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Future anesthesia job market ?

Discussion in 'Anesthesiology' started by wtyson, Mar 25, 2014.

?

Do you recommend going into Anesthesia (projected residency graduation in 2019)

  1. Yes

    83 vote(s)
    38.1%
  2. No

    59 vote(s)
    27.1%
  3. not sure, too hard to predict

    78 vote(s)
    35.8%
Multiple votes are allowed.
  1. wtyson

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    So I am a 3rd year med student trying to pick a future specialty, and really liking anesthesia. however, I have been getting a lot of questions from family and friends (both medical and non), about whether the specialty is already saturated (now, and especially in 5 years when i would be looking for a job). I was hoping to find some sort of labor projections or labor need projections, as well as salary projections, but my research has been limited to the 2013 medscape data and older 2010-2011 data. I would really appreciate some advice, as I have to make my 4th year schedule pretty soon and start thinking of where I want to apply.

    Best

    Will
     
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  3. Wiscoblue

    Wiscoblue ASA Member

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    Will the future us bright for those who work hard and have good attitude.
     
  4. Per4mer8

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    Do. What. You. Like.

    Are we going to own our own practices or get hospital subsidies? Not likely. Should we expect even 400-500k/yr? Probably not on avg. Will the market be a little tight for at least a few years? Likely (though no one who wanted to go out on their own in my program has had any issues). Etc.

    Trying to guesstimate and pick a specialty based on the demand or the salary is a recipe for disaster. I know quite a few cardiologists that hate life because they went into the field because of the crazy money they made when they held the cath labs.....
     
  5. Per4mer8

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    Do. What. You. Like.

    Are we going to own our own practices or get hospital subsidies? Not likely. Should we expect even 400-500k/yr? Probably not on avg. Will the market be a little tight for at least a few years? Likely (though no one who wanted to go out on their own in my program has had any issues). Etc.

    Trying to guesstimate and pick a specialty based on the demand or the salary is a recipe for disaster. I know quite a few cardiologists that hate life because they went into the field because of the crazy money they made when they held the cath labs.....
     
  6. IanMcGalt

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    Should you expect even 250k? Probably, but not for long.
     
  7. IanMcGalt

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    Should you expect even 250k? Probably, but not for long.
     
  8. chudat

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    If 250k isn't expected anymore, I'm better off going into IM than anesthesia
     
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  9. chudat

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    Do you know what kind of money the new grads from your programs are getting?
     
  10. Per4mer8

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    Only a couple. 300+ to start. Seriously though, if you think you're better off doing IM for 250k than anesthesia I think you have your answer.

    I'd do anesthesia for 200k before I'd do IM for 400k
     
  11. Stank811

    Stank811 Junior Member

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    I had no problem finding a job...doesnt seem like groups are advertising as much as in the past. I feel that there will be plenting of jobs going forward. Aging population of this country will need surgeries. Pts will be more complex and require the same surgeries and thus will need anesthesiologist. The only question people are unable to answer is what healthcare will look like in 15 yrs....but that question resonates across all areas of medicine.
     
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  12. wolverine09

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    http://www.rand.org/pubs/research_briefs/RB9541/index1.html

    "The study's key finding is that the United States is currently experiencing a shortage of both Anesthesiologists and CRNAs, although this varies across regions and states. Under most scenarios, there will be a shortage of Anesthesiologists but a surplus of CRNAs by 2020. "
     
  13. pgg

    pgg Laugh at me, will they?
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    $250K is military anesthesiologist pay. I can't see the civilian mean really dropping below that. Maybe for mommy track jobs or people who MUST live in a few saturated highly competitive cities.
     
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  14. bronx43

    bronx43 Word.

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    I wouldn't trust any of these "projections," because there's apparently a dire shortage of everything... and we know that ain't true.
     
  15. chudat

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    For those of us who have matched into anesthesia, what do you suggest we do? Try to switch specialties?
     
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  17. Per4mer8

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    Dude, if you matched into anesthesia you did so because you like the field. Don't run for greener pastures based on what sdn says. I like sdn for its unbridled honesty as much as the next dude but I'm not letting a few people, attendings or not, ruin the field I LOVE. Every field has its issues, true. Most of the time many of these cant be appreciated until out in the real world I'll agree. But to let a minority sway your view so easily is concerning to me. No field is gonna be all dump trucks full of money and rainbows.
     
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  18. gas2014

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    You seem to doubt your career selection.

    http://www.fsahq.org/wp-content/uploads/2014/02/FSA_Survey.pdf

    Look at survey question number 16. When 750 people in the country's 3rd biggest state were surveyed regarding anesthesia care, a whopping NINETY-TWO percent (let me repeat...92) said they would prefer an anesthesiologist directing their anesthesia care. Only 6 percent (let me repeat...6) said they would prefer a nurse anesthetist.

