Future/Career Outlook for Anesthesiologists/Radiologists/Emergency Med: Spec select

[8675309]

What do you think of these specialties and the job outlook for them in the future?
For instance, do you think there will be a shortage of Anesthesiologists/Radiologists/Emergency Med in the future? Which of these specialties would you choose to pursue and why?

Also, more importantly, what are some good websites, books, places to go and find information about career outlooks for the various medical specialties?

Thank you in advance

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[Pilot]

Anesthesiology - I concur, and I believe the outlook is dim for physician anethesiologists.

E.R. - still one of the fields I am considering. An E.R. doc friend (late 40's) told me that there are only so many acute OM you can look at before you get really bored with the job.

Radiology - another field I have been considering. However, I just listed to a C.E. course last month in which the speaker made an argument that there was no need for more than 5 radiologist in the entire country due to the computer advances. He cited a comapny in Dallas that has the capability to read all the CT's and MRI's for the nation currently. So, I don't know what the future holds in that field either.

I guess I will just be a cardiologist. There will always be geriatrics with heart problems.

 

[gasdoc]

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[This message has been edited by gasdoc (edited March 31, 2001).]

 

[WingZero]

Awww gasdoc, too bad you can't delete your posts, eh? I rather enjoyed reading your long defense of anesthesiology - too bad you chose to replace it with a resounding "."

I personally believe that anesthesiology is not in any immediate danger from CNRA's, but the salaries in gas will decrease once more people are drawn back into the field.

 

[gasdoc]

B/c of WingZero's encouragement, I have decided to relist my defense of anesthesia. I welcome both for/against arguments. Also, I think anesthesia salary will decrease proportional to other specialty salaries. Please look at the past when predicting the future. No matter what the payer keeps saying, they STILL reimburse the procedure specialties at a HIGHER rate. I rest my case.

As you can guess by my username, I am going into anesthesiology, so take these opinions accordings.
That said, I completely agree w/ Stinky Tofu and don't agree w/ Pilot.
1. Anesthesiology: Its true that CRNA's are always itching and actively seeking to get rid of the anesthesiologists, but MDs are here to stay b/c CRNA's may be able to do the simple cases involving relatively healthy patients, but what about all the complicated patients. Anyone in medical school would know about the VA patients and the rest of the elderly population. A cardiologist to-be should know about the dangers of heart conditions and surgery, to say the least. ALSO, HOW MANY OF YOU WOULD WANT YOURSELF OR YOUR GRANDMA TO HAVE A CRNA (WHO HAS 1 YEAR OF BASIC SCIENCE AND 1 YEAR OF CLINCAL ANESTHESIA TRAINING after their RN degree) vs. an anesthesiologist (who trains for 4 years of medical school followed by a 4 year residency, with the first year being a clincial internship taking care of patients in the wards as "real" doctors).
2nd point: Although CRNA's are competing w/ anesthesiologists and making the field "dim" (which I obviously don't agree) according to the Pilot, what about the nurse practitioners? They have the potential to bring down the primary care specialties, FP, general IM, and peds. But, I don't think they will. Also, what about optometrists and ophthalmologists? What about podiatrists and orthopedists? What about nurse midwives and ob/gyns? What about psychologists and psychiatrists? NEED I HARANGUE any more? Virtually every specialty in medicine is under threat b/c of cost savings and HMOs. So, Pilot, you think cardiology is safe? W/ cost cutting, more specialist services are being shifted to the primary physician. As I was also saying, geriatric patients need surgery (and anesthesiologists for their multiple conditions) as much as they need all the other doctors' services. Surgeries in this country is increasing yearly and getting more complicated. Good luck on having the CRNA take care of you!
3rd point: So called experts were heralding the fall of the anesthesiologists from this earth a few years back when everyone thought that HMOs would limit surgery and utilize CRNA's more and more. That is why in 1996, only like 50 or something US grads went into anesthesiology in a field that has >1000 spots a year. Everyone thought anesthesiology was a dead specialty. Guess what???? Hospitals cannot get enough anesthesiologists to fill their ORs today. Anesthesiology graduates are being offered some of the highest salaries of any specialties, including surgerical specialties. I won't quote the figures here.
4th point: If the future is so dim, why are more and more American grads going back into it??? Since 1996, there has been a huge increase in the number of American grads filling spots. In fact, during this past match, the rate was 89% of spots filling. The choice programs are being filled back w/ AMG's like during the past.
5th point: Specialties like anesthesiology, radiology and pathology, in general, are very cyclical specialties. There are years of immense competition when jobs are plentiful and years of noncompetition when there is a drought in jobs. Anesthesiology was one of the most competitive specialties to enter into in the 80s and is heading back that way. Radiology was easy to get into just 3 years ago and now you better be darn good to even land a community program spot. Pathology had a 8% increase in the last match.
5th point: For those 3rd year med students, I wouldn't let the CRNA situation worry you, b/c its been going on longer than both you and I have been alive and the CRNA's haven't gotten rid of the anesthsiologists yet. Anesthesiologists have always enjoyed some of the highest pay for doctors and has a great lifestyle, as does the radiologists. Also, contrary to what many doctors say, anesthesiologists are every bit as much a doctor as the next one. Do they no alleviate pain and suffering??? Do they not literally keep the patient alive during surgery? What more do you want from them? Why do you think insurance companies pay their high fees. Do you think they do it b/c they like anesthesiologists? I think not!
To go into another specialty w/o some foresight (and just tunnel vision) is being ignorant and depriving yourself one more opportunity to have a good life.

