you're own center, etc.
I could have done anything I wanted, and I did. I like what I do, the diversity of cases, environment, no clinic, applied critical care, no clinic (worth mentioning twice), etc. It's not for everyone. You can't make your own hours, take Wed off, etc. If you want that kind of job you have to go find it and move there. Want you're ego stoked, love letters from happy patients, etc. it ain't gonna happen in gas.
If you're looking for a giant pot of gold, surgical subspecialization was always the answer. Go do that.

You are clearly much further in your career than me, but I'm choosing anesthesia with the same mindset. Day-to-day, I think I will be way happier practicing anesthesia than any other specialty.

 

[gasattack3]

where are you located if you dont mind me asking? As I prepare to apply to med school, I often think about what I will be most interested in. I refuse to glorify any specialty, since it would be ignorant to do so, but I do daydream about "how its gonna be"alot. It's interesting to see your post, because I heard gas is the way to go for lifestyle. I have had the fortune of befriending a nearly 60 year old ( but really cool) anethesiologist who I frequently see at the gym. He is a rare case ( i guess) because he seems to love his job. He NEVER talks bad about anesthesiology's current state, or future state for that matter. I even try to nudge him into doing so by bringing up topics like CRNA takeover, medicare, and the impending salary cuts, but no dice. He always tells me that he enjoys his job. Possibly, it is because he works a 2 week off/2 week on call schedule, and he was a working physician at the time that gas docs were making a killing( several years ago right?) Maybe he is the last one of his kind, and the future gas docs will be miserable ..IDK. All I know is, my brother recently finished his surgery residency, and for him, it seemed like 5 years of pure hell. I guess your job is really what you make of it ( or atleast for the most part)...

I hope the guys who hate their job start liking it again somehow.

Take this CA-2 input with a grain of salt, but the fact of the matter seems to be that people who pursue anesthesiology as a "lifestyle" specialty seem to be the types whom may/are disappointed.

From what I see in very successful groups, they work very hard for what they earn. In the future, you'll likely work the same or even harder for almost certainly less. So, don't do it for the "lifestyle".

I look at it this way. Way gone are the days when MOST anesthesiologists will get wealthy from the job. BUT, if you like the job and you're o.k. with making decent money for being a doctor, then it's a good gig IMHO.

Obviously things like student loans, and the relativity of it all come into play, and you should consider that stuff. We can argue opportunity costs and do risk/benefit analysis all day long. Likely, though, it'll still offer some good opportunities for those with a love and respect for the field. But, you will work hard, just like everyone else making money (again, relative) in medicine.

 

[scudrunner]

Buyer beware with anesthesiology.

Just to add on to this... in the spirit of jet...

READER BEWARE OF THIS THREAD

THESE ARE PERSONAL OPINIONS AND SPECULATION

Negative voices are ALWAYS the loudest.

I've worked with a TON of anesthesiologists these past few years in several academic centers and a couple of private practices... only ONE said they would not chose this specialty again. 99% of my sampling, in the midwest, LOVE anesthesia and wouldn't trade it for anything.

Get in where you fit in, and you'll be happy.

 

[Colbare]

It would help to hear from those with negative overall experiences what their expectations were going into anesthesia. What made you decide to pursue it?

 

[BLADEMDA]

This field has changed in private practice. Academia is sheltered from the reality of anesthesia management companies and falling salaries. Eventually, even academia will feel the impact of the decline as their salaries get frozen or cut.

How can I explain to a young person the true impact of the loss of private practice to the specialty? The work will be there for a young graduate but it will involve longer hours and lower pay.

Does this mean there isn't a need for Anesthesiologists in the USA? Absolutely not. But, you will be a cog in the machine or an employed physician where in the past you would have chartered your own course.

Again, Gas is more like ER in the sense you are viewed as a commodity and a service provider. Hence, some will shop for the cheapest provider of the service who will maintain decent quality (not necessarily the best quality).

 

[wjs010]

This field has changed in private practice. Academia is sheltered from the reality of anesthesia management companies and falling salaries. Eventually, even academia will feel the impact of the decline as their salaries get frozen or cut.

