Future of Anesthesia (for med school class of 28' and beyond)

[NSB2288]

First year here wondering what the future of anesthesia will look like.

Will mid-level creep continue to rise and does that affect physician practice?

W-2 versus 1099 as a practicing anesthesiologist (which is "better")?

Do research pubs/presentations etc. help with negotiating positions out of residency?

Fellowship or just go straight to general anesthesia practice?

Anything else you guys think is important, thanks

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[mathezar]

Will mid-level creep continue to rise and does that affect physician practice?
No one can predict this. However be comforted in knowing there will always be a need for competent Anesthesiologists.

W-2 versus 1099 as a practicing anesthesiologist (which is "better")?
Balance benefits vs tax benefits. Compare and contrast both types of jobs to find what works best for you. It's not something you need to worry about until you're a CA3 looking at jobs.

Do research pubs/presentations etc. help with negotiating positions out of residency?
Out of all the jobs I sent my CV to out of residency, none of them asked for additional information on research. I did not apply to any academic jobs however.

Fellowship or just go straight to general anesthesia practice?
Do what you're passionate about. The General anesthesia market is very strong right now, but it certainly may change by the time we are in the 2030s.

 

[amyl]

yes. Depends. No. Depends.

1099 works for people who can play the tax game. W2 better for everyone else. I have mixed feelings on locums for new grads…. You really do learn the most on your first year out of residency than residency - you may not have the same learning experience doing locums.
When I was in residency many told me not to do cv unless I wanted to do academics as cv surgery would be dead in 10 years…. Yet here they are more than 10 years later still cutting open chests…. I wouldn’t worry about fellowship now. If you love some subspecialty or want to do academics do a fellowship - if not do general. The $ difference usually isn’t that different.
Things change quickly in anesthesia- I never could have predicted this market a couple years ago when they were shutting down elective surgeries. Anything - literally anything - could happen

 

[SRYSPAC]

Will mid-level creep continue to rise and does that affect physician practice?
No one knows; you are already in an anesthesiology residency so does it truly matter? Perhaps refer to your 4th question and my short answer.

W-2 versus 1099 as a practicing anesthesiologist (which is "better")?
Neither are "better." Why not both? The traditional, call-taking, vacation-lottery job is not all that exists out there.

Do research pubs/presentations etc. help with negotiating positions out of residency?
No. Academic attendings with 5+ years of publishing and presenting at multiple meetings a year without being promoted will tell you that anything you do in residency is worthless if you are doing it for a job, and not because you are passionate about it. Those that have lower bars for promotion couldn't care less what you published in residency. Please do not get the impression that anything you publish as a resident, unless you personally invent the next LMA, will help you negotiate a position out of residency.

Fellowship or just go straight to general anesthesia practice?
If you don't love a particular subspecialty of anesthesiology, go into practice as a general anesthesiologist, it's as simple as that. *MAYBE*, just *MAYBE* going into adult cardiothoracic, general pedi, or more likely pedi cardiac will give you some degree of protection from the mid-level creep you refer to.

 

[mdo1738]

First year here wondering what the future of anesthesia will look like.

Will mid-level creep continue to rise and does that affect physician practice?

W-2 versus 1099 as a practicing anesthesiologist (which is "better")?

Do research pubs/presentations etc. help with negotiating positions out of residency?

Fellowship or just go straight to general anesthesia practice?

Anything else you guys think is important, thanks

1. Mid-level creep will likely continue indefinitely. It would take significant systemic changes to keep creep down, and those changes are unlikely to happen. Thankfully, anesthesia is arguably the specialty where the battle between actual doctors and midlevels is most established. I don’t see anesthesiologists gaining ground, but at the same time we’re kind of at an equilibrium/stalemate where I don’t see CRNAs significantly gaining anything more than they have. Contrast that to other specialties where midlevels are largely new instead of having been around for 60+ years.

2. Not important until you’re looking at jobs, and it depends entirely on the particular job. Hard to beat a very high paying 1099 job, but you’ll have a lot of additional administrative work to do on your own if you’re 1099 instead of W2 (health insurance, taxes, etc).

3. I’m sure they help if you’re going for an academic (sh-itty) job.

4. Impossible to predict. Market for generalists is scorching hot currently, but that can change on a dime (2-3 years is a dime in medical terms). If you’re passionate about something, I would recommend doing it. I went into pain right as the market for general was taking off, and you would have to pay me $2.5 million a year to go back to general anesthesia.

 

[aneftp]

Med school class of 1990 was probably the greatest anesthesia class (those who finished in 1994/1995) training only to be hit with Hilarycare.

As for anesthesia class of 2032. Who knows. Many of the docs in their late 50s/early 60s will be retired or part time if they are bored by in 7 plus years.

I can’t image myself even working full time in 7 years. My kids will be in college or done with college by than. Barring a second wife or 3rd kid. There is no chance I see myself working full time in 2032.

So it depends how much the older generation wants to work. And also the current younger generation doesn’t want to work hard anymore. It’s just a trend

I see anesthesia going to primarily a shift schedule.

The days of working 7-whenever with a peel off system and calls q4/5 are gone in 90% of the USA.

