Future anesthesia job market ?

[Jay K]

Short version: if you know you could go to either a top anesthesia program or a solid but not top ortho program and you'll become an attending around 2020, which would you pick?

My advice to him would be to go with orthopedics with a focus in hip/knee replacements, followed by spine if the former doesn't interest him.

That being said, I personally do not have an interest in orthopedics.

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[Baller MD]

Thanks to this forum I probably will not go into anesthesiology.

 

[Stank811]

As for anesthesia getting you prepared to do ICU via a Fellowship I totally agree.

Thanks to this forum I probably will not go into anesthesiology.

Haha…b/c of a couple voices that have been saying the same things for over a decade. Maybe some of the voices you are listening to have personal gains to be made by the ACT model or are part of the administration board of AMCs….or have significant time bias bc of regional pressures from AMC over the past couple years. If you are drawn to the practice of anesthesiology and feel you could have a passion for the specialty please don't base you decision off of this forum and do what you think you will love to do daily….if you are on the fence regarding anesthesiology and are choosing it bc of lifestyle and it is a specialty that pays alright then continue on your search for something you will enjoy doing daily. I have zero regrets with my decision to choose anesthesiology and still recommend it to medical students.

The hospital system I joined was historically all PP physician groups…over the past decade multiple groups have become employed by the hospital system….they include IM, cardiology, CT surgery, one GS practice, and most recently the orthopedic practice. The ER physicians are contracted through a management company. Midwife presence with multiple training programs. I was donating some blood over the weekend for a particular cause and the nursing checking me in began to go on and on how she was on call Sat night. She then began to tell me how she is training to be a midwife and she delivers babies under the supervision of a certified nurse midwife and they did not need any physicians to help. She then started to talk about outcome data regarding decreased CS rate with midwife delivery blah blah. My point is that every speciality is seeing the same pressures we are and often times individual opinions have regional variance.

 

[BuzzPhreed]

Thanks to this forum I probably will not go into anesthesiology.

Go into a surgical specialty. They are still the royalty of the medical field. Everyone else is becoming an order-taker. Everyone.

 

[BLADEMDA]

Thanks to this forum I probably will not go into anesthesiology.

What are your other options? Despite this thread Anesthesiology plus Fellowship is still a decent choice. However, if you cam match into Ortho or ENT then by all means do so.

 

[BuzzPhreed]

What are your other options? Despite this thread Anesthesiology plus Fellowship is still a decent choice. However, if you cam match into Ortho or ENT then by all means do so.

There is going to be a massive - and I mean massive - shortage of general surgeons in about 10 years. Hardish lifestyle. But you still get treated like royalty. Don't discount that either.

 

[BLADEMDA]

In summary: More patients, less money, more bureaucracy, less money, more CRNA providers, and less money. These are the challenges ObamaCare presents to anesthesiologists. Stay tuned. Legions of patients with ObamaCare cards will be knocking on hospital doors. The government is expecting enough anesthesiologists to sign up for ObamaCare contracts to make the new system successful. It’s impossible to tell what behaviors ObamaCare will incentivize. Each anesthesiologist has the benefit of 25+ years of education, and each anesthesiologist will make intelligent choices regarding their career and their time.

Bob Dylan once sang, “I ain’t gonna work on Maggie’s Farm no more.”

Time will tell if ObamaCare is Maggie’s Farm for physicians.

Richard Novak, MD

 

[BuzzPhreed]

Here's also the link to Novak's post. It's a VERY good read.

http://theanesthesiaconsultant.com/2014/02/14/obamacare-and-anesthesia/

 

[pgg]

Midwife presence with multiple training programs. I was donating some blood over the weekend for a particular cause and the nursing checking me in began to go on and on how she was on call Sat night. She then began to tell me how she is training to be a midwife and she delivers babies under the supervision of a certified nurse midwife and they did not need any physicians to help. She then started to talk about outcome data regarding decreased CS rate with midwife delivery blah blah.

There's no midlevel-true-believer like a midwife. Throw a doula in the mix and you can really get them riled up with an innocent comment about home deliveries.

 

[Laryngophed]

There's no midlevel-true-believer like a midwife. Throw a doula in the mix and you can really get them riled up with an innocent comment about home deliveries.

Walked into that particular fire trap, have ya?

 

[pgg]

Walked into that particular fire trap, have ya?

Oh, it was deliberate pot stirring, actually aimed more at screwing with the OB in the room. Getting the doula & midwife riled up was just a means to an end. I'm not just a smartass on the internet. Sometimes you've got to make your own fun.

 

[deleted171991]

Thanks to this forum I probably will not go into anesthesiology.