How can I explain to a young person the true impact of the loss of private practice to the specialty? The work will be there for a young graduate but it will involve longer hours and lower pay.

Does this mean there isn't a need for Anesthesiologists in the USA? Absolutely not. But, you will be a cog in the machine or an employed physician where in the past you would have chartered your own course.

Again, Gas is more like ER in the sense you are viewed as a commodity and a service provider. Hence, some will shop for the cheapest provider of the service who will maintain decent quality (not necessarily the best quality).

is your last sentence the absolute reason that CRNA's are dangerous to you anesthesiologists?

 

[ssmallz]

is your last sentence the absolute reason that CRNA's are dangerous to you anesthesiologists?

If you think Gas is like ER then you should know why CRNAs are no more a threat to anesthesiologists then PAs are to ER docs

 

[jetproppilot]

Just to add on to this... in the spirit of jet...

READER BEWARE OF THIS THREAD

THESE ARE PERSONAL OPINIONS AND SPECULATION

Negative voices are ALWAYS the loudest.

I've worked with a TON of anesthesiologists these past few years in several academic centers and a couple of private practices... only ONE said they would not chose this specialty again. 99% of my sampling, in the midwest, LOVE anesthesia and wouldn't trade it for anything.

Get in where you fit in, and you'll be happy.

Hey Scud I'm LOVING the fonts dude

 

[DannyB]

This same thread pops up every two weeks with the same five or six disgruntled people posting their usual rants. If you want to be a surgeon, be a surgeon. If you want to be an anesthesiologist, be an anesthesiologist. The way these people can interchange these very different careers makes absolutely no sense to me. Luckily we're attracting better people in the field now. My favorite post of this thread though is the guy saying anesthesia residency hours are as bad as surgery, I almost spit out my drink

 

[imfrankie]

Do you like clinic? Ask yourself. Because at least half your time as a surgeon is in the clinic. You guys talk money, money, money. How much time do you think the surgeon is enjoying that money? "Boy is this 911 a great ride for driving between the three surgical sites I need to service this morning before clinic this afternoon." If you want to make money without working your backside off for it, do something else. Learn to count cards, use your head and manufacture widgets, do something else besides taking care of patients.

 

[OB1🤙]

I posted this a few months ago, still feel the same, and will relink it here.

http://forums.studentdoctor.net/showthread.php?t=929822

A link from inside that thread worth reading- http://askalex.stanford.edu/archives/2012/07/i-dont-think-th-1.html

 

[BLADEMDA]

I posted this a few months ago, still feel the same, and will relink it here.

http://forums.studentdoctor.net/showthread.php?t=929822

A link from inside that thread worth reading- http://askalex.stanford.edu/archives/2012/07/i-dont-think-th-1.html

never been a better time to be an Anesthesiologist??! Seriously? 7 years ago you could have finished residency without a fellowship and landed a job earning big bucks almost anywhere. AMCs were still getting a foothold. The guys on SDN who landed those jobs will be far better off than the new graduate of today.

The glory days are a past tense in terms of money/lifestyle and the field is now 50 hours a week for $350K. 7 years ago could have earned double that amount for the same hours. Now, groups are facing reduced subsidies, all CRNA groups taking over ASCs and management companies low balling bids to get contracts.

Sorry, today looks a lot more like the mid 1990s than the early 2000s and that isn't going to change anytime soon.

I'm not bitter or angry about my career choice. I've made a lot of money in my career. But, with high taxes and lower reimbursement my advice is to seek a field where you control your hours and payer mix as much as possible.

I know many of you are young and full of excitement about your chosen field; that's great at the start of your career but after 15-20 years in practice the business side of Anesthesiology will matter to you much more.

Of course you must choose the area of medicine you want to practice for the next 30 years but consider all aspects of that decision

 

[OB1🤙]

There is lots and lots and lots of BS facing the field, there is no doubt. You will get paid less than in the halcyon days of yore, there is no doubt.

But I still look forward to going to work every day, and that would not be true about ANY other field in medicine.

Because anesthesia is f'ing awesome.

 

[Stellar Clouds]

Because anesthesia is f'ing awesome.

That's what I like to hear!

