Every field thinks they are in trouble

[Arch Guillotti]

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Current CA1. My understanding of the income potential has always been in the 350-450 range which always sounded pretty green to me. How much greener was it before!?

Twice that, sometimes more.

 

[Psai]

Current CA1. My understanding of the income potential has always been in the 350-450 range which always sounded pretty green to me. How much greener was it before!?

Yeah well when you're billing for 800, working your tail off and barely seeing your kids but watching 4 crnas instead, making 350 suddenly doesnt sound so great. Sometimes people are getting way less than that. It's not about what you need to live, its about what you're worth and who is stealing your money right out of your pocket.

Why should some dbag suit make more than you from what you earn just because they "own" your work? The change in mentality to shift work for a certain salary makes me sad. Eat what you kill and bank out.

 

[GA8314]

I'm an M4 applying in anesthesiology, despite many CRNAs having come up to me, unsolicited, during my surgical clerkships and telling me I was entering a dying field. Crass, no? Kinda ruined my day.

However, the plight of the doctor vs. the wannabe-without-the-requisite-training is not unique to our field.

Every forum I go to on here, and I mean every one, has threads about how this field or that is "dying". My response to this: oh, please.

Even the traditionally high paying fields are lamenting the "end times".

Examples:
1) Ophthalmologists are terrified of Optometrists gaining the right to do surgery, as they have in one or two states. There are just as many rude, optometry students on the Ophtho forums are there are CRNA students here. They also say every major market is ultra-saturated.
2) Radiologists say there are no jobs anymore. It's impossible to find anything if you're not interventional, because all of their images are being outsourced to other countries.
3) Pathologists are terrified of government regulation of hospitals, the desire to only have a few pathologists, longer hours, and salaries, vs. fee for service. They also say that with the advent of telepathology, their careers are in as much jeopardy as the Radiologists.
4) All the primary care fields, and even some that are not primary care, such as ortho, are terrified that nurse practitioners are going to steal all of their clinical patients and relegate them to supervisory or purely surgical roles.
5) Radiation Oncology (RAD-ONC!) complains that they are going to be discovered by the government, cutting their reimbursements, and it is only a matter of time before nurses decide that if they can SET UP stereotactic XRT, that hey, maybe they should be allowed to do it by themselves.
6) Plastic surgery laments that it is impossible to get started in a practice, as no one is hiring, you have to be "known", and all the good cases are taken by senior partners. Besides, its only a matter of time before any "general" surgeon thinks they can do plastics. Or any nurse practitioner "thinks" they can do botox.

I could go on and on and on and on. The fact of the matter is this. There will be a DOCTOR shortage in this country. A very large one, and it will last for a generation. There is no substitute for a doctor in any field. Period.

From every corner of this country there is a backlash against Obamacare, and government regulation of healthcare in general, that is so strong that it may even be irreversible. When the dust settles, especially in an age of ever increasing availability of information, people are going to want choice. And when they choose, they will always choose a doctor over a nurse.

The pompous statements of the CRNAs, the optometrists, the nurse practitioners, its all wishful thinking. Because of our nation's budgetary situation, in 10 years, we will have a health system that has far less government involvement, including drastic changes to medicare and medicaid. Physician salaries will go up, not down. Our healthcare system will be less diffusely negatively egalitarian and will be stratified. And it will be the wannabe physicians, overproduced and underqualified, who will be left picking up the slack undesired.

So stop panicking medical doctors. The night is darkest right before the dawn. This is the nadir, a key turning point in history. And if you're in residency and about to leave, or in school and about to enter residency, you'll have bypassed the hard times, the tribulations, and will find only success and fruitfulness on the otherside.

I couldn't agree more. This has also been my experience. Doctors are a neurotic bunch.

 

[DirtDocMD]

“We will have a system that has far less government involvement..”

Ummm. Good luck with that....

 

[Vandalia]

Why should some dbag suit make more than you from what you earn just because they "own" your work?

That is exactly what Marx and Lenin said. In the 50's you would have been called before the House Un-American Activities Committee.

 

[deleted126335]

The grass was much greener 10-12 years ago. Now, the opportunity to make big $$$ is far less. That said, they are still out there for the fortunate 10-15 percent who can find one of those jobs.

For the rest, the majority of jobs are not nearly as lucrative with income in the $350-$450 range. So, if you adjust your expectations accordingly the glass is still half full.