    We have the overwhelming support of the public. If we lose the battle, we have nobody to blame but ourselves.
     
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  19. Knights

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    Become the best anesthesiologist possible. Join and become an active member in both your state society and ASA. Become educated on the issues. Don't sit on the sidelines and expect others to fight the battle for you. Write/call/e-mail your national and state representatives about important issues that impact the field, your patients, and your career. Advocate for your patients' safety. Educate your future co-residents on the issues, motivate them, and mobilize them to become as knowledgeable and politically active as you. Start paying more attention to local, state, and national politics. Vote.
     
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  20. pgg

    pgg Laugh at me, will they?
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    And donate to ASAPAC and your state PACs.

    It doesn't have to be a lot. With ASAPAC you can sign up to have $10 or $20 donated via credit card every month. It's easy, just do it.
     
  21. Yo GabbaPentin

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    Drop out and work at mcdonalds. I hear they might unionize and their hourly wage futures are looking up.

    I predict that anesthesia will be completely extinct by next January and that all surgery will be performed with no anesthesia at all. The good insurances will cover a fifth of whiskey for sedation.
     
  22. Dwindlin

    Dwindlin ASA Member

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    We just got a new group of hypnotists here that will be replacing the current anesthesia staff.
     
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  23. scudrunner

    scudrunner ASAPAC Supporter

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    SDN is a terrible place to ask for predictions. You will INVARIABLY get a negative doom and gloom response from 90%. I'm surprised our Chicken Little member hasn't chimed in yet. Go talk to docs in practice that you come into contact with if you want good info.

    Rotating through all of these other specialties as an intern has done nothing but reinforce my decision to go into anesthesia. I'd be a very unhappy person if I had ended up in most anything else, even for significantly more money.

    Bottom line, take fortune tellers on this board with a grain of salt. Make your own decisions and do what you want to do.
     
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  24. gasdoc77

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    5-years left 10 tops. Then again medicine will likely be an altogether different beast in 10.
     
  25. notyep06

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    Your posts are wonderful
     
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  26. sheeed

    sheeed ASA Member

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    You'll probably be an employee as opposed to someone working towards ownership in a group...that's something you could safely bet $100 on. Otherwise, it's hard to say what the actual numbers will look like.
     
  27. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    ROTFL. That's why most of Florida has an ACT model, because 92% prefer anesthesiologists. Overwhelming support, my overwhelming butt! They want a doctor because of malpractice issues and gut feeling; very few of them actually know and appreciate what we do, not to speak of paying extra for it.

    The question that should have been asked is: "Would you cancel your surgery if, the morning of surgery, you find out that you will be taken care of by a nurse anesthetist, under the supervision of an anesthesiologist who covers 3 other rooms?" A whopping 92% would answer no. :p In the last 5 years, I remember only one patient who did that. I never get the question: "How many ORs do you cover, doctor?"

    Our future is about as bright as Family Medicine's.
     
    #25 FFP, Mar 27, 2014
    Last edited: Mar 27, 2014
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  28. Stank811

    Stank811 Junior Member

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    FFP you are right when you say the general public has no idea what we do and most likely do not know what the difference is between a CRNA and a physician anesthesiologist. So educate them. If I created a commercial comparing hospital X with hospital Y. The commercial would state that your anesthetic at hospital x will be delivered by an anesthesiologist guaranteed and at hospital y it would most likely delivered by a nurse. The commercial would then follow with the stat that a anesthesiologist prevents 1 death for every thousand anesthetics. I would bet $100 that the surgical volume of hospital X would increase significantly. Obviously this is a bold example, but with increased patient education I have a feeling more and more patients would demand an anesthesiologist deliver their anesthetic.
     
  29. Yo GabbaPentin

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    I'm a big believer of investing in things when no one else is crazy enough to do so. A lot of the anesthesiologists who reaped serious rewards went into their residencies when no one else in their right minds would pick that field. Anesthesia hasn't hit rock bottom yet, but it's working it's way there.

    When I matched, times were very very good. When I graduated, things were not great at all. There is no saying what it will be like in 4+ years. If you like the field, then go into it. Keep your financial expectations low and you'll be alright.

    We might be driving Hondas instead of Mercedes. I'm ok with that because that's what I'd be driving even if I were pulling in 600k.
     