We have night float docs q2 x 6/7 calls. We have weekend specialists (Friday /sunday calls docs making. Working 40 hrs for 500k)

 

[PpfSuxTube]

Shooting fish in a barrel kid. Keep on plugging away

 

[addoncase]

Just know the majority of CRNA’s don’t want to take any call, don’t want to work weekends, don’t want to work past 3pm ever, want to leave at 2:30pm. Also require a morning break and an afternoon break before their 2:30pm departure that’s expected to occur without question. God forbid they work an extra 5 minutes….
Oh and nights forget about that..
Hospitals are catching on

 

[NicholasPavona]

Just know the majority of CRNA’s don’t want to take any call, don’t want to work weekends, don’t want to work past 3pm ever, want to leave at 2:30pm. Also require a morning break and an afternoon break before their 2:30pm departure that’s expected to occur without question. God forbid they work an extra 5 minutes….
Oh and nights forget about that..
Hospitals are catching on

And what's wrong with this? Hospitals aren't catching on to sh_it. They are desperate for anesthesia coverage and will take what they can get.

 

[aneftp]

Just know the majority of CRNA’s don’t want to take any call, don’t want to work weekends, don’t want to work past 3pm ever, want to leave at 2:30pm. Also require a morning break and an afternoon break before their 2:30pm departure that’s expected to occur without question. God forbid they work an extra 5 minutes….
Oh and nights forget about that..
Hospitals are catching on

Crnas especially at trauma centers want to work the
24 hr
24 hr
24 hr
8 hr (call out sick those 8 hr)

As their 2 week schedule

Plus 8-10 weeks off

 

[aneftp]

Just know the majority of CRNA’s don’t want to take any call, don’t want to work weekends, don’t want to work past 3pm ever, want to leave at 2:30pm. Also require a morning break and an afternoon break before their 2:30pm departure that’s expected to occur without question. God forbid they work an extra 5 minutes….
Oh and nights forget about that..
Hospitals are catching on

The real issue is it’s difficult to find the traditional 7-3 m-Friday 5 days a week crnas

Those are almost non existent in Florida w2

 

[UscGhost]

Med school class of 1990 was probably the greatest anesthesia class (those who finished in 1994/1995) training only to be hit with Hilarycare.

As for anesthesia class of 2032. Who knows. Many of the docs in their late 50s/early 60s will be retired or part time if they are bored by in 7 plus years.

I can’t image myself even working full time in 7 years. My kids will be in college or done with college by than. Barring a second wife or 3rd kid. There is no chance I see myself working full time in 2032.

So it depends how much the older generation wants to work. And also the current younger generation doesn’t want to work hard anymore. It’s just a trend

I see anesthesia going to primarily a shift schedule.

The days of working 7-whenever with a peel off system and calls q4/5 are gone in 90% of the USA.

We have night float docs q2 x 6/7 calls. We have weekend specialists (Friday /sunday calls docs making. Working 40 hrs for 500k)

Greatest how?

The last 5-10 years of grads generally are much better academically than prior years.

Prior years full of FMGs, etc

 

[aneftp]

Greatest how?

The last 5-10 years of grads generally are much better academically than prior years.

Prior years full of FMGs, etc

Nah. Fmg were 1996-2002 primarily.

We are talking 1990. (Those finished in 1994) extremely competitive. Only around 900-1000 residency slots as well. There are like 1500 residency slots these days for anesthesia

I know my data

Med school admissions entering class of 1995-1996 were also the most competivd. 15k med school slots and 45k applications

These days there are 22-23k lcme med school slots and 58k applications. (20 new med schools opens from 2000. Prior was 1976? USF or Mercer med school up to 2000. A huge gap between new lcme med school

So everything is relative.

 

[A Deep Breath]

That’s interesting.

I was surprised when an attending who trained at a more prestigious program told me how impressed he was by the residents at mine.

He said we took our training much more seriously than the old days. He spent his residency focused on drinking at bars.

The timeline matches up with what sounds like a less competitive era.

 

[UscGhost]

Nah. Fmg were 1996-2002 primarily.

We are talking 1990. (Those finished in 1994) extremely competitive. Only around 900-1000 residency slots as well. There are like 1500 residency slots these days for anesthesia

I know my data

Med school admissions entering class of 1995-1996 were also the most competivd. 15k med school slots and 45k applications

These days there are 22-23k lcme med school slots and 58k applications. (20 new med schools opens from 2000. Prior was 1976? USF or Mercer med school up to 2000. A huge gap between new lcme med school

So everything is relative.

Quick Google search of avg gpa and step 1 scores in 2015 vs 1990

2015
3.7-3.8
230s

1990
3.5-3.7
220-230

According to available data, the medical school acceptance rate was significantly lower in 2015 compared to 1990, meaning it was harder to get into medical school in 2015; while exact figures vary depending on the source, around 2015 the acceptance rate was closer to 40%, while in 1990 it was likely closer to 50% or slightly higher


So Google seems to show that it was easier to get into medical school in 1990, lower GPA and lower step scores for anesthesia residency.