 

[Colbare]

Thanks for the posts Bruin those were great articles. I've always thought I'd do internal medicine, but I became very interested in anesthesia recently when I found out my best and favorite 2 subjects were the basis of this specialty. I'm trying to get the best feel for what it takes personality wise. This thread from awhile back was pretty good: http://forums.studentdoctor.net/archive/index.php/t-64663.html

How did you guys know in medical school you might be able to handle the sudden crashing patient situations that occur in anesthesia?

Is there a significant additional amount of stress knowing that something that goes wrong fast could be primarily your fault? Or do you have enough knowledge and understanding to have an immediate checklist to run through that you just do it without having time to worry or fear? How often do you feel like the situation is out of your control even when you are giving the case your full attention?

Sorry for so many questions and any responses are greatly appreciated

 

[pgg]

How did you guys know in medical school you might be able to handle the sudden crashing patient situations that occur in anesthesia?

I just had faith that whichever residency I chose would take me from a MS4 who knew enough to be dangerous --> a new attending who knows enough to be safe. And it did, as it does 99% of everyone else, too. It takes work, and supervision, and gradually increasing autonomy ... but that's what residency is for.

Is there a significant additional amount of stress knowing that something that goes wrong fast could be primarily your fault? Or do you have enough knowledge and understanding to have an immediate checklist to run through that you just do it without having time to worry or fear? How often do you feel like the situation is out of your control even when you are giving the case your full attention?

All doctors in all specialties can hurt patients with an error, oversight, or inattention. Sure we in surgical fields can hurt people faster than psychiatrists or pathologists, but the risk exists for every field. You learn your specialty, you practice with caution and diligence, and things work out.

I'm not sure exactly how to articulate it. You pay attention, things sometimes go sideways, you do the right things, even then sometimes the outcome is bad. Anesthesia is pretty safe and bad outcomes are pretty rare, unless you do a lot of trauma. Even in those cases when the patient is circling the drain after starting way behind the 8 ball, I have rarely felt out of control. That doesn't mean the factors I can control will be enough to salvage the situation ...

But it does mean that I remember law #4, the patient is the one with the disease, and that helps me with the stress and bad feelings that come with bad outcomes.

 

[NightNight]

the field is now 50 hours a week for $350K.

.

 

[MiracleforMD]

the field is now 50 hours a week for $350K

Seems ok to me. I get it, it used to be better, and yes I'm graduating with way more debt than most of the senior people on this forum, but I still think (grain of salt) that this field is better than any surgical sub specialty. I wanna be that guy who can do the lines and airways that absolutely NOBODY else can do, that gets called when all the other docs have thrown their hands up. Yeah, it's gonna be worse than a decade ago. I get it, but knowing all the doomsday scenarios gleaned from those who came before me, I'm still excited about it, because I'm still convinced that gas is the best possible specialty I could pursue with my medical knowledge and the place I'll be happiest. Maybe I'll work harder, and do it for less money, but I'll be HAPPY doing it.

+1. Those hours with that salary? Even you if you have to put up with some bull**** as long as you still enjoy the work a little bit, it seems like a pretty awesome option.

"The great mass of men live their live in quiet desperation"

 

[countingdays]

+1. Those hours with that salary? Even you if you have to put up with some bull**** as long as you still enjoy the work a little bit, it seems like a pretty awesome option.

"The great mass of men live their live in quiet desperation"

The 350k isn't a problem. 350k is a great income. The problem is that you are making more than that while someone is stealing a portion of your income either partners or surgeons or corporate bureaucrats. If you can ignore the theft and be happy with the income, you'll be happier.
This used to be a profession. Now it's a factory. It's great for a factory job, other than the prolonged, expensive education.
The other side of the issue is that if & when the income decreases significantly, this won't be worth doing; Not so much for anesthesiologists today, but for those to come. Honestly, I'd have to keep doing this even if income fell to 150k. What else am I gonna do? Go back to school? But I would discourage anyone choosing anesthesia if income is below 250k or so.

 

[Colbare]

I just had faith that whichever residency I chose would take me from a MS4 who knew enough to be dangerous --> a new attending who knows enough to be safe. And it did, as it does 99% of everyone else, too. It takes work, and supervision, and gradually increasing autonomy ... but that's what residency is for.