  30. BLADEMDA

    BLADEMDA ASA Member

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    Let me answer the OP's question in a straightforward manner:

    1. What other options do you have? Are your grades, scores and medical school good enough for Ortho for example?
    2. Do you mind being an employee for your career; that is, no partnership or ownership in your practice?
    3. Do you mind being told how to practice and in what manner?
    4. Do you want to do your own cases or supervise 5 CRNAS whose union claims that you are an unnecessary expense?
    5. Do you want the OPTION to earn more than an "average" wage in your specialty?
    6. Do you want to set your own schedule in terms of lifestyle, vacation, hours worked, etc?

    Anesthesia used to offer a lot more in terms of items 1-6 than it will in 2019. Unlike previous cycles there are many more medical school graduates DYING for any ACGME residency so the supply of available people won't be an issue for Residency programs. They will adapt to the new Paradigm of the specialty just like Pediatrics and Family Medicine have done the past 3 decades.

    Anesthesia offers stable employment and job opportunities as an Employee of Mednax or Sheridan in 2019. This type of job is decent pay ( low compared to the better specialties) with a reasonable lifestyle (5 weeks vacation). However, retirement plans are poor and benefits are mediocre at best.

    Anesthesiology is a reasonable choice for Med Students with limited options or a limited comprehension of the economic complexities of the specialty. That said, $350 is a decent wage but nowhere near the income other specialties offer for those willing to work hard.

    I have no doubt that many will be satisfied with the new paradigm of the field. Best of Luck.
     
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  31. bronx43

    bronx43 Word.

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    Not sure why ortho is touted as this goose that will forever lay the golden egg. There will inevitably be a paradigm shift in the medical industry in the coming decades, and there's no reason to believe that ortho, ent, or urology is somehow immune to it. They may be in a good position now, but this is all just squabbling over deck chairs on the Titanic.
     
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  32. DermViser

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    IM is non-competitive for a good reason.
     
  33. DermViser

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    This.
     
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  34. Baller MD

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    Maybe because they are smart when governing themselves by limiting their residency spots? And not letting nurses come anywhere close to their practice?
     
  35. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    DermViser, I'd do anesthesia even for a CRNA salary. It's not the money people should think about; it's the boss.

    If one likes to work in a corporate environment, where bean counters and paper pushers will dictate almost every single thing that one does, in an absurd "1984" manner, then anesthesia is the way. However, if one loves freedom, treating patients personally and being one's own boss, then there are better specialties, including IM. It's more difficult to survive in a small group nowadays, but not impossible (as long as one is happy with a lower income in exchange for increased freedom).

    I am still looking for the small anesthesia group that would value long-term freedom over AMC sellout money, and I have a feeling that I will never find it. The only way such a group could survive is by working for multiple independent surgical employers, which is more and more difficult given the ACA-encouraged consolidation, to the level of regional monopolies.

    Another thing to consider is the viability of a cash-only practice in the given specialty:
    http://www.theatlantic.com/health/archive/2014/03/doctors-and-tech-who-serves-whom/284518/
     
    #33 FFP, Mar 28, 2014
    Last edited: Mar 28, 2014
  36. gasdoc77

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    Echoing what many have said, if you read between the lines the money has nothing to do with it. Throughout your training and education you have had some degree of control over your destiny. As medicine changes, that does too. Anesthesia particularly has been commoditized by our predecessors and its allowed a "race to the bottom" looking for the least expensive vehicle to deliver the service. Most hospitals are administratively top heavy, a disproportionately large number of whom are nurses. They will slash and burn any expenses that they can't fully comprehend and if they can replace us with nurses, well winner winner chicken dinner! I hear talks of shortages. Impossible. Simply look at the numbers of crna's being pumped out. Surgery centers are almost uniformly moving to them. Each of these jobs is one position not filled by an MD. At least with some fields you have the security of knowing you could "hang a shingle". In anesthesia, groups want an assembly line so that the surgeons see the same techniques ie the same way every time. Now who better to fill that role. An MD or a CRNA?
     
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  37. BLADEMDA

    BLADEMDA ASA Member

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    This is where we fundamentally disagree. Specialties which are well compensated by CMS and bring patients to the hospital will do much better than specialties which are poorly compensated by CMS, e.g, anesthesia, and are viewed as an expense by administrators.
     
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  38. bronx43

    bronx43 Word.

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    You're assuming that fee-for-service and our current payment model will not change. Obviously, in the status quo, those getting better reimbursement is going to fare better, but my entire point was that our current system will change as it is grossly unsustainable.
     
  39. BLADEMDA

    BLADEMDA ASA Member

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    I agree the entire system will change and all Physicians take a hit. I just disagree with you on which Physicians suffer the most under the new system. Again, Ortho will fare much better than anesthesia under the new payment system.
     