So no, 1990 wasn't a stronger class

 

[aneftp]

Quick Google search of avg gpa and step 1 scores in 2015 vs 1990

2015
3.7-3.8
230s

1990
3.5-3.7
220-230

According to available data, the medical school acceptance rate was significantly lower in 2015 compared to 1990, meaning it was harder to get into medical school in 2015; while exact figures vary depending on the source, around 2015 the acceptance rate was closer to 40%, while in 1990 it was likely closer to 50% or slightly higher


So Google seems to show that it was easier to get into medical school in 1990, lower GPA and lower step scores for anesthesia residency.

So no, 1990 wasn't a stronger class

Nope. Compare lcme slots.

Quick Google search of avg gpa and step 1 scores in 2015 vs 1990

2015
3.7-3.8
230s

1990
3.5-3.7
220-230

According to available data, the medical school acceptance rate was significantly lower in 2015 compared to 1990, meaning it was harder to get into medical school in 2015; while exact figures vary depending on the source, around 2015 the acceptance rate was closer to 40%, while in 1990 it was likely closer to 50% or slightly higher


So Google seems to show that it was easier to get into medical school in 1990, lower GPA and lower step scores for anesthesia residency.

So no, 1990 wasn't a stronger class

incorrect. I know my data and have posted this data numerous times

1995/1996 were the hardest years to get into med school. Than the applications tanked. Why? Simple. The tech boom lured many of the brightest to the tech industry from 1997-2000. Look how the applications tanked from 1996 to 2000

Look at the number of applicants to number of slots available

I’m giving you official aamc data.

https://www.aamc.org/media/8661/download

 

[UscGhost]

Nope. Compare lcme slots.

incorrect. I know my data and have posted this data numerous times

1995/1996 were the hardest years to get into med school. Than the applications tanked. Why? Simple. The tech boom lured many of the brightest to the tech industry from 1997-2000. Look how the applications tanked from 1996 to 2000

Look at the number of applicants to number of slots available

I’m giving you official aamc data.

https://www.aamc.org/media/8661/download

You said 1990.

And given that they had a lower GPA, lower test scores for the anesthesia residency specifically...I don't know what metric you are using to define best class.

Admission rates to medical school is very non specific

 

[Bertelman]

Med school admissions entering class of 1995-1996 were also the most competivd. 15k med school slots and 45k applications

Hah. I graduated college the following year. Not surprised to hear that.

 

[aneftp]

You said 1990.

And given that they had a lower GPA, lower test scores for the anesthesia residency specifically...I don't know what metric you are using to define best class.

Admission rates to medical school is very non specific

I need to fish out 1990 Anesthesia Match data. It was a very competitive match. Number of open slots vs filled

We are at peak anesthesia competitive again (2024 data)

Med school admissions rate. I was responding to your statement saying 2015 med school class entry was super competitive. It was not. The numbers don’t lie. 1995-1995-1997. Very hard years to get into med school. I didn’t say anything about 1990 med school admissions. (1989 entering med school class was the weakest in terms of completion (thats not on the aamc data, which is weird). I have a pretty bullet proof memory of numbers. I’m a numbers guy.

Regardless things go in cycles. The op asked what the outlook for anesthesia would be in 2032. I have no clue. Shoot me if im even working more 2-3 days week by than. I’d be close to 58. I don’t want to work full time pass the age 53/54.

I sense most docs will be w2 employed. Hospitals are so controlling and now that trump has won. The non compete ban won’t take place.

And envision trying is trying to make up some bs 75 miles radius rule for 1099 and want ur drivers license. Like wtf does 75 miles rule have to do with 1099. That even exceeds the normal irs 50 mile rules for real estate transactions for selling ur primary homes. Just shows u the envisions executives don’t even know the irs rules for what is considered a primary home. Clueless. And controlling

 

[UscGhost]

I need to fish out 1990 Anesthesia Match data. It was a very competitive match. Number of open slots vs filled

We are at peak anesthesia competitive again (2024 data)

Med school admissions rate. I was responding to your statement saying 2015 med school class entry was super competitive. It was not. The numbers don’t lie. 1995-1995-1997. Very hard years to get into med school. I didn’t say anything about 1990 med school admissions. (1989 entering med school class was the weakest in terms of completion (thats not on the aamc data, which is weird). I have a pretty bullet proof memory of numbers. I’m a numbers guy.

Regardless things go in cycles. The op asked what the outlook for anesthesia would be in 2032. I have no clue. Shoot me if im even working more 2-3 days week by than. I’d be close to 58. I don’t want to work full time pass the age 53/54.

I sense most docs will be w2 employed. Hospitals are so controlling and now that trump has won. The non compete ban won’t take place.

And envision trying is trying to make up some bs 75 miles radius rule for 1099 and want ur drivers license. Like wtf does 75 miles rule have to do with 1099. That even exceeds the normal irs 50 mile rules for real estate transactions for selling ur primary homes. Just shows u the envisions executives don’t even know the irs rules for what is considered a primary home. Clueless. And controlling

Not sure what "your" proprietary data is. But per Google, again, the 1990 anesthesia residency class had generally lower test scores and GPA than the 2015 class.