All doctors in all specialties can hurt patients with an error, oversight, or inattention. Sure we in surgical fields can hurt people faster than psychiatrists or pathologists, but the risk exists for every field. You learn your specialty, you practice with caution and diligence, and things work out.

I'm not sure exactly how to articulate it. You pay attention, things sometimes go sideways, you do the right things, even then sometimes the outcome is bad. Anesthesia is pretty safe and bad outcomes are pretty rare, unless you do a lot of trauma. Even in those cases when the patient is circling the drain after starting way behind the 8 ball, I have rarely felt out of control. That doesn't mean the factors I can control will be enough to salvage the situation ...

But it does mean that I remember law #4, the patient is the one with the disease, and that helps me with the stress and bad feelings that come with bad outcomes.

That definitely helps thank you.

I'm at AZCOM and we don't get an anesthesia rotation. Does anyone else get one? Is the best way to get exposure to try during surgery rotation? I'll be starting rotations next year

 

[Stellar Clouds]

That definitely helps thank you.

I'm at AZCOM and we don't get an anesthesia rotation. Does anyone else get one? Is the best way to get exposure to try during surgery rotation? I'll be starting rotations next year

We have an anesthesia rotation during both third and fourth year (both elective).

You can try and get some exposure during your surgery rotation--I would often ask the anesthesiologist if I could intubate the patients that I was going to "operate" on. I even snagged a few central lines as an MS4 during a surgery rotation (but the anesthesiologist knew I was going into anesthesia, so I think that helped). Just make sure the surgery residents don't think you are ignoring your surgical duties while trying to get exposure to anesthesia.

Another great way to get exposure is for you to shadow. Do it now when you have free time. If you have a little time off before you start your rotations next year, go shadow for a few days in a row. Take a break from studying for step 1 and go shadow for half a day.

 

[BLADEMDA]

The 350k isn't a problem. 350k is a great income. The problem is that you are making more than that while someone is stealing a portion of your income either partners or surgeons or corporate bureaucrats. If you can ignore the theft and be happy with the income, you'll be happier.
This used to be a profession. Now it's a factory. It's great for a factory job, other than the prolonged, expensive education.
The other side of the issue is that if & when the income decreases significantly, this won't be worth doing; Not so much for anesthesiologists today, but for those to come. Honestly, I'd have to keep doing this even if income fell to 150k. What else am I gonna do? Go back to school? But I would discourage anyone choosing anesthesia if income is below 250k or so.

That's the inherent problem with Anesthesiology and E.R. They don't bring patients to the hospital, can't control the payer mix and are viewed as an expense rather than an asset.

I don't see how salaries are mainatined at current levels over the next ten years considering the surge of CRNA availability (cheaper labor), AANA national opt out plan and the rise of the employment/AMC model.

Salaries for the new graduate have already been slashed significantly and I see that trend continuing through the next few years (?2020). Rather than base your dreams on $350K a more realistic approach is $250K but don't forget to subtract taxes from that money. What you are left with may seem like a large amount but I can assure you that in the end that money means solid middle class lifestyle. Those who know how to game the system properly will report $80K to the IRS and live far better than you ever will on your "250"

Again, Anesthesiology is a great field but the business side of this specialty is atrocious in the USA and getting worse. I would not advise my children to be an Anesthesiologist as once the excitement phase wanes the reality sets in and by then you are stuck in a poor business model for the remainder of your career.

 

[BLADEMDA]

The 350k isn't a problem. 350k is a great income. The problem is that you are making more than that while someone is stealing a portion of your income either partners or surgeons or corporate bureaucrats. If you can ignore the theft and be happy with the income, you'll be happier.
This used to be a profession. Now it's a factory. It's great for a factory job, other than the prolonged, expensive education.
The other side of the issue is that if & when the income decreases significantly, this won't be worth doing; Not so much for anesthesiologists today, but for those to come. Honestly, I'd have to keep doing this even if income fell to 150k. What else am I gonna do? Go back to school? But I would discourage anyone choosing anesthesia if income is below 250k or so.

It is very common for the owners of Ambulatory Surgery Centers to "steal" anesthesia revenues from the providers. IMHO, more than 3/4 of surgicenters are in some kind of shady arrangement where the provider is NOT collecting the full anesthesia fee.