Don’t forget something like half of recent residency grads now are doing fellowships to make themselves more marketable. That’s an extra year investment. 10-15 years ago a much smaller percentage of residency grads were willing to make the investment, because you didn’t need to to land a good position

 

[d9sccr]

Yeah well when you're billing for 800, working your tail off and barely seeing your kids but watching 4 crnas instead, making 350 suddenly doesnt sound so great. Sometimes people are getting way less than that. It's not about what you need to live, its about what you're worth and who is stealing your money right out of your pocket.

Why should some dbag suit make more than you from what you earn just because they "own" your work? The change in mentality to shift work for a certain salary makes me sad. Eat what you kill and bank out.

I don't understand why this is such a hard concept to pass on to my generation. The saddest thing is this is happening in all fields. At some point I hope physicians wake up and take some control back. It really bothers me the amount of work, dedication, etc. we put into our respective fields to have it be used to pay for non-clinical BS

 

[kmurp]

I think a good way to imagine where anesthesiology is headed is to imagine that you are the owner of a hospital. Just imagine for a few minutes.

All profits go into your pockets.

Your hospital also has a reputation in the community.

On deciding which anesthesia providers to use, how would you balance the use of cheaper (relatively speaking) CRNAs against the use of more expensive (relatively speaking) MDAs for providing anesthesia?

How would you balance the risks and benefits of using either CRNAs and MDAs?

Wouldn't you want to make more money as the owner of the hospital?

Just something to think about.

Why would I care unless I’m supporting the group financially. ?

 

[gshocke]

For the people acting as if anesthesia is going to crash and burn or as if they pay sucks..what else then? What other specialty is just has the same average level amount of competitiveness, comparable years of training (even with the one year fellowship), doesn’t require research to match, and pays just as much?

I’ll wait...

It’s not just medicine that sucks nowadays. It’s everything. 40-50yrs ago all you needed was a high school diploma to become a nurse. Pharmacists only needed a bachelors. Every field including non medical is taking a hit. We are Paying 3-4x as much for the same education our parents got but not making anywhere near 3-4x the salary. Life. Oh well.

 

[gshocke]

As Blade mentioned, most jobs now are in the $350-$450k range. Nobody is starving, but if you looked at the job market 12-14 years ago, most jobs were in EXACTLY that range, or better. Ask friends in other specialties, cops, teachers, firemen, if their income has been FLAT in the last decade.

No, I’m not talking about your buddy (1 out of 10) who practices at the local palace with all private insurance. I’m talking about folks at run of the mill hospitals, whose group is getting a subsidy and has most likely been taken over by an AMC. That extra pay is going in somebody else’s pocket, now.

On the bright side, you’re not handing over half or more of your pay in your first 3 years to your greedy old “partners” as a buy-in. OTOH, you’re now giving 10/20/30% of your pay in perpetuity to “the man” (AMC)....

Well.. 12-14 ago I was just hitting puberty and a little too young to be an anesthesiologist. We are in 2018. This is our reality. Instead of complaining, help. Healthcare, education costs, mid level encroachment are issues that were propagated by the physicians and adults from the “good old days”. I get annoyed when attendings talk about these issues b/c most of them are not doing **** about it. Mid levels are here to stay. The end. There’s a demand and they have a supply. Physicians need to increase their supply. Why is Med school still 4 years long? Especially for those doing primary care? Why did we add stupid exams like step 2CS while NPs are getting their DNP online? Like WHO SIGNED OFF on this ****??!!

 

[deleted697535]

sorry lads but you/we all earn more than 99% of the worlds population to sit down all day and talk sh1te. 350k is massive money. If you cant live on that you gotta ditch the hookers and coke
Move on

 

[Modanq]

Well.. 12-14 ago I was just hitting puberty and a little too young to be an anesthesiologist. We are in 2018. This is our reality. Instead of complaining, help. Healthcare, education costs, mid level encroachment are issues that were propagated by the physicians and adults from the “good old days”. I get annoyed when attendings talk about these issues b/c most of them are not doing **** about it. Mid levels are here to stay. The end. There’s a demand and they have a supply. Physicians need to increase their supply. Why is Med school still 4 years long? Especially for those doing primary care? Why did we add stupid exams like step 2CS while NPs are getting their DNP online? Like WHO SIGNED OFF on this ****??!!