You said the "med school class of 1990 was the best anesthesia class". Per Google, the Gpa and step 1 scores don't support that assertion.

General med school admission rates, and even anesthesia residency match rates don't determine how good the class is. If there were only 10 spots and 100 applicants, and all 100 applicants got 3.0 GPAs with 220 step scores, I wouldn't call that a good class.

The only general measurable metric would be avg test scores, and avg gpa. You can get more detailed with that if you normalize it based on the historical trends in those scores

 

[aneftp]

Not sure what "your" proprietary data is. But per Google, again, the 1990 anesthesia residency class had generally lower test scores and GPA than the 2015 class.

You said the "med school class of 1990 was the best anesthesia class". Per Google, the Gpa and step 1 scores don't support that assertion.

General med school admission rates, and even anesthesia residency match rates don't determine how good the class is. If there were only 10 spots and 100 applicants, and all 100 applicants got 3.0 GPAs with 220 step scores, I wouldn't call that a good class.

The only general measurable metric would be avg test scores, and avg gpa. You can get more detailed with that if you normalize it based on the historical trends in those scores

Basically you are saying gpa and scores matter….

Just think what you just said

Think very hard what you just said.

 

[UscGhost]

Basically you are saying gpa and scores matter….

Just think what you just said

Think very hard what you just said.

Yes gpa and test scores specifically for the anesthesia residency class of 1990/1995 vs the class of 2015. SAT scores were higher for the 2015 class as well. Basically every academic metric was higher in the 2915 class

You referenced the 1990 anesthesia residency class as being the best. You havent provided any metrics specific to that residency class that supports your assertion. So I am not sure why you are having trouble with this.

Your only support for your argument was related to med school/residency acceptance rates. Those aren't directly correlated at all with how strong a class is...as shown in my example

It sounds more like the "they don't make them like they used to* argument that old people make

 

[aneftp]

Yes gpa and test scores specifically for the anesthesia residency class of 1990/1995 vs the class of 2015. SAT scores were higher for the 2015 class as well. Basically every academic metric was higher in the 2915 class

You referenced the 1990 anesthesia residency class as being the best. You havent provided any metrics specific to that residency class that supports your assertion. So I am not sure why you are having trouble with this.

Your only support for your argument was related to med school/residency acceptance rates. Those aren't directly correlated at all with how strong a class is...as shown in my example

It sounds more like the "they don't make them like they used to* argument that old people make

Sat scores are inflated we all know that.

Usmle scores inflated as well. It’s the percentile that matters the most. Look at the usmle “mean” scoring. The average mean has risen over the years.

You compete with ur cohort. People who know me know I live nba basketball. The mean scoring in nba has risen over the last 30 years. So LeBron James averaging 28 points a game in 2022/3 sounds great on paper. But overall nba scoring is up. Everyone is scoring at a higher rate

That’s how usmle scoring is these days. A good usmle 1 score 25 years ago was 230-235. Now it’s pretty average. Same with inflated sat scoring.

As for residency training. It’s a matter of dilution. We all seen expansion of residency into hca programs. Just like mlb expansion. You dilute the talent pool. And some residents aren’t getting the same training due to dilution of talent.

 

[UscGhost]

Sat scores are inflated we all know that.

Usmle scores inflated as well. It’s the percentile that matters the most. Look at the usmle “mean” scoring. The average mean has risen over the years.

You compete with ur cohort. People who know me know I live nba basketball. The mean scoring in nba has risen over the last 30 years. So LeBron James averaging 28 points a game in 2022/3 sounds great on paper. But overall nba scoring is up. Everyone is scoring at a higher rate

That’s how usmle scoring is these days. A good usmle 1 score 25 years ago was 230-235. Now it’s pretty average. Same with inflated sat scoring.

As for residency training. It’s a matter of dilution. We all seen expansion of residency into hca programs. Just like mlb expansion. You dilute the talent pool. And some residents aren’t getting the same training due to dilution of talent.

Inflated by what?

You have two options. One, the candidates are smarter and more prepared in 2015 which would cause their scores to increase across multiple different exams as well as GPA

Or option 2. Somehow the scoring or questions got easier for SAT and Step 1, despite being completely different exams made by different companies and somehow college also got easier across the country to allow for higher GPAs.
Seems pretty implausible.

The simplest answer is that the candidates in med school and residency are better now than before. As expected

 

[aneftp]

Inflated by what?

You have two options. One, the candidates are smarter and more prepared in 2015 which would cause their scores to increase across multiple different exams as well as GPA

Or option 2. Somehow the scoring or questions got easier for SAT and Step 1, despite being completely different exams made by different companies and somehow college also got easier across the country to allow for higher GPAs.
Seems pretty implausible.

The simplest answer is that the candidates in med school and residency are better now than before. As expected

If u say so.

Cohorts compete with each other.

The one point I will agree with you is students are better prepared to take tests. There is definitely more resources available (for those who take advantage of it) to maximize scoring

Just like how nba “metrics” have been inflated by the 3 points scoring systems. Players have figured it’s better to jack up more 3 points shots to score more n

I would not say candidates are better though. Many are weak minded. Can’t handle the pressure. Complain and entitled. Many of the older colleagues will agree with me. These residents these days would die working 120 hours a week because they aren’t prepare to work like that. The mentality is different for sure.