I believe that arrangements such as those are illegal but I know of at least 6 surgicenters which still maintain such deals. The owners making huge sums of money off these deals are willing to risk a fine by the govt.

I also know of several surgicenters in a major city in my state which fired the anesthesiologists entirely and hired CRNAs only. The surgicenter owners now collect 50% or more of all the anesthesia revenue. (I'm in a non opt out state).

This leaves Anesthesiologists out in the cold for the big surgicenter volume and better payer mix. Hospitals no longer want to shoulder the burden of subsidies for Anesthesia Groups and are demanding more services for less money. If the existing group won't swallow the deal the CEO threatens to hire a management company who utilizes CRNAs in a more cost effective manner (not to mention pays the CRNAs 10% less).

So while the House of Medicine faces a downsizing from Mansion to just large homes Anesthesiology is going from mansion to 1500 square feet. The explosion of ObamaCare in the next few years will only hasten the economic decline of Anesthesiology.

Meanwhile the existing Group owners know everything I have posted is true so they are maximizing gains over the next 3-5 years. This means some will sell out to Management companies for millions of dollars each (average is around 2.5 million per partner) or hire new graduate labor as cheaply as possible as employees.

 

[BLADEMDA]

On a positive note I do see ample job opportunities in Anesthesiology down the road as older Anesthesiologists retire and others seek to cut back on hours.

I'm not sure the next generation of Anesthesiologists are willing to work as much as the previous and current groups. I think lifestyle matters more to the upcoming generation of Anesthesiologists than ever before.

Most of the job openings will be "employee" positions for Hospitals or Management companies.

 

[deleted126335]

It is very common for the owners of Ambulatory Surgery Centers to "steal" anesthesia revenues from the providers. IMHO, more than 3/4 of surgicenters are in some kind of shady arrangement where the provider is NOT collecting the full anesthesia fee.

I believe that arrangements such as those are illegal but I know of at least 6 surgicenters which still maintain such deals. The owners making huge sums of money off these deals are willing to risk a fine by the govt.

I also know of several surgicenters in a major city in my state which fired the anesthesiologists entirely and hired CRNAs only. The surgicenter owners now collect 50% or more of all the anesthesia revenue. (I'm in a non opt out state).

This leaves Anesthesiologists out in the cold for the big surgicenter volume and better payer mix. Hospitals no longer want to shoulder the burden of subsidies for Anesthesia Groups and are demanding more services for less money. If the existing group won't swallow the deal the CEO threatens to hire a management company who utilizes CRNAs in a more cost effective manner (not to mention pays the CRNAs 10% less).

So while the House of Medicine faces a downsizing from Mansion to just large homes Anesthesiology is going from mansion to 1500 square feet. The explosion of ObamaCare in the next few years will only hasten the economic decline of Anesthesiology.

Meanwhile the existing Group owners know everything I have posted is true so they are maximizing gains over the next 3-5 years. This means some will sell out to Management companies for millions of dollars each (average is around 2.5 million per partner) or hire new graduate labor as cheaply as possible as employees.

Sadly agree.

 

[deleted126335]

On a positive note I do see ample job opportunities in Anesthesiology down the road as older Anesthesiologists retire and others seek to cut back on hours.

I'm not sure the next generation of Anesthesiologists are willing to work as much as the previous and current groups. I think lifestyle matters more to the upcoming generation of Anesthesiologists than ever before.

Most of the job openings will be "employee" positions for Hospitals or Management companies.

I think that the old guys will be around alot longer than anyone thinks. Also there will plenty of the younger generation willing to work the long hours- if they are incentivized to do so. Student loan debt that needs to be serviced is a pretty big motivator.

 

[ssmallz]

I'm not sure the next generation of Anesthesiologists are willing to work as much as the previous and current groups. I think lifestyle matters more to the upcoming generation of Anesthesiologists than ever before.

Most of the job openings will be "employee" positions for Hospitals or Management companies.