I for one has already matched into anesthesiology and am thrilled with it. To tell you the truth, it doesn't hurt me one bit if medical students shun away from the field b/c it just makes me in higher demand in the future. I am providing all those medical students that still haven't decided on a specialty a service here.
I AGREE THAT MONEY AND LIFESTYLE IS NOT EVERYTHING AND THAT WE NEED ALL OF THE SPECIALTIES, BUT IF YOU ENJOY RADIOLOGY OR ANESTHESIOLOGY, THERE IS NO NEED TO FEAR THEM B/C YOU THINK YOU WILL LOSE OUT LATER. The worst thing is going into a specialty you don't like b/c you think it will continue to do well. Go with what you like, first and foremost.
As you can guess by my username, I am going into anesthesiology, so take these opinions accordings.
That said, I completely agree w/ Stinky Tofu and don't agree w/ Pilot.
1. Anesthesiology: Its true that CRNA's are always itching and actively seeking to get rid of the anesthesiologists, but MDs are here to stay b/c CRNA's may be able to do the simple cases involving relatively healthy patients, but what about all the complicated patients. Anyone in medical school would know about the VA patients and the rest of the elderly population. A cardiologist to-be should know about the dangers of heart conditions and surgery, to say the least. ALSO, HOW MANY OF YOU WOULD WANT YOURSELF OR YOUR GRANDMA TO HAVE A CRNA (WHO HAS 1 YEAR OF BASIC SCIENCE AND 1 YEAR OF CLINCAL ANESTHESIA TRAINING after their RN degree) vs. an anesthesiologist (who trains for 4 years of medical school followed by a 4 year residency, with the first year being a clincial internship taking care of patients in the wards as "real" doctors).
2nd point: Although CRNA's are competing w/ anesthesiologists and making the field "dim" (which I obviously don't agree) according to the Pilot, what about the nurse practitioners? They have the potential to bring down the primary care specialties, FP, general IM, and peds. But, I don't think they will. Also, what about optometrists and ophthalmologists? What about podiatrists and orthopedists? What about nurse midwives and ob/gyns? What about psychologists and psychiatrists? NEED I HARANGUE any more? Virtually every specialty in medicine is under threat b/c of cost savings and HMOs. So, Pilot, you think cardiology is safe? W/ cost cutting, more specialist services are being shifted to the primary physician. As I was also saying, geriatric patients need surgery (and anesthesiologists for their multiple conditions) as much as they need all the other doctors' services. Surgeries in this country is increasing yearly and getting more complicated. Good luck on having the CRNA take care of you!
3rd point: So called experts were heralding the fall of the anesthesiologists from this earth a few years back when everyone thought that HMOs would limit surgery and utilize CRNA's more and more. That is why in 1996, only like 50 or something US grads went into anesthesiology in a field that has >1000 spots a year. Everyone thought anesthesiology was a dead specialty. Guess what???? Hospitals cannot get enough anesthesiologists to fill their ORs today. Anesthesiology graduates are being offered some of the highest salaries of any specialties, including surgerical specialties. I won't quote the figures here.
4th point: If the future is so dim, why are more and more American grads going back into it??? Since 1996, there has been a huge increase in the number of American grads filling spots. In fact, during this past match, the rate was 89% of spots filling. The choice programs are being filled back w/ AMG's like during the past.
5th point: Specialties like anesthesiology, radiology and pathology, in general, are very cyclical specialties. There are years of immense competition when jobs are plentiful and years of noncompetition when there is a drought in jobs. Anesthesiology was one of the most competitive specialties to enter into in the 80s and is heading back that way. Radiology was easy to get into just 3 years ago and now you better be darn good to even land a community program spot. Pathology had a 8% increase in the last match.
5th point: For those 3rd year med students, I wouldn't let the CRNA situation worry you, b/c its been going on longer than both you and I have been alive and the CRNA's haven't gotten rid of the anesthsiologists yet. Anesthesiologists have always enjoyed some of the highest pay for doctors and has a great lifestyle, as does the radiologists. Also, contrary to what many doctors say, anesthesiologists are every bit as much a doctor as the next one. Do they no alleviate pain and suffering??? Do they not literally keep the patient alive during surgery? What more do you want from them? Why do you think insurance companies pay their high fees. Do you think they do it b/c they like anesthesiologists? I think not!
To go into another specialty w/o some foresight (and just tunnel vision) is being ignorant and depriving yourself one more opportunity to have a good life.