 

[aneftp]

Inflated by what?

You have two options. One, the candidates are smarter and more prepared in 2015 which would cause their scores to increase across multiple different exams as well as GPA

Or option 2. Somehow the scoring or questions got easier for SAT and Step 1, despite being completely different exams made by different companies and somehow college also got easier across the country to allow for higher GPAs.
Seems pretty implausible.

The simplest answer is that the candidates in med school and residency are better now than before. As expected

Also when you compare 1990 data and 2024 data.

The percent of us med students who match in anesthesia compared to non us seniors.

1990 had a 90% us seniors matching in anesthesia (out of all slots)

2024 had 70% of us seniors matching anesthesia (out of all anesthesia slots)

The data is there for the world to see. It just shows you more non us seniors want to get into anesthesia in 2024 and “competing” with us seniors

So your data point about non us seniors is also incorrect.

Obviously 2024 was a tremendous match for anesthesia but us seniors are getting pushed aside by non us seniors in obtaining those coveted slots. Thus accounting for zero open positions.

This is also a telling sign nrmp is not favoring us seniors in the match and letting more fmg into anesthesia

https://www.nrmp.org/wp-content/uploads/2021/07/resultsanddata1990.pdf

https://www.nrmp.org/wp-content/uploads/2024/07/2024-Main-Match-Results-and-Data-Final.pdf

 

[NSB2288]

Sat scores are inflated we all know that.

Usmle scores inflated as well. It’s the percentile that matters the most. Look at the usmle “mean” scoring. The average mean has risen over the years.

You compete with ur cohort. People who know me know I live nba basketball. The mean scoring in nba has risen over the last 30 years. So LeBron James averaging 28 points a game in 2022/3 sounds great on paper. But overall nba scoring is up. Everyone is scoring at a higher rate

That’s how usmle scoring is these days. A good usmle 1 score 25 years ago was 230-235. Now it’s pretty average. Same with inflated sat scoring.

As for residency training. It’s a matter of dilution. We all seen expansion of residency into hca programs. Just like mlb expansion. You dilute the talent pool. And some residents aren’t getting the same training due to dilution of talent.

Guys I asked about the future of anesthesiology, not for a USMLE Lebron scoring analogy.

 

[aneftp]

Guys I asked about the future of anesthesiology, not for a USMLE Lebron scoring analogy.

Things can change in a hurry. That’s the answer for you. What you are asking the future of anesthesia 7-8 years in the future

Remember Covid changed everything in anesthesia. People were sick and tired of management companies temporarily cutting salaries by 30% in April and May of 2020. That pissed a ton of people off

Than crazy money was handed to those who wanted to work in New York and other places during Covid.

Anesthesia goes in cycles. 1995-1999 likely very bleaked years for the job market.

2014-2018 also very bleak years for new grads entering the job market.

What’s in store for 2032? My best guess is 90% of us will likely be employed by w2 amc, or hospitals in big cities.

I also think we will go more to an EM style shift model. with docs doing solo cases 7-3 along with independent crnas doing their own cases.

The analytics of almost every hospital or amc (it’s crazy how they use analytics without thinking how the real world works) is to try to keep salaries standard across the board.

We are just like chickens all following in line. That’s what they want u to be.

 

[UscGhost]

If u say so.

Cohorts compete with each other.

The one point I will agree with you is students are better prepared to take tests. There is definitely more resources available (for those who take advantage of it) to maximize scoring

Just like how nba “metrics” have been inflated by the 3 points scoring systems. Players have figured it’s better to jack up more 3 points shots to score more n

I would not say candidates are better though. Many are weak minded. Can’t handle the pressure. Complain and entitled. Many of the older colleagues will agree with me. These residents these days would die working 120 hours a week because they aren’t prepare to work like that. The mentality is different for sure.

Yes, cohorts of less qualified applicants in 1995

It's the usual old person mentality that their generation was the best. Meanwhile, the younger generations have to deal with the mess they got handed.

The older generations of residents never should have set the precedent that allowed residents to work 100 hour weeks, while getting paid less than minimum wage. Dont blame the residents now because they want reasonable hours for reasonable pay. Residents back then got snookered

 

[aneftp]

Yes, cohorts of less qualified applicants in 1995

It's the usual old person mentality that their generation was the best. Meanwhile, the younger generations have to deal with the mess they got handed.

The older generations of residents never should have set the precedent that allowed residents to work 100 hour weeks, while getting paid less than minimum wage. Dont blame the residents now because they want reasonable hours for reasonable pay. Residents back then got snookered

If u say so. Increased med school slots dilutes talent pools. Like anything in life. Can u image if nba teams expanded their roster. The players would be getting better. U Would have more players in the nba most of whom wouldn’t make it if the roster or expansion didn’t happen

Med school will become like law schools with expansion and admissions

Why do u think derm and rad onc keep their slots low. It’s by design. Less spots. Higher demand.

