People will probably disagree with what I have to say, but anesthesia has better hours, higher pay, and a less crazy/busy time while at the hospital than EM. Some people find the craziness of EM appealing, some find the sterile OR setting that’s fairly controlled (until it isn’t) more appealing. But if you’d be happy with either, do gas.
Currently, I’d probably say EM still has the edge on the job market, but that is rapidly changing and by the time you graduate we might see EM making about the same as hospitalists (250k). At least CRNAs still require supervision at the beginning of procedures, whereas midlevels in the ER work-up low acuity cases independently. Also CRNAs have a higher barrier to entry vs the tidal wave of NPAs that will hit us in the next 5 years.
Other thing to consider, in most countries, including those with more ‘universal’ healthcare UK, Australia, Germany etc. EMs make about the same as GPs. Whereas anesthesiology is still the more highly paid medical profession, even in countries who don’t pay their doctors much like Spain and Russia or even Venezuela. In other words, I feel it is a less “replaceable” role than EM.
I think the biggest con for EM is long-term circadian rhythm disruption which honestly has trickle down effects for everything else in your life. Anesthesia certainly works longer hours and deals with their own BS but at least you're not working 10am-6pm one day and then potentially 7pm-2am the next day and so on and so forth for the rest of your career. My vote is for anesthesia.
***MS4 perspective which I understand is counter to what some of the anesthesia attendings here will say***
Unfortunately you are 100% very wrong about this.
If you are interested in both, do EM. Both have similar cons, but EM has more pros in my opinion. MUCH higher per hour pay, Way more time off.
The biggest downside about EM to me is you have to deal with a lot of paperwork compared to anes, and depending on where you are, may have to deal with homeless, drunks, difficult patients, etc. You are also frontline for anything infectious.
Anes is cleaner than EM since you'd work in the ORs, but thats really just compared to EM. You still deal with blood, secretions/gastric contents, urine. You will work much more hours per week if you want to be paid like EM.
I'm EM and did gas rotations in medical school and residency. They're not even close at all. You really need to rotate in both. As to the above, it's much easier to make good money in gas than EM, especially with our upcoming job climate.
How? Gas makes 400+ and EM about 300+. EM has higher burnout (because the job itself is stressful) and it’s a sprint seeing tons of patients the entire time you’re there. Also EM will probably settle down once they open up enough residencies and the market is flooded. Gas you focus on one patient at a time (4 while an attending) and you get scheduled breaks while at work. You’ll deal with disrespect in both.
Despite similar people being attracted to them (probably because they're critical care specialties that are fairly high earning), they're pretty different. To me the biggest difference EM is a lot more patient contact, much more of a clinic feel, while anesthesia is obviously in the OR with a focus on one patient at a time. EM is more diverse in terms of pathology, but at the trade off of not being viewed as an expert in anything, while anesthesia gets to be undisputed master of the airway. EM has less hours but at worse times (more nights/evenings), anesthesia you can have a more normal schedule.
Have you rotated in them? If not, you may find yourself surprised by what you enjoy. I pro/conned my way into several specialties that I ended up disliking when I rotated through them.
Can you elaborate on the upcoming job climate?
Can you elaborate on the upcoming job climate?
EM is going thru what anesthesiology has been going thru for some time now.. and it affects jobs negatively. business takeovers, midlevel independence, lower reimbursement, etc
i would expect hours to go up and salaries to go down for EM
@Rekt @EmergDO, thank you for sharing. Is this something that could be a deal breaker for upcoming applicants, say if you had to do it all over again?
I'd personally avoid medicine all together.
I'd personally avoid medicine all together.
I’m scared of this. I find myself not really loving any specialties, tolerating few, while it seems most of my classmates are loving it. I hate waking up and pretending to enjoy myself and acting interested/enthusiastic. I’m definitely disappointed bc medicine isn’t what I thought it would be as a naïve pre-med. I’m in too deep at this point so my goal is to just find a job where I can get the biggest bang for my buck to pay off loans, go to work and go home without taking it with me.
I’m scared of this. I find myself not really loving any specialties, tolerating few, while it seems most of my classmates are loving it. I hate waking up and pretending to enjoy myself and acting interested/enthusiastic. I’m definitely disappointed bc medicine isn’t what I thought it would be as a naïve pre-med. I’m in too deep at this point so my goal is to just find a job where I can get the biggest bang for my buck to pay off loans, go to work and go home without taking it with me.
I know a few doctors who switched from EM to anesthesia. I don’t know any who went the other direction. I’m in anesthesia and I wouldn’t want to do EM. That said, I also know EM docs who LOVE their job.
go to work and go home without taking it with me.