I for one has already matched into anesthesiology and am thrilled with it. To tell you the truth, it doesn't hurt me one bit if medical students shun away from the field b/c it just makes me in higher demand in the future. I am providing all those medical students that still haven't decided on a specialty a service here.
I AGREE THAT MONEY AND LIFESTYLE IS NOT EVERYTHING AND THAT WE NEED ALL OF THE SPECIALTIES, BUT IF YOU ENJOY RADIOLOGY OR ANESTHESIOLOGY, THERE IS NO NEED TO FEAR THEM B/C YOU THINK YOU WILL LOSE OUT LATER. The worst thing is going into a specialty you don't like b/c you think it will continue to do well. Go with what you like, first and foremost.

 

[Pilot]

Gasdoc,

I hope you are right and I am wrong about the future of anesthesiology. My personal opinion is that CRNA's will be forced on patients instead of physicians for cost-cutting reasons. Why would an insurance company/government want to pay a physician more money for the same procedure done by a CRNA? I think OBRA '90 prohibits "two standards of care", and thus there cannot be two levels of reimbursement for the same procedure. Insurance companies and goverment certainly will not pay CRNA's more money just because physicians receive more.

I personally would never want a CRNA administering gas to me or any member of my family - the same will hold true for my patients if I have any say in the matter (which I probably will not). How many patients would be willing to pay an extra $1000 out of pocket? Not very many. And when Medicare begins to reimburse all providers at the CRNA rate, how many anesthesiologists will be satisfied?

If you look at my posts over the last year, you will see that I oppose prescribing authority by ARNP's, CRNA's, chiropracters, PA's, pharmacists, et. al. I oppose non-physician prescribing for the simple fact that eventually insurance companies will require that PA's and ARNP's will be the PCP instead of a physician. Rather than a physician deciding that a patient should see a specialist, the PA/ARNP will decide wether a patient's condition warrants seeing a general practitioner, who will then decide if a patient needs to see a specialist (with a lag time of days to months, depending on the HMO).