 

[Coffee PRN]

Look, if I had a crystal ball, I wouldn’t be an anesthesiologist.

 

[DrN2O]

Look, if I had a crystal ball, I wouldn’t be an anesthesiologist.

After sitting in a driver-less taxi, I wonder if I just saw that crystal ball. Robot is coming for us. It already drives better than half the people on the road. Get someone to put in an IV and hook it up, put the tube in and 99% of the skin to skin work can be done by the machine. Patients don't care about your bedside manner under anesthesia. I bet the robot can have a killer playlist, laugh at surgeons' jokes, and won't tell them off.

 

[UscGhost]

If u say so. Increased med school slots dilutes talent pools. Like anything in life. Can u image if nba teams expanded their roster. The players would be getting better. U Would have more players in the nba most of whom wouldn’t make it if the roster or expansion didn’t happen

Med school will become like law schools with expansion and admissions

Why do u think derm and rad onc keep their slots low. It’s by design. Less spots. Higher demand.

Not necessarily. Population increases, talent pool increased in size, increased need for physicians, etc. also have to match med school slots to resident slots, residency slots depend on medicare funding

If talent pool was diluted, then GPA and average test scores would drop.

Derm and radiology keep slots low to increase salaries, which subsequently increases interest in the field.

If interest in medicine decreases, then admission criteria will decrease, scores and GPA will drop accordingly. Med school these days is much harder to get into. Kids have to have great scores, GPA and extracurr

 

[pgg]

Quick Google search of avg gpa and step 1 scores in 2015 vs 1990

2015
3.7-3.8
230s

1990
3.5-3.7
220-230

According to available data, the medical school acceptance rate was significantly lower in 2015 compared to 1990, meaning it was harder to get into medical school in 2015; while exact figures vary depending on the source, around 2015 the acceptance rate was closer to 40%, while in 1990 it was likely closer to 50% or slightly higher


So Google seems to show that it was easier to get into medical school in 1990, lower GPA and lower step scores for anesthesia residency.

So no, 1990 wasn't a stronger class

Steps scores from the 90s aren't comparable to step scores from the 10s.

It's like trying to compare MCAT or SAT scores from different eras. If we had %-ile data that'd be useful. Simple numbers are harder to compare across years.

Moreover, there's been significant (absolute) score inflation on steps and specialty board exams in the last decade or so because of the invention and widespread use of question banks.

 

[pgg]

Guys I asked about the future of anesthesiology, not for a USMLE Lebron scoring analogy.

Welcome to the internet! 😉

Threads drift. Also, we have this "future of the specialty" thread every month or so.

 

[UscGhost]

Steps scores from the 90s aren't comparable to step scores from the 10s.

It's like trying to compare MCAT or SAT scores from different eras. If we had %-ile data that'd be useful. Simple numbers are harder to compare across years.

Moreover, there's been significant (absolute) score inflation on steps and specialty board exams in the last decade or so because of the invention and widespread use of question banks.

Certainly a plausible argument. I would counter that with the fact that GPAs and SAT, ACTs scores have also risen. Harder to say q banks affect GPA.

I would also counter that the exams are far more difficult now as the sheer amount of tested information is much greater now than 30 years ago. Alot has been discovered since then.

 

[aneftp]

Steps scores from the 90s aren't comparable to step scores from the 10s.

It's like trying to compare MCAT or SAT scores from different eras. If we had %-ile data that'd be useful. Simple numbers are harder to compare across years.

Moreover, there's been significant (absolute) score inflation on steps and specialty board exams in the last decade or so because of the invention and widespread use of question banks.

These kids on this message board in their early 30s to mid 30s)these days have recency bias.

Not all but many. Especially when I try to explain to them cohorts and completion and numbers.

And you are correct. With the internet and sharing of testing strategies and questions. There are only so many versions of the same questions test makers can compose. So it makes the test easier to pass these days.

I know I was in college in the early 90s and had access to old college tests from fraternities even my other friends fraternities Made some of the tests so easy.

The modern internet was in early early stages.
Many of the 30s something year old never heard of compuserve or prodigy internet services. Excite was one of the main internet portals. Question banks are readily available to test takers these days.

I use nba basketball examples because even my 14 yo son thinks LeBron is the best. And I’m like u never seen Jordan play. And before that was magic Dr J and Larry bird. Just different eras. Different rules.

 

[Dr. Rude]

Depends on how you look at it. Circa 1990, I went to one of the half a dozen residencies that were on everyone's short list for "best in the country" There was usually one MD-PhD in each class and lots of name brand college and med school credentials in the residency trainee groups. Conversely there were also lots of unfilled slots in anesthesia across the country in the less competitive programs. I suspect that there are just many killer CVs in the A-list super competitive residency programs of today and very few unfilled slots today.
Ranking a few Anesthesia programs was not uncommon as a backup for would be ophthalmology, dermatology, surgery wannabes. Not sure how great these docs turned out to be at anesthesia. Things went to **** for a few matches in the mid 90s. Fast.

I don't know if anybody can even apply to more than one specialty during one year today.