EM job is challenging but there is no specialty in medicine where one can work 2 days/wk and still make 200k+...So many good points in this thread I’m even more confused now lol. Leaning slightly more towards anesthesia but idk how I feel about working 55-60 hours a week...
Currently, I’d probably say EM still has the edge on the job market, but that is rapidly changing and by the time you graduate we might see EM making about the same as hospitalists (250k). At least CRNAs still require supervision at the beginning of procedures, whereas midlevels in the ER work-up low acuity cases independently. Also CRNAs have a higher barrier to entry vs the tidal wave of NPAs that will hit us in the next 5 years.
Other thing to consider, in most countries, including those with more ‘universal’ healthcare UK, Australia, Germany etc. EMs make about the same as GPs. Whereas anesthesiology is still the more highly paid medical profession, even in countries who don’t pay their doctors much like Spain and Russia or even Venezuela. In other words, I feel it is a less “replaceable” role than EM.
WHy would you tell ANYONE not to worry about the future?OP, I would stop worrying about the future of medicine
If you're a full time ER doc, the average would never be 250k per year, unless you work in academics, NYC, Denver, etc (basically pockets of saturation). Medscape and other surveys are usually on the lower end for ER salaries. The average right now is 350k minimum, so you're asking for a 30% decrease in salary. I have not seen this in any specialty in any number of years. There's too much doom and gloom all over SDN.
Anesthesia has CRNAs. Ophthalmology has optometrists. Radiology has AI/technology. Derm, GI, surgical subspecialties all have private equity looming. Non-surgical specialties all have nurse practitioners waiting in the wings. Community ICUs are being staffed by NPs at night, while the intensivist is on-call from home. Surgical specialties will one day have NPs/surgical techs doing the non-critical portions of the surgery. Robots will then take over.
OP, I would stop worrying about the future of medicine and just focus on what you like to do or what you hate the least. If you still can't pick, then choose based on lifestyle, then potential income level. It is still a job and many physicians have other hobbies or even change careers.
WHy would you tell ANYONE not to worry about the future?
IT is a good exercise to be concerned about the future.
Why would you want to pick a specialty that will be obsolete in 20 years if thats the case. Wouldn't you want to know?
That's like telling financial analysts don't worry about trends and future trends, just go with your gut and pick what you like.
The issue is it's very difficult to predict what will happen 20 years in the future. There's a big chance (almost a certainty) of significant healthcare changes in the next twenty years, from Medicare for All to simple changes in what CMS/insurers decide to pay for things. Something as simple as deciding to not pay for screening colonoscopies anymore could tank GI salaries, or the invention of some new therapy could make some obscure subspecialty very lucrative. New AI things could ruin the radiology job market, or it could allow them to read (and bill for) a zillion more scans and double their income.
You're much more likely to enjoy your job if you pick a specialty you enjoy as opposed to trying to figure out the best cost/benefit analysis using assumptions that are certainly going to change. The vast majority of specialties allow you to live very comfortably in basically anywhere in the US, and it's not like making $250k vs $350k is going to dramatically change your happiness level.
FWIW people were saying anesthesia was dead in 1996-1997. Only about 150 out of the 1100 spots filled. The job market did suck then but it turned around dramatically in 5 years. More recently the same thing happened to a lesser degree in radiology. Both fields are doing great IMO. So is EM. Nobody can predict the future.
You are contradicting yourself. First you point out the AAMC made an inaccurate prediction. They didn’t. Then you also say you can make “reasonable predictions based on available data.”Tell that to the AAMC, who predicted a “physician shortage” 10-15 years ago that everyone believed. How can physicians blindly believe this and yet refuse to do their own analysis and advocate for themselves?
You can make reasonable predictions based on available data.
Tell that to the Radonc folk. They’re all in agreement that the field is dead.
But it would be foolish for anyone to go into rad onc now thinking things will be better in 5 years...It won’t be in 10 years. A shortage of radonc docs is almost guaranteed in 5 years.
But it would foolish for anyone to go into rad now thinking things will be better in 5 years...
It was not smart... Things got better of course, but people don't get into titanic when it's sinking.Actually it would be very smart. Just like it was for people who went into radiology 5 years ago and anesthesia back in 1996. If you’re interested in radiology, do radiology.
It was not smart... Things got better of course, but people don't get into titanic when it's sinking.
We did not know if things were going to turn around. Things has not turned around for pathology, for instance.How wasn’t it smart? Definitely smarter than following the herd.