I agree to the above statement but would add that those of us on SDN should realize that the framework we use to discuss the field of Anesthesiology also impacts our own future. A certain percentage of undergrads, medical students and physicians from other specialties do read across these forums and form opinions about the field. It may not be a lot of people but a certain percentage - especially when it comes time for applications. Our group here is doing their part by pushing the boundaries of what an Anesthesiologist is by expansion of scope of practice - Vascular Access, Intra-hospital intensivist, Periprocedural Cards, Pulm, GI procedure coverage, Echo, ICU, ECMO, Devices, Procedures trachs, leadership on pharmacy and economic purchasing etc. It might be a wrong approach but it is an approach to self preservation.

 

[Twiggidy]

Why should some dbag suit make more than you from what you earn just because they "own" your work?

Why is Dan Gilbert a billionaire when it was Lebron on the court getting the triple doubles?

 

[Twiggidy]

\ We are Paying 3-4x as much for the same education our parents got but not making anywhere near 3-4x the salary. \

This is the actual problem.

 

[Neopolymath]

For the people acting as if anesthesia is going to crash and burn or as if they pay sucks..what else then? What other specialty is just has the same average level amount of competitiveness, comparable years of training (even with the one year fellowship), doesn’t require research to match, and pays just as much?

I’ll wait...

It’s not just medicine that sucks nowadays. It’s everything. 40-50yrs ago all you needed was a high school diploma to become a nurse. Pharmacists only needed a bachelors. Every field including non medical is taking a hit. We are Paying 3-4x as much for the same education our parents got but not making anywhere near 3-4x the salary. Life. Oh well.

I would love to hear what attendings have to say about what medical specialty they would do instead of anesthesiology if they were in my M2 shoes. I can't think of a better (and realistic) specialty to be honest. If I said radiology everyone would be lining up to tell me the sky was falling on them too.

I really like this subforum's regular posters and respect their opinions, but don't feel like I have ever seen a truthful answer to this question beyond "Don't do anesthiology" and the classic "I would do business"

 

[Twiggidy]

I would love to hear what attendings have to say about what medical specialty they would do instead of anesthesiology if they were in my M2 shoes. I can't think of a better (and realistic) specialty to be honest. If I said radiology everyone would be lining up to tell me the sky was falling on them too.

I really like this subforum's regular posters and respect their opinions, but don't feel like I have ever seen a truthful answer to this question beyond "Don't do anesthiology" and the classic "I would do business"

Interventional Radiology.

Not as great a lifestyle as other radiology colleagues, but it's a procedure based field but not as extreme as being a surgeon. When you're not doing a procedure you're probably reading film. Whenever a student says, "I want to do anesthesia because I like procedures" I always tell them to give IR a close look as well. Both fields have positives and negatives.

Some in the field may say "interventional pain" but that practice where the only thing you do is pain procedures and don't see chronic pain patients is SUPER rare

 

[deleted697535]

I was an electronic engineer for 6 years. It was good fun but a dead end. I had 50 or more guys with more experience and more time in the company than me pushing for promotions. For every 1 engineer that makes it big, 1000s more make low money. I tried 2 start ups and got burned

I love my job now, make way more for the same number of hours, its easy as crap most of the time, get way more respect that i dont feel i deserve, and i can leave at the drop of a hat to work in europe, oz, america or just do locums. Or do research, and engage my engineer brain and retire early!!

We have a great job, well i do anyway. I wouldnt do anything else other than anesthesia with a touch of icu. Sorry!

 

[Neopolymath]

Interventional Radiology.

Not as great a lifestyle as other radiology colleagues, but it's a procedure based field but not as extreme as being a surgeon. When you're not doing a procedure you're probably reading film. Whenever a student says, "I want to do anesthesia because I like procedures" I always tell them to give IR a close look as well. Both fields have positives and negatives.

Some in the field may say "interventional pain" but that practice where the only thing you do is pain procedures and don't see chronic pain patients is SUPER rare

I had several mentors say that was what I should do, but being realistic, I could never match IR. I would put that up there with surgical subs and derm in competitiveness. Thanks for your input.

 

[cubsrule4e]

For the people acting as if anesthesia is going to crash and burn or as if they pay sucks..what else then? What other specialty is just has the same average level amount of competitiveness, comparable years of training (even with the one year fellowship), doesn’t require research to match, and pays just as much?