Defiantly agree with this statement.....as our salary gets cut more and more you're going to see fewer people willing to work 60hrs/week and take call every 5th night. In the end I see anesthesia turning into an ER type job where you hire a bunch of providers for shift work and pay them X dollars per shift with an average salary around 250k working 40hrs/week. All an all its not a bad way to go especially when you consider the multiple days off each month.

ER may be seen as an expense by the hospital but ER docs are insulated because there is no midlevel who can replace them, NPs and PAs are not even close to qualified to replace them and have trouble managing even the most basic of cases. Salaries eventually even out at aroudn 250-300k which is reasonable for both administration and providers. Anesthesia needs to be able to do the same and convince administration that CRNAs are not qualified to work in a hospital setting alone. I don't think it will be that difficult to do and most of the surgeons I work with would refuse to work with CRNAs in a hospital setting because the acuity of the patients and cases is much higher than an ASC

 

[deleted126335]

Defiantly agree with this statement.....as our salary gets cut more and more you're going to see fewer people willing to work 60hrs/week and take call every 5th night. In the end I see anesthesia turning into an ER type job where you hire a bunch of providers for shift work and pay them X dollars per shift with an average salary around 250k working 40hrs/week. All an all its not a bad way to go especially when you consider the multiple days off each month.

ER may be seen as an expense by the hospital but ER docs are insulated because there is no midlevel who can replace them, NPs and PAs are not even close to qualified to replace them and have trouble managing even the most basic of cases. Salaries eventually even out at aroudn 250-300k which is reasonable for both administration and providers. Anesthesia needs to be able to do the same and convince administration that CRNAs are not qualified to work in a hospital setting alone. I don't think it will be that difficult to do and most of the surgeons I work with would refuse to work with CRNAs in a hospital setting because the acuity of the patients and cases is much higher than an ASC

If your salary is X for working 40 hours, There will always be plenty of people willing to work 60 hrs for 1.5X.

So you (administrator) let the supervisory ratios drift up from 1:4 to 1:6 or more. You let the CRNAs function solo on small cases or healthy patients. Have ac anesthesiologist aroend as the fire department.

 

[BLADEMDA]

 

[Colbare]

How does the job outlook seem for those with fellowships such as cardio? I would think they'd have a niche that the CRNA's would be unqualified for

 

[Consigliere]

CRNAs do cardiac everywhere. It's just as dismal a market for those with cardiac fellowships.

 

[Colbare]

Is it really that unique of a position though compared to other specialties that use PAs? Or is it that comparatively CRNAs can do way more in anesthesia than PAs in specialties like IM?

I think it would be awesome if physician's could start new hospitals with minimal administration. They could then undercut big hospitals and still make the same income. Way too much involved though I'm sure is the reason doing that isn't big.

You guys may have already seen this, but I think its good people are thinking of alternatives to standard hospital practice.

http://www.youtube.com/watch?v=0uPdkhMVdMQ

 

[BLADEMDA]

Is it really that unique of a position though compared to other specialties that use PAs? Or is it that comparatively CRNAs can do way more in anesthesia than PAs in specialties like IM?

I think it would be awesome if physician's could start new hospitals with minimal administration. They could then undercut big hospitals and still make the same income. Way too much involved though I'm sure is the reason doing that isn't big.

You guys may have already seen this, but I think its good people are thinking of alternatives to standard hospital practice.

http://www.youtube.com/watch?v=0uPdkhMVdMQ

You don't get it. That surgicenter only takes paying patients so they can easily undercut the hospital by 1/2. If I don't get that paying patient then the pressure mounts on the hospital to subsidize my salary.

The hospital must treat the dirtbag (excuse me homeless) person under the bridge for free and all illegal aliens. Obamacare pays a fraction of what private insurance pays.

I agree our health care system is broken but the surgicenter model doesn't address the real problem in our health system. Obamacare will lead to the demise of the current system much sooner than without ObamaCare so maybe some societal good may yet come out of that law.

If I treated only paying patients (no Obamacare/No CMS) I could work 1/2 as much and make even more money than I do now.

 

[Colbare]

Ah I see the disadvantage of not having patients as negotiating leverage now.

 

[emd123]

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.

As a non-anesthesia Pain guy, how can anesthesia suck this bad? Seriously.