  40. bronx43

    bronx43 Word.

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    Hard to make a blanket statement like that without actually describing the details of which payment model will come next, but I do agree that in most models, fields that bring patients to the hospital or clinic will fare better, but this isn't unique to ortho at all.
     
  41. MaximusD

    MaximusD Anatomically Incorrect
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    The only people that should care about "pay cuts" coming down the pikes are people already raking it in as anesthesiologists. For the rest of us, I'd hope, 250k-300k should look like plenty.
     
  42. pgg

    pgg Laugh at me, will they?
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    On the contrary, the ones already raking it in have the least to worry about. Or they should, if they've limited themselves to just one Ferrari and one wife and have saved in proportion to their incomes.

    It's not that $250K isn't plenty to live in a house with heat/AC and own a car that starts every time you turn the key. IMO, for newcomers who aren't living extravagant lifestyles, the difference between earning $250K and $400-500K isn't so much whether either is enough to live well while working ... it's the amount an aggressive saver can put away every year. It could be the difference between retiring at 50 and continuing to live just as well, or retiring at 65.

    I've posted before that anesthesia is the field I love for many reasons, and that I'd rather do it than most higher paying specialties with greater likelihood of continuing autonomy. But right now it's coming up on 5 AM and I'm in the hospital after getting paged at 3 AM, and I don't plan on doing this when I'm 65, much less 55. I'm tired and I've got a full day of cases starting at 7:30.

    My circumstances are different than most because I'm already employed by the federal government to the tune of about $250K/year (plus comprehensive benefits and a pension that'll pay me somewhere around an inflation-adjusted $60-70K/year until I die). I know that $250K is plenty to live on, because I live on it. (It's sure not riches with 3 kids and a stay-at-home mom, but it's plenty.) In a few years I'll retire from the .mil job, start collecting the pension, and get a job in the civilian world. The state of the anesthesia job market in the US then will concern me NOT because I'll be worried about having plenty of money to live on (no worries there), but because it could be the difference between hitting my retirement goals after working full time another 5-10 years ... or working full time another 10-20.

    $400K might mean the last 3 AM page of my life will be when I'm 55. $250K might mean it'll be when I'm 60.

    However long I end up working though, better anesthesia than ortho or IM or, well, anything else.


    Any amount of money can be spent every year though. I know an orthopod who's in his 70s, still working his ass off. When you've got a stable full of ex-wives and a jet to make payments on, you've got to work. I did a case with him last weekend (on a cocaine+ noncompliant morbidly obese patient with a pus'ing out neglected open fracture that'll never heal right) ... maybe he's a bazillionaire who just loooooves to operate, but having to work weekends and answer pages from the ER for Medi-Cal pay when I'm past 70 isn't my idea of success.
     
  43. BLADEMDA

    BLADEMDA ASA Member

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    Ortho is just one example. Other examples include ENT, Urology, neurosurgery, Retina, hand surgery, etc. All of which will fare better than anesthesia.

    The fact is CMS does not value anesthesia services and the reimbursement from the government reflects it. If you think any new system will alter this situation you are misguided.
     
  44. IanMcGalt

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    And don't forget partnership is disappearing. Even if you bill for plenty of money, you won't get it. AMC owners and group partners will extract as much of what you earn as they can. Even if our billing rates don't fall, your salary will fall while some douche takes the money you earn.

    That's what's bad about anesthesia. We have limited options if your unnecessary employer takes too much.
     
  45. dr doze

    dr doze To be able to forget means to sanity
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    I nominate this for all time wisest financial post on SDN Anesthesia.
     
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  46. aneftp

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    Don't think Mednax of Sheridan will be around (at least in their current model) in 2019.

    Reason: if the AANA claims MDs are an unnecessary expense supervising and adding no value. AANA should claim management companies add zero value as well in their overall cost savings movement.
     
  47. aneftp

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    AMCs won't be around if we got president hilary.
     
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  48. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    What??? Au contraire, mon ami.

    AFAIK, the first Obamacare-type healthcare reform was Hillary's pet project during the Clinton administration. It was nicknamed "Hillarycare".
     
    #46 FFP, Mar 28, 2014
    Last edited: Mar 28, 2014
  49. IanMcGalt

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    Are you trying to convince us to vote for Hillary?
     
  50. IanMcGalt

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    Wasn't that a single payor plan?
     
  51. FFP

    FFP Grunt, cog, body, pompous ass, pissant
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    I am too young to remember. :)
     
  52. msmith83

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    What about for an average student though, those aren't exactly options
     

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