Think I'm wrong? Let's look back at the insurance industry over that past two decades. At one time, if a patient had a heart problem, he/she could go directly to a cardiologist. Now the patient must first go to a PCP, who must get approval from the insurance company for the patient to go to a cardiologist for a specific number of visits (and no more without prior authorization).

Incidentally, have you heard the CRNA ad that runs periodically on Rush Limbaugh's radio program promoting CRNA's in surgery? I haven't heard anything like that from the AMA or any anesthesiology specialty board.

 

[gasdoc]

You will need to go to the ASA site to find the full details. You are correct in many sense, but not all. The reason insurance companies have to pay anesthesiologists is b/c of SAFETY. CRNA's can do the simple cases, but not the complicated ones. Also, right now CRNAs have full backup when a procedure goes wrong. By the way, even simple cases involving health patients can go wrong, as everyone knows about the classicaly 'malignant hyperthermia.' Its not that insurance companies want to pay anesthesiologists, but safety forces them to. Also, the medicare plan to cut anesthesiologists had nothing to do w/ cost. They will reimburse either crna or anesthesiologists the same money for the procedure. so, there is no dual code. Also, the very well funded CRNAs (and President Clinton's mother was also a CRNA) heavily lobbied for the CRNA independence bill, which President passed 3 days before leaving office, w/ many other laws that has since been rescinded by President Bush for further review. But, anesthesiologists haven't lost yet b/c President Bush's secretary of health has suspended it for another 60 days to study the safety issue. The reason you don't hear anesthesiology ads is b/c the ASA is not as well funded or militant as the CRNA's. Doctors, as you know, are by nature very independent people and not well organized. For more information, check out www.asahq.com.

[This message has been edited by gasdoc (edited March 31, 2001).]

[This message has been edited by gasdoc (edited March 31, 2001).]

 

[Pilot]

Gasdoc,

I tried the site, but got a page not found. Very interesting about Clinton's mother. I had not ever heard this before.

As I said before, I sincerely hope I am wrong. I wish you success in your residency, and a long and fruitful career.

 

[gasdoc]

Hey Pilot, I am glad you are starting to pay attention. Thanks. Here's the CORRECT ASA site. All medical students can fight by clicking on this site an sending a preformed letter opposing the CRNA action. Remember, its easy to say that your specialty will be safe until the nurse pacticitioner takes away your office too.

http://www.asahq.org/homepageie.html

p.s. Hey Pilot, are you going into internal medicine since you are wanting to be a cardiologists (a great subspecialty), although you won't have time to spend all your money.

[This message has been edited by gasdoc (edited April 01, 2001).]

 

[Pilot]

Gasdoc,

I was always paying attention, I just don't agree. However, I went to website and filled out the form for your benefit (hopefully).

As to what I am going to be - who knows. A couple of cardiologists have tried to talk me out of it (18 hour workdays, etc.). ER interests me, but so does FP, peds, and radiology (worried about the future of that one as well). I've still got a few years to decide.

Best of Luck.

 

[Matt Norman]

Hmm. Perhaps with the computer/ communications technology avilible the need for radialogist will decrease. However, 5 radiologists for the entire nation. Come on this is stretching it a bit. I am an RN persueing med school. I currently work in the ER. I know that many times in our peak season the one radiologist covering our hospital and our sister hospital has a hard time keeping up. I agree that with the technology we will see fewer Rads covering more area. But even tese rads can't work 24/7 and they might want to take the occassional vacation. Furthermore, I can't speak for other hospitals, but I know that our hospital it currently acheing for more rads. Lastly, if all the rads went away, who would perform all these new and exciting interventional radiology procedures?? So, this is just my opinion but Rads are here to stay.



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