 

[Bertelman]

The older generations of residents never should have set the precedent that allowed residents to work 100 hour weeks, while getting paid less than minimum wage. Dont blame the residents now because they want reasonable hours for reasonable pay. Residents back then got snookered

"set the precedent"?

You understand that's where the term "resident" originated, right? Training physicians literally lived in the hospital. The precedent was set 100 years ago. Multiple generations.

 

[Dr. Rude]

"set the precedent"?

You understand that's where the term "resident" originated, right? Training physicians literally lived in the hospital. The precedent was set 100 years ago. Multiple generations.

Dictionary
Definitions from Oxford Languages · Learn more

in·tern
verb
past tense: interned; past participle: interned

1. 1.
   confine (someone) as a prisoner, especially for political or military reasons.
   "the family were interned for the duration of the war as enemy aliens"
   
   Similar:
   imprison
   incarcerate
   impound
2. jail
   put in jail
   put behind bars
   detain
   take into custody
   
   hold in custody
   hold captive
   hold
   
   
   lock up
   
   
   keep under lock and key
   
   
   confine
   
   
   put away
   
   
   
3. 
   2.
   NORTH AMERICAN
   serve as an intern.

 

[IlDestriero]

Guys I asked about the future of anesthesiology, not for a USMLE Lebron scoring analogy.

The anesthesia history lesson nobody wanted. It is ok to argue in PMs. 😆
Sometimes I do wonder how I got admitted to a highly regarded medical school though, especially at that time. It was rough out there. My premed advisor told me to be a dentist…

 

[UscGhost]

"set the precedent"?

You understand that's where the term "resident" originated, right? Training physicians literally lived in the hospital. The precedent was set 100 years ago. Multiple generations.

Yup.

And then each generation of physicians continued it until recently. The older physicians, like aneftp, chalked it up to "well in my day, we had to work 100 hrs so you should too" or "new residents can't handle what we did" and they fought and criticized the new residents who sought change.

Now the residents have obtained hours reductions, improved pay and benefits but there is still a long ways to go. Hospitals make tons of money off the residents and then act like the residents are lucky to be working for minimum wage, while trying to pay off 409k in loans, only to graduate into a system that cuts physician pay each year.

Just sayin

 

[nimbus]

The anesthesia history lesson nobody wanted. It is ok to argue in PMs. 😆
Sometimes I do wonder how I got admitted to a highly regarded medical school though, especially at that time. It was rough out there. My premed advisor told me to be a dentist…

I think it’s harder now to get into medical school than it’s ever been.

Most people in my generation went straight from undergrad to med school. All you needed were a decent GPA from a reputable undergrad and decent MCAT scores. Nobody spent years scribing or working in a lab after graduating college. I don’t know if I would have jumped through the hoops required be admitted to medical school nowadays and I’m almost 100% sure that I would have been rejected from the med school I attended.

 

[pgg]

With the internet and sharing of testing strategies and questions. There are only so many versions of the same questions test makers can compose. So it makes the test easier to pass these days.

That's key.

2009 when I was studying for the anesthesia boards there were no online question banks. Closest thing was a paperback review book by Hall with about 1000 questions plus explanations.

The ABA had released three exams from the 1990s with the answer key (no explanations). Almost 1000 questions total. I digitized them for myself and my class and put them on the internet in a very simple test format. Click through a few at a time, save your progress. Nothing special but there were no commercial options. I absolutely destroyed the ITEs and anesthesia written, and while I think I'm a clever guy I don't think my total medical knowledge was exceptional. (My USMLE scores were below the mean.)

As you say, there are only so many things they can ask on the exam ... at least until they started adding non-anesthesia fluff. 🙂

Before people could grind through a couple thousand board questions until they could pattern match / recognize the idea being tested on sight, the way to prep was Big Blue and ranger runs and coffee by the campfire with Niels Jensen.

I know there are people who never cracked a textbook in residency, just slogged through qbanks and passed or even smoked the written exams.

Remember that First Aid For the USMLE review book? Prep materials are enormously better now.

 

[aneftp]

That's key.

2009 when I was studying for the anesthesia boards there were no online question banks. Closest thing was a paperback review book by Hall with about 1000 questions plus explanations.

The ABA had released three exams from the 1990s with the answer key (no explanations). Almost 1000 questions total. I digitized them for myself and my class and put them on the internet in a very simple test format. Click through a few at a time, save your progress. Nothing special but there were no commercial options. I absolutely destroyed the ITEs and anesthesia written, and while I think I'm a clever guy I don't think my total medical knowledge was exceptional. (My USMLE scores were below the mean.)

As you say, there are only so many things they can ask on the exam ... at least until they started adding non-anesthesia fluff. 🙂

Before people could grind through a couple thousand board questions until they could pattern match / recognize the idea being tested on sight, the way to prep was Big Blue and ranger runs and coffee by the campfire with Niels Jensen.

I know there are people who never cracked a textbook in residency, just slogged through qbanks and passed or even smoked the written exams.

Remember that First Aid For the USMLE review book? Prep materials are enormously better now.

Yeah. My sister wrote one of the chapters for first aid from ucsf. What a gang those med school classes.