 

[Stellar Clouds]

As a non-anesthesia Pain guy, how can anesthesia suck this bad? Seriously.

Take the outrageously negative comments with a grain of salt. As you can see, most people that have posted here don't think that anesthesia "sucks this bad"

 

[Noegrus]

Anesthesia sucks real bad according to SDN. The practice of anesthesia just doesn't allow people enough time to spend on managing their investment portfolios.
In other news my trauma surgery attending is about to have a nervous breakdown because he only got to sleep eleven hours in the last five days. He drives a Porsche Panamera, though. Also, the peds endocrinology attending I shadowed at my teaching hospital is double boarded, makes $130k/yr and reads papers on the treadmill just so she can keep her academic job as an instructor in peds with 10+ years of experience. She is 41 and single, never married.
Yep, gas sucks.
Also, I have zero loans so I 'may' be able to make ends meet on a paltry 300k/yr. Maybe I'll have to work two jobs to feed my wife and kids.

 

[pgg]

Anesthesia sucks real bad according to SDN.

🙂 There are about 4 people here who feel the way Consigliere does.


Most of us love the field, some of the drawbacks he/they list in other posts weigh on the con side, but the pros outweigh them.

I wouldn't work a clinic based specialty for 2x the money, but that's just me.

 

[BLADEMDA]

Anesthesia sucks real bad according to SDN. The practice of anesthesia just doesn't allow people enough time to spend on managing their investment portfolios.
In other news my trauma surgery attending is about to have a nervous breakdown because he only got to sleep eleven hours in the last five days. He drives a Porsche Panamera, though. Also, the peds endocrinology attending I shadowed at my teaching hospital is double boarded, makes $130k/yr and reads papers on the treadmill just so she can keep her academic job as an instructor in peds with 10+ years of experience. She is 41 and single, never married.
Yep, gas sucks.
Also, I have zero loans so I 'may' be able to make ends meet on a paltry 300k/yr. Maybe I'll have to work two jobs to feed my wife and kids.

Nice Post.👍 FYI, at my hospital the General Surgeons work about 1/3 less than I do. Even the Neurosurgeons work less. So, practice environments vary from place to place. That said, I know plenty of Anesthesiologists working 40 hours per week pulling in $400K. The problem is this specialty has a serious Medicare reimbursement issue and when all Physicians get cut 30% my hourly reimbursement will be less than my plumber or electrician. Still, I'd take my job over that Peds Endocrinology Attending any day.

For some Medicine is a passion or a Calling like being a Priest. For others, it is a job or a business/career path to a nice lifestyle. Which is it for you and what do you want out of your career?

 

[countingdays]

What you do (lines, blocks, tubes, pressors, wake-ups) in anesthesia is nice.
What you don't do (clinic, rounds, dictation, progress notes) is fantastic.

 

[EtherBunny]

Yeah, anesthesiology can definitely get a bum rap on SDN (I have certainly contributed my fair share to the doom and gloom on this forum). However, there are definitely some huge perks to being an anesthesiologist...

No clinic, no rounding, minimal paperwork, no social work nonsense, positive interactions with patients, lots of fun procedures, high pay relative to primary care (currently), excellent separation between your personal and professional life (when you're off, you're truly off), great outcomes from your work with a very low complication rate (one of the lowest in medicine, period), relatively ample vacation time in private practice (8+ weeks on average)

You can definitely be happy as an anesthesiologist. I know plenty of very happy anesthesiologists where I work. The important thing is that you make an informed choice when you decide to go into anesthesiology. Like every other specialty in medicine, it has its own set of drawbacks.

 

[BLADEMDA]

Anesthesiology is changing dramatically. My advice is to find a decent job in this field with a nice lifestyle and good working conditions with reasonable hours (this doesn't describe my practice whatsoever). Forget about trying to make huge amounts of money working 65 hours a week in a place that demands a 5 year partnership track.

Either get a job in the boonies earning $500K or get one paying $350 with limited call and a great lifestyle. Always live below your means.

 

[Per4mer8]

what you do (lines, blocks, tubes, pressors, wake-ups) in anesthesia is nice.
What you don't do (clinic, rounds, dictation, progress notes) is fantastic.

+1,000,000,000