Then be nice and donate some tax-deductible money to the charity called SDN, would you?

 

[circulus vitios]

Go into a surgical specialty. They are still the royalty of the medical field. Everyone else is becoming an order-taker. Everyone.

The downside is you have to work like a ****ing slave through residency and for the rest of your life.

 

[deleted171991]

That's the downside of almost every good residency. Except that surgeons also have an upside.

 

[BLADEMDA]

A doula (/ˈduːlə/, also known as a labour coach[1] and originating from the Ancient Greek word δούλη meaning female slave),[2] is a nonmedical person who assists a woman before, during, or after childbirth, as well as her partner and/or family, by providing physical assistance, and emotional support.[3] The provision of continuous support during labour by doulas (as well as nurses, family, or friends) is associated with improved maternal and fetal health and a variety of other benefits.[4]

Certification and training is offered to doulas, though there is no oversight to their practice and the title can be used by anyone.[5] The goal of a doula is to ensure the mother feels safe and confident before, during, and after delivery.[6] Doulas can be controversial within medical settings due to pressure on mothers to avoid medical interventions in labor and pursue natural childbirth without an epidural or caesarean sections.[7]

 

[BLADEMDA]

The downside is you have to work like a ******* slave through residency and for the rest of your life.

Not true. Residency is 5-6 years long after which you can choose your hours and lifestyle. In fact, most surgical sub specialties work less than anesthesia and earn 50 percent more money.

Your view of practice is skewed by academics which isn't the real world

 

[Laryngophed]

Oh, it was deliberate pot stirring, actually aimed more at screwing with the OB in the room. Getting the doula & midwife riled up was just a means to an end. I'm not just a smartass on the internet. Sometimes you've got to make your own fun.

Haha! Did they politely request you return to your coffee and crossword?

 

[circulus vitios]

Not true. Residency is 5-6 years long after which you can choose your hours and lifestyle. In fact, most surgical sub specialties work less than anesthesia and earn 50 percent more money.

Your view of practice is skewed by academics which isn't the real world

The money claim is refuted by every physician compensation survey I've ever seen. I haven't seen any lifestyle studies so I can't refute the work hour claim, although I doubt it's true. You might be able to choose your hours and lifestyle, but you sure as hell won't be making making average surgical subspecialty incomes, which are still far below "50% more" than anesthesia income.

 

[deleted171991]

Maybe you haven't seen the latest anesthesia incomes.

 

[BLADEMDA]

The money claim is refuted by every physician compensation survey I've ever seen. I haven't seen any lifestyle studies so I can't refute the work hour claim, although I doubt it's true. You might be able to choose your hours and lifestyle, but you sure as hell won't be making making average surgical subspecialty incomes, which are still far below "50% more" than anesthesia income.

Those surveys are BS. You don't know what you don't know.

I've seen academic surveys for Cardiac Anesthesiologists which show 700K at the 90th percentile. Median over $400K. Academics. The survey is skewed high so those guys can pressure the chair for higher pay.

Anesthesia is skewed low as are the other specialties. We don't want the world to know what we really earn.

 

[BLADEMDA]

The money claim is refuted by every physician compensation survey I've ever seen. I haven't seen any lifestyle studies so I can't refute the work hour claim, although I doubt it's true. You might be able to choose your hours and lifestyle, but you sure as hell won't be making making average surgical subspecialty incomes, which are still far below "50% more" than anesthesia income.

You are ignorant. Anesthesia is heading towards $300K pretty quickly while any surgical sub specialty will still easily exceed $450K. Right now an ENT or Ortho surgeon would make 50 percent more than an anesthesia doc employed by an AMC.

Those that control the patients control the money.

 

[BuzzPhreed]

Those that control the patients control the money.

They certainly control the ass-kissing. You bring in the business, you get pretty much whatever you want. It's not just about the money either. All a surgeon has to do if they don't like something is say "fine I'll take my patients to the hospital down the street." It's amazing how fast mountains will move when they offer up that line. Depends on your market, of course.

 

[GasEmDee]

They certainly control the ass-kissing. You bring in the business, you get pretty much whatever you want. It's not just about the money either. All a surgeon has to do if they don't like something is say "fine I'll take my patients to the hospital down the street." It's amazing how fast mountains will move when they offer up that line. Depends on your market, of course.

This is absolutely true.

As an interesting side note though, I have seen several surgeons throw this tantrum at each hospital they went to. Ultimately, they ran out of places they could threaten to run to, and learned to play nice.

 

[DoctorDude]

You are ignorant. Anesthesia is heading towards $300K pretty quickly while any surgical sub specialty will still easily exceed $450K. Right now an ENT or Ortho surgeon would make 50 percent more than an anesthesia doc employed by an AMC.