I’ll wait...

I would love to hear what attendings have to say about what medical specialty they would do instead of anesthesiology if they were in my M2 shoes. I can't think of a better (and realistic) specialty to be honest. If I said radiology everyone would be lining up to tell me the sky was falling on them too.

I really like this subforum's regular posters and respect their opinions, but don't feel like I have ever seen a truthful answer to this question beyond "Don't do anesthiology" and the classic "I would do business"

Ophtho is one (not that Ive ever been an anesthesiologist for comparison, and perhaps more competitive to acquire). The residency is brutal, but you cant beat private practice life. Sure, youre not billing 2k on a cataract anymore, but there's so many cash option additions for cataract surgery now, youre still making it well worth your time, and with current technology and proper OR set up doing 5 cases an hour is a breeze (We employ MDs, not CRNAs just for the record). The 350-450 range mentioned above is pretty standard in this field for general/refractive ophthos as well (higher ceiling if youre willing to carry a certain surgery load), and you're doing all that working 32-36 hours a week (different scenario for retina specialists). The optom thing parallels CRNAs, but is always blown out of proportion IMO. Most optoms you talk to in reality dont even want to do surgery (maybe some lasers), hence why they went to OD school instead; theres just some rogue wanna-bes out there that are driving that agenda. Sky isnt quite falling over here just yet.

 

[gshocke]

Interventional Radiology.

Not as great a lifestyle as other radiology colleagues, but it's a procedure based field but not as extreme as being a surgeon. When you're not doing a procedure you're probably reading film. Whenever a student says, "I want to do anesthesia because I like procedures" I always tell them to give IR a close look as well. Both fields have positives and negatives.

Some in the field may say "interventional pain" but that practice where the only thing you do is pain procedures and don't see chronic pain patients is SUPER rare

The average step 1 score for students who matched IR in 2018 was a 246 and for those who didn’t match IR, there avg was 242. Anesthesia’s avg was 232 for those who matched. Our matched applicants aren’t even competitive enough for IR’s UNmatched pool of applicants.

IR is very cool but statistically, it would not be feasible for the avg anesthesia applicant.

 

[pgg]

sorry lads but you/we all earn more than 99% of the worlds population to sit down all day and talk sh1te. 350k is massive money. If you cant live on that you gotta ditch the hookers and coke
Move on

Perspective is important, yes, and we're all fortunate to have these first world problems.

We've had this discussion about 80 times before, but here's another bit of perspective for you: money is time.

The difference between 350K and 550K might be the difference between taking your last overnight or weekend call at age 50 vs age 65.

 

[gshocke]

Ophtho is one (not that Ive ever been an anesthesiologist for comparison, and perhaps more competitive to acquire). The residency is brutal, but you cant beat private practice life. Sure, youre not billing 2k on a cataract anymore, but there's so many cash option additions for cataract surgery now, youre still making it well worth your time, and with current technology and proper OR set up doing 5 cases an hour is a breeze (We employ MDs, not CRNAs just for the record). The 350-450 range mentioned above is pretty standard in this field for general/refractive ophthos as well (higher ceiling if youre willing to carry a certain surgery load), and you're doing all that working 32-36 hours a week (different scenario for retina specialists). The optom thing parallels CRNAs, but is always blown out of proportion IMO. Most optoms you talk to in reality dont even want to do surgery (maybe some lasers), hence why they went to OD school instead; theres just some rogue wanna-bes out there that are driving that agenda. Sky isnt quite falling over here just yet.

Optho is another one where the avg step 1 score was a 245. Their bottom 25% of applicants had an avg 239, which was still higher than anesthesia’s matched. And this is just using step 1 scores as an example, I’m sure if we dig further, optho basically requires research if your in that bottom 25% for step 1.
I’ve yet to hear of an anesthesia program that weights research heavy at all.
The “lifestyle” specialties are taken over by the more talented (I don’t blame them)... but for the avg med student (which is most of us), It’s one of the best options. EM is a good alternative, however they require away rotations, require video interviews submitted prior to application submission, and are also facing mid level encroachment by PAs in the ED. Not to mention the burnout..