One of the ucsf classmates committed suicide as their 20 year reunion was taking place.

 

[buddababa]

Many of the 30s something year old never heard of compuserve or prodigy internet services. Excite was one of the main internet portals. Question banks are readily available to test takers these days.

miss those days, and that dial up tone, 50/50 chance it would connect to the interwebs or BB

 

[UscGhost]

That's key.

2009 when I was studying for the anesthesia boards there were no online question banks. Closest thing was a paperback review book by Hall with about 1000 questions plus explanations.

The ABA had released three exams from the 1990s with the answer key (no explanations). Almost 1000 questions total. I digitized them for myself and my class and put them on the internet in a very simple test format. Click through a few at a time, save your progress. Nothing special but there were no commercial options. I absolutely destroyed the ITEs and anesthesia written, and while I think I'm a clever guy I don't think my total medical knowledge was exceptional. (My USMLE scores were below the mean.)

As you say, there are only so many things they can ask on the exam ... at least until they started adding non-anesthesia fluff. 🙂

Before people could grind through a couple thousand board questions until they could pattern match / recognize the idea being tested on sight, the way to prep was Big Blue and ranger runs and coffee by the campfire with Niels Jensen.

I know there are people who never cracked a textbook in residency, just slogged through qbanks and passed or even smoked the written exams.

Remember that First Aid For the USMLE review book? Prep materials are enormously better now.

It's an arms race. Qbanks help you study and teach you the facts and improve your ability to recall the information. It doesn't reduce the amount of knowledge you need to acquire. The test makers have to normalize the exams in order to make the results consistent and fit that nice bell curve. They know the percentages of which questions people get correct/wrong and adjust the test.

Can't have an exam that too many pass or fail.

But the sheer amount on new information generated in the last 30 years, plus the fact that you need a ton of extracurriculars makes it significantly more difficult to get in to medical school these days.

If you don't play orchestra level violin and build clinics in Somalia, goodluck getting in.

 

[secretasianman]

And when you finally start to practice, you get to participate in the racket that is med license fees, moc, cme.

Meanwhile you can just do nursing, get straight As in their sham watered down basic science courses, write a bunch of bs leadership papers, and go to np school to do derm or hop around specialties q3 months, all with little to no repercussion for harming patients or even just providing shoddy watered down care. Whole system is stupid.

It's an arms race. Qbanks help you study and teach you the facts and improve your ability to recall the information. It doesn't reduce the amount of knowledge you need to acquire. The test makers have to normalize the exams in order to make the results consistent and fit that nice bell curve. They know the percentages of which questions people get correct/wrong and adjust the test.

Can't have an exam that too many pass or fail.

But the sheer amount on new information generated in the last 30 years, plus the fact that you need a ton of extracurriculars makes it significantly more difficult to get in to medical school these days.

If you don't play orchestra level violin and build clinics in Somalia, goodluck getting in.

 

[NightyNight]

Mid level creep is never going away. It will just be a balance of how surgeries will grow in volume versus providers who retire. Thankfully CAAs will grow so we can mitigate this independent nonsense where anesthesiologists primarily are employed to be firefighters.

Do a fellowship because it actually is interesting to you. The money difference is not as much when you account for the extra call (at least from my discussion with locals).

Your first job should be a W2 job in an environment that values consistency and has veterans to help you through tough situations. No surgery centers or places doing only brain dead ASA 1 cases. No 100% supervision EVER! After about three years of gaining some wisdom, you can decide on something more lifestyle oriented whether that’s 1099 or W2.

I decided that I still want to do my own cases and my own blocks. I don’t want to supervise 4 CRNAs. That’s my take back in 2010 and still now.

 

[Bertelman]

Yup.

And then each generation of physicians continued it until recently. The older physicians, like aneftp, chalked it up to "well in my day, we had to work 100 hrs so you should too" or "new residents can't handle what we did" and they fought and criticized the new residents who sought change.

Now the residents have obtained hours reductions, improved pay and benefits but there is still a long ways to go. Hospitals make tons of money off the residents and then act like the residents are lucky to be working for minimum wage, while trying to pay off 409k in loans, only to graduate into a system that cuts physician pay each year.

Just sayin

I'm not sure what you mean by "recently", and I can't to speak for aneftp. But work hour restrictions came in 2003, put forth by the ACGME. in 2003, leaders of the ACGME were probably in their 50's. You should thank them in their retirement homes. Prior to that, the first work hour restrictions came in 1987. I'm not sure there are any lurkers on this board that trained before 1987. I can tell you I was an MS-3 in 2003. We weren't picketing for work hours, nor did we celebrate our resident brothers and sisters for fighting the good fight.

The training sucks, but the struggle builds tenacity. Close to 50% of hospitals are actually losing money. Few are "making tons" Either way, we live in a capitalist economy. Hospitals will continue doing what they do until they can no longer recruit medical residents. As long as someone is willing to sign up, there is no incentive for them to change.

But you've got this to look forward to: One day, someone 20 years younger will blame you for the world's problems, too. And you'll get to blame them for all the things that have changed. It's been happening for centuries.