Those that control the patients control the money.

Is 300k bad though? That still seems pretty good compared to surgeons even if they are at 450k. They went through more years of more rigorous training. They also have to deal with bs like clinic and rounding.

 

[Skip2myLou]

as a private practice attending who is employed by the group , I can live with 300k per year ... assuming I'm not on call q3 or 4. I never saw the money that there was 5 to 10 years ago and I backed out of a track because I saw the writing on the wall for future reimbursement.

 

[Random Anesthesiologist]

Is 300k bad though? That still seems pretty good compared to surgeons even if they are at 450k. They went through more years of more rigorous training. They also have to deal with bs like clinic and rounding.

A fellowship trained anesthesiologist and straight general surgeon train the same amount of years. They also chose the rounding and clinic, but then again some anesthesiologists "round" and/or have clinic, e.g. Pain med, ob, postop inpatient, etc.

 

[Planktonmd]

Well... it is refreshing when someone who is doing an anesthesia residency or planing to do so says that it's OK to make less money and that we are over paid!
In reality though... we are not overpaid and our job is pretty complicated and ****ty and that's why people tend to pay us lot's of money!

 

[IkeBoy18]

anyone have any ideas about rad onc vs anesthesia?

 

[pgg]

anyone have any ideas about rad onc vs anesthesia?

They'll all be unemployed 45 seconds after we find a cure for cancer?

 

[deleted171991]

They'll all be unemployed 45 seconds after we find a cure for cancer?

... but it will take another 45 years to find the cure for cancer.

 

[aneftp]

Not true. Residency is 5-6 years long after which you can choose your hours and lifestyle. In fact, most surgical sub specialties work less than anesthesia and earn 50 percent more money.

Your view of practice is skewed by academics which isn't the real world

Blade is a lot tougher for surgical subs than you think. Sure some who are lucky to have financial backing can still make great money working less.

But plastics you are close to 40 by the time you make real plastics money working less. Startup costs are well over $300k.

Same with optho sub. My friend barely clears 200k in Cali.

Another ortho oncologist does around $350k but she's works 55 plus hours a week. This is private practice.

The ortho guys are going to get their drastic cuts soon.

 

[pgg]

... but it will take another 45 years to find the cure for cancer.

Cold fusion too. And strong AI. Those things are always 50 years away. I bet we see cancer cured before we see either of those things, actually.

Wouldn't want to be a radiation oncologist the morning after we find something better than barbaric stuff like implanted radioactive pellets. I am, of course, speaking about 92% tongue-in-cheek.

 

[deleted171991]

Yeah, but the CRNAs are a reality, so right now rad onc looks way better than anesthesia (for the medical student contemplating which specialty).

 

[DocOk]

I am a long time lurker of the these forums. Just reading a lot of the post it seems that most attending physicians have issues with the standard of care of anesthesia. I was wondering why not change the standard of care in black and white practice guidelines as seen with the AHA and codes. If every surgical patient requires an ASA classifications why not stipulate a requirement of anesthesiologist supervision/ coordination of care during the perioperative period of ASA class 3-6 and E and physician supervison/coordination of class 1-2's?
ASA Physical Status 1# - A normal healthy patient
ASA Physical Status 2# - A patient with mild systemic disease
ASA Physical Status 3* - A patient with severe systemic disease
ASA Physical Status 4* - A patient with severe systemic disease that is a constant threat to life
ASA Physical Status 5 *- A moribund patient who is not expected to survive without the operation
ASA Physical Status 6 *- A declared brain-dead patient whose organs are being removed for donor purposes

#Require physician...... *-Require anesthesiolgoist.....

Just a question that crossed my mind. If you changes the pracice guidelines would the bean counters not want to avoid possible breaches of standard of care litigation?

 

[bronx43]

They'll all be unemployed 45 seconds after we find a cure for cancer?

F*** that, they'll be unemployed 45 seconds after we find something better than radiation - that's sooner than 45 years. At least with medical oncology, they have strong enough a base in medical management that any future treatment that isn't surgical in nature will go to them. You know your field can't adapt when the name of the field is the actual treatment modality, lol.

 

[naus]

F*** that, they'll be unemployed 45 seconds after we find something better than radiation - that's sooner than 45 years. At least with medical oncology, they have strong enough a base in medical management that any future treatment that isn't surgical in nature will go to them. You know your field can't adapt when the name of the field is the actual treatment modality, lol.

Agree with this. Rad onc is like CT surgery, one trick pony.