 

[cubsrule4e]

Optho is another one where the avg step 1 score was a 245. Their bottom 25% of applicants had an avg 239, which was still higher than anesthesia’s matched. And this is just using step 1 scores as an example, I’m sure if we dig further, optho basically requires research if your in that bottom 25% for step 1.
I’ve yet to hear of an anesthesia program that weights research heavy at all.
The “lifestyle” specialties are taken over by the more talented (I don’t blame them)... but for the avg med student (which is most of us), It’s one of the best options. EM is a good alternative, however they require away rotations, require video interviews submitted prior to application submission, and are also facing mid level encroachment by PAs in the ED. Not to mention the burnout..

You can get fantastic surgical oriented residencies with no research whatsoever actually, I had none. If you want big name research powerhouses then obviously theyre going to weigh that heavily, but its not required for ophtho. I did note the competitiveness discrepancy, my post was more directed to the "the sky is falling in every specialty" aspect of the thread. In the original post from years ago ophtho was listed as their first example citing optometrist turf wars, and here we are 7 years later and its better than ever.

 

[Consigliere]

I love my job now, make way more for the same number of hours, its easy as crap most of the time, get way more respect that i dont feel i deserve, and i can leave at the drop of a hat to work in europe, oz, america or just do locums. Or do research, and engage my engineer brain and retire early!!

"I'll take 'Things That Don't Happen" for $500, Alex."

 

[sniderwes]

Is pain salary still 400-500k for 40 hours a week? If so that's pretty good.

 

[GravelRider]

sorry lads but you/we all earn more than 99% of the worlds population to sit down all day and talk sh1te. 350k is massive money. If you cant live on that you gotta ditch the hookers and coke
Move on

Or find cheaper hookers...

350k is plenty to live on. The absolute salary number means nothing to me without talking about workload. 350 working 40 hours a week and 8 weeks of vacation is a very different job from making 350 and working 65 hours a week with 4 weeks vacation. It all comes down to how your time is being valued.

 

[nimbus]

Interventional Radiology.

Not as great a lifestyle as other radiology colleagues, but it's a procedure based field but not as extreme as being a surgeon. When you're not doing a procedure you're probably reading film. Whenever a student says, "I want to do anesthesia because I like procedures" I always tell them to give IR a close look as well. Both fields have positives and negatives.

Some in the field may say "interventional pain" but that practice where the only thing you do is pain procedures and don't see chronic pain patients is SUPER rare

When I was a resident, one of our staff guys who was editor in chief of Anesthesiology at the time told me he would have done IR if he had to do it again.

 

[Twiggidy]

When I was a resident, one of our staff guys who was editor in chief of Anesthesiology at the time told me he would have done IR if he had to do it again.

I think it's a field that fits most of our personalities and you still get to do procedures, but true, you have to get accepted to and get through a radiology residency to get to it.

 

[VA Hopeful Dr]

I think it's a field that fits most of our personalities and you still get to do procedures, but true, you have to get accepted to and get through a radiology residency to get to it.

There's a new direct path to it, but very very competitive

 

[dhb]

sorry lads but you/we all earn more than 99% of the worlds population to sit down all day and talk sh1te. 350k is massive money. If you cant live on that you gotta ditch the hookers and coke
Move on

150k is also more than what 99% of the worlds populations earns so you could be happy with that.

 

[Psai]

sorry lads but you/we all earn more than 99% of the worlds population to sit down all day and talk sh1te. 350k is massive money. If you cant live on that you gotta ditch the hookers and coke
Move on

Why should I care about what 99% of the world makes? Because other people make less money, that makes it okay for people with no useful function steal my money?

 

[Ronin786]

I think it's a field that fits most of our personalities and you still get to do procedures, but true, you have to get accepted to and get through a radiology residency to get to it.

Radiology residency is terrible. Hours on end, sitting in the dark and looking at films. And everybody wants to do interventional, making it incredibly competitive and even if you don't get it you need a fellowship regardless to get a job. No thanks.

 

[Twiggidy]

Radiology residency is terrible. Hours on end, sitting in the dark and looking at films. And everybody wants to do interventional, making it incredibly competitive and even if you don't get it you need a fellowship regardless to get a job. No thanks.

I'm a slight introvert and I love computers and technology so this actually sounds like paradise to me. Honestly, radiology would've been my route if it weren't for one bad day on the rotation and my anesthesiology rotation give a BIG misconception about the field. I sort of wish SDN was around in those days.

 

[flightnurse2MD]

How's CCM for anesthesiologists looking these days? I'm debating on whether or not a CCM fellowship would be worth it down the line.