Confused MSIII - help !!!!

[GasMD]

Love anesth. but following things scare me
-CRNA's creeping faster into this profession
-See myself market tightening in next 5 years
-Longer time period to be a partner in the future
-MD's future will be to supervise CRNA's and do the complicated cases with tons of complications and horendous hours in OR
-Reimbursments will be dragged down by CRNA's and MD's will have to comply to stay competitive
-No more life-style speciality


Love ER too but 2nd option currently. Good things are
-Heard that all ER's in the future will hire only EM certified docs
-No competition from allied health care workers ( I guess no one wants to mess up with the emergencies)
-If worked the same hours as anesth. salaries are pretty competitive
-with population growth, ER's will be overflowing.

Reasons for my thought process
-I have a family with kids to support and tons of debt to repay so I dont want to end up working for a job in anesth. in a small rural town where nobody wants to work.
-reasonable salary
-good lifestyle
-Whole dilemma started when CA-3 told me that " I should watch the speciality very closely before deciding to go for it because of the CRNA issues"
-ER will have ample opportunities everywhere and much more flexibility and I see the future bright.


Some of you will hate this post for same old crap but, hey guys I have to make my life long decisions and commitments, so all honest opinions or links from everyone will be appreciated. Good luck to people heading to the final week of ROL certification !!!. Thanks

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[invitro]

Hi, I'm a msIII too...with the same issues.

I think it really boils down to how much you like to take chances.

The points you made are valid possibilities....they could happen....of course they could not. There are a lot of factors (i.e. state/government decisions) that could limit/extend the range of practice of CRNAs in the next couple of years....I just don't know.

Whereas I am DEFINITELY NOT an expert in this field, the main thing that concerns me, is that if CRNAs are able to do most of the bread and butter cases (I guess which comprises at least 50%, if not more, of all gas cases), and able to do them reasonably well, what is preventing hospitals from hiring a bunch of CRNAs to do the majority of cases, and only one or two anesthesiologists to look over them? In this case I imagine what you predicted will become true....MDAs will have the most difficult cases, and work much harder hours, and the job market (along with the incredible salaries) will inevitably tighten. I have noticed that quite a few plastic surgeons in the area I live use CRNAs exclusively, and have a anesthesiologist "on call" should an emergency arise.

Also, with the flow of med students into the "lifestyle" specialities (there was a recent USNEWS or Newsweek article on this) I wonder if the field will get saturated soon. The author cited cardiology, ob-gyn and neurosurgery as being the specialities with most demand.....let's see if this turns out to be true. Also, this article could be considered "fluff" by many, as the quality of the author's sources probably was not the best.

Again, I am not an expert, and for all I know this might just be a bunch of BS. Currently, the anesthesiologists graduating from my school's program (GW) are doing quite well (200-300k in cities, 300-400k+ offers in rural areas), and I guess that this will continue for at least the next 5-10 years. My concern, of course, is what will happen after that.

Good luck with your decision.

Love anesth. but following things scare me
-CRNA's creeping faster into this profession
-See myself market tightening in next 5 years
-Longer time period to be a partner in the future
-MD's future will be to supervise CRNA's and do the complicated cases with tons of complications and horendous hours in OR
-Reimbursments will be dragged down by CRNA's and MD's will have to comply to stay competitive
-No more life-style speciality


Love ER too but 2nd option currently. Good things are
-Heard that all ER's in the future will hire only EM certified docs
-No competition from allied health care workers ( I guess no one wants to mess up with the emergencies)
-If worked the same hours as anesth. salaries are pretty competitive
-with population growth, ER's will be overflowing.

Reasons for my thought process
-I have a family with kids to support and tons of debt to repay so I dont want to end up working for a job in anesth. in a small rural town where nobody wants to work.
-reasonable salary
-good lifestyle
-Whole dilemma started when CA-3 told me that " I should watch the speciality very closely before deciding to go for it because of the CRNA issues"
-ER will have ample opportunities everywhere and much more flexibility and I see the future bright.


Some of you will hate this post for same old crap but, hey guys I have to make my life long decisions and commitments, so all honest opinions or links from everyone will be appreciated. Good luck to people heading to the final week of ROL certification !!!. Thanks

 

[UTSouthwestern]

Not to dredge up topics that have been covered ad nauseum, but these issues are not unique to anesthesiology.

OB/Gyn and midwives
Opthamology and optometry
Primary care and NP's/PA's
Radiologists and outsourcing

Don't choose a field because of another's competition. The job market will wax and wane as it always does, but like the 90's when the biggest scare occurred in our field, it is likely a product of hysteria as well as propaganda by the competition.

Bottom line, choose what you would enjoy doing most. Being rich and unhappy is still a recipe for misery.

 

[MAC10]

Love ER too but 2nd option currently. Good things are
-Heard that all ER's in the future will hire only EM certified docs
-No competition from allied health care workers ( I guess no one wants to mess up with the emergencies)

At the ERs I work in, University, VA, private, they all have a number of PA's, NPs working there. Though every couple of hours some sort of trauma will roll in (mainly only rolls into the University)......MOST of the stuff seen in the ED is not an emergency. Think primary care clinic mixed with some acute cases, if you like this then ER is for you. Unless you are going to work in an academic/university/trauma center your ER job after residency is not going to be like the show. If it were me working at X commuinty hosptial I WOULD be worried about that cheaper NP, PA working alongside me. Dont be fooled into thinking EM dosent have the same problems the rest of us have.

:If worked the same hours as anesth. salaries are pretty competitive

Really????

:with population growth, ER's will be overflowing

Thats a good thing? Especially if you are post residency? Have you even done an ER rotation yet? If you havent I suggest you do one, I mean really do one, take your own rooms. You will find that trying to empty your rooms is like using a bucket to bail water out of a sinking ship.. as soon as you get some out it just fills right back up....and you will be bailing water for your entire shift.

My advice, do rotations in both anesthesiology and and ER. Take the role of the intern/resident in both situations. Ive worked with students in the ED who wanted to to EM and they see a couple of patinets here and there, Ill call them over to do a suture or I&D so I can go drain some rooms and I think they get the wrong perception about what its really like. Either way you and your family are not going to starve but in the long run, your happiness is the only thing thats going to keep you content with your chioce.