Anesthesia is heading towards $300K pretty quickly while any surgical sub specialty will still easily exceed $450K. Right now an ENT or Ortho surgeon would make 50 percent more than an anesthesia doc employed by an AMC.

A lot of ortho guys are coming out making $300k and working over 55 hrs, so if anesthesiology is going down to $300k, it's not a bad gig at all, yet.

 

[koreanguy]

well if you can't switch residency would you experienced guys recommend looking at pain...?

 

[gasdoc77]

I've seen several talk specifically about money/hours, but there's so much more to the equation. It's about having autonomy as a physician, some semblence of respect in the workplace, and security, assuming that exists in any field of medicine.
1. autonomy- you may be allowed to "play doctor" as long as the anesthesia you deliver is what the surgeon is expecting. they are trained to do everything the same way, every time while we are trained to treat each patient as an individual. The two can be directly contradictory. When they are, you will have to ask permission.
2. respect- you will be a second class citizen within the physician community. I've even had psychiatrists for whom I was doing ECT's that tell me specifically how many mg of propofol/succ they want "their" patient to have. Nobody has a clue what we do or how deep our knowledge is of physiology and critical care. Every day you can choose to argue your relevance until you are blue in the face, or quietly assimilate. You may go back and forth, but it's a battle that grows old. Furthermore, if you are in a model such as an AMC, an employed physician within a group hoping for "partner" (or maybe not even), or something similar, you will quietly assimilate.
3. Security- you can theorize all day about the dangers of other specialties, but our's is clear and present.

 

[BuzzPhreed]

I've seen several talk specifically about money/hours, but there's so much more to the equation. It's about having autonomy as a physician, some semblence of respect in the workplace, and security, assuming that exists in any field of medicine.
1. autonomy- you may be allowed to "play doctor" as long as the anesthesia you deliver is what the surgeon is expecting. they are trained to do everything the same way, every time while we are trained to treat each patient as an individual. The two can be directly contradictory. When they are, you will have to ask permission.
2. respect- you will be a second class citizen within the physician community. I've even had psychiatrists for whom I was doing ECT's that tell me specifically how many mg of propofol/succ they want "their" patient to have. Nobody has a clue what we do or how deep our knowledge is of physiology and critical care. Every day you can choose to argue your relevance until you are blue in the face, or quietly assimilate. You may go back and forth, but it's a battle that grows old. Furthermore, if you are in a model such as an AMC, an employed physician within a group hoping for "partner" (or maybe not even), or something similar, you will quietly assimilate.
3. Security- you can theorize all day about the dangers of other specialties, but our's is clear and present.

I agree with most of this. It also depends on how much you want to be a doormat and go with the flow. There is a right and wrong way to complain and assert yourself. Most anesthesiologists I've met simply don't want to rock the boat in a lot of cases and for a lot of reasons. They haven't met the patient until 15 minutes before they are ready to put them to sleep. So the respect to the surgeon who brought them there is due. Sometimes it's overdone though.

You develop a rapport. That takes time. That's also the best way to solidify relationships with surgeons and their patients. Obvious stuff, right? It doesn't mean joking about what was on Jimmy Fallon last night or who won the Braves vs. Dodgers game yesterday. It means knowing the patient and having a well-formed opinion about the case. Developing a rapport means you have a professional conversation with the surgeon about the patient before the case and say things like "I'm concerned about this" or "what do you think if we try this" if it falls outside the norm. Totally different than asking for permission. But the fact is a lot of anesthesiologists are ****ing lazy. Just ****ing lazy. And if you are perceived to be this way that will be the sense the surgeons have of you. And not just them but no one else will respect you either.

I was at my last job for only a short time. But in that short time I had surgeons circumventing some of the partners and coming to ask me what I thought should be done in certain cases. Why? Because I care about what I do and in the short time I was there it showed. A lot of those partners, especially the senior ones, didn't care anymore (if they ever did). They just wanted to let the CRNA sit in the room while they collected their big paycheck. ****ing lazy. If you actually show that you care you will change minds and people will see the value in what you provide. And that's how you get trust and autonomy. If someone asks you to do something that you think is unreasonable then with that rapport you will be able to tell them that it is unreasonable. And they will listen to you. You won't simply be an order taker. So many gas passers just don't get that. There is a dearth of true leadership in our field.

This kind of thing is what will be completely lost if the AMC model takes over. They are taking over. Dearth of leadership. Then what you say gasdoc77 will absolutely become the norm. Some psychiatrist will be telling you how to give anesthesia. Not because they know anything about what you actually do or how it might be done better. Just because this is what has always been done, this is what works, and "this is what I want you to do you interchangeable and unimportant 'provider'."

It's our own fault. ****ing laziness.

 

[msmith83]

Would it be risky to go into anesthesia with the plan on going into pain? With everything trending the way it is, it might become so competitive that it may be too risky to set as an end goal for the student who isn't as competitive as others


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[IanMcGalt]

Would it be risky to go into anesthesia with the plan on going into pain? With everything trending the way it is, it might become so competitive that it may be too risky to set as an end goal for the student who isn't as competitive as others


Sent from my iPad using SDN Mobile

I think the risk of pain is having orthopods and neurosurgeons do all the injections themselves since they often get the first crack at the patients.

 

[Pooh & Annie]

I think the risk of pain is having orthopods and neurosurgeons do all the injections themselves since they often get the first crack at the patients.

This is very far from being a concern of pain physicians.

 

[IanMcGalt]

This is very far from being a concern of pain physicians.

Ha ha. Good. The one's here should be cause those guys do more every month. Hopefully there's more than enough to go around- not for the people with pain, but for the docs.

 

[Consigliere]

Thanks to this forum I probably will not go into anesthesiology.

Great move! You seem like a good dude and I'd hate to see you make the same mistake I did.

 

[BLADEMDA]

In 2012 44% of graduating residents reported they were going to be EMPLOYEES of a company.

In 2013 62% of graduating residents said they were going to be EMPLOYEES of a company.

The % entering a partnership track has fallen dramatically to 38% in just 1 year.

Starting salaries are reported to be around $260K.

The trends are quite clear in this field.

 

[deleted171991]

Starting salaries are reported to be around $260K.

Not only that, but some places try to force you to either accept a lower salary on contract renewal, or they will hire a new grad.

 

[gasdoc1]

I've even had psychiatrists for whom I was doing ECT's that tell me specifically how many mg of propofol/succ they want "their" patient to have.

I am the first person to tell the surgeon that I will give the anesthesia that I believe is appropriate for the surgery they are doing, not him/her, but this is a unique situation. These patients have multiple ECT's and sometimes the length of the seizure activity is adequate and sometimes it is not. When it is not, this can usually be corrected by giving lower dose of meds. The psychiatrist has all that info in his notes from the patient's previous ECT's. Collaboration is necessary in deciding dosages for this procedure. So in this situation, it all depends on the WAY he is "collaborating" with you. In my facility, the psychiatrists treat us with respect, asking our opinion on dosages or changing sleep meds, methohexital vs etomidate, etc. But if a protocol has been working well for a patient, the psychiatrist may say to me "We have been using "X" and "Y" with great results on this patient." I'm not going to take it personally.

 

[IanMcGalt]

I am the first person to tell the surgeon that I will give the anesthesia that I believe is appropriate for the surgery they are doing, not him/her, but this is a unique situation. These patients have multiple ECT's and sometimes the length of the seizure activity is adequate and sometimes it is not. When it is not, this can usually be corrected by giving lower dose of meds. The psychiatrist has all that info in his notes from the patient's previous ECT's. Collaboration is necessary in deciding dosages for this procedure. So in this situation, it all depends on the WAY he is "collaborating" with you. In my facility, the psychiatrists treat us with respect, asking our opinion on dosages or changing sleep meds, methohexital vs etomidate, etc. But if a protocol has been working well for a patient, the psychiatrist may say to me "We have been using "X" and "Y" with great results on this patient." I'm not going to take it personally.

What if he writes '100mg propofol IV once' on an order sheet?

 

[deleted171991]

Unfortunately, this specialty is turning into a service industry, where we have multiple customers: the surgeon, the patient and the facility. Make any of them unhappy repeatedly, and your chances of keeping your position (or even finding another position within the same geographic area) diminish significantly. Because anesthesia is perceived as being almost 100% safe, all the complications and difficulties are not ascribed to the patients, but to the anesthesiologist. You are the one being difficult/incompetent etc. This is becoming the norm as institutional culture, especially as anesthesia becomes just a part of the surgical package, same as the scrub nurse or OR aid.

If it's a safety issue, the anesthesiologist can still win, but even when we win we lose. Pick your battles carefully. You are not in a position to take anything personally. This is not about good patient care anymore; this is all about your public image, smoke and mirrors.

I've seen several talk specifically about money/hours, but there's so much more to the equation. It's about having autonomy as a physician, some semblence of respect in the workplace, and security, assuming that exists in any field of medicine.

Unless you are making good money for the hospital and/or your employer (and all parts involved know it), there will be no autonomy, respect, or job security in the future.

 

[Lysinee]

2014 Medscape has anes as the 6th highest paying specialty at $338k, which probably includes benefits. Is it correct to assume new grads can't expect that salary in the beginning?