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Hey there folks,

I am a German Med Student, currently in my 4th year of med school and will start my basic rotations in this coming semester. During my 2nd year of med school i fell in love with the idea of practicing medicine in the US and have since been working on my Profile( USMLEs, USCE, improving English,etc) trying to make me the best applicant i can be.

So the main thing now is that i am currently undecided between Anesthesiology and Cards.

I have to choose between them as the application deadline for a Rotation through a cooperation between my home Univ and the US University is heading close. So i thought i could ask the physicians here who are already practicing what would you choose if you were in my place, given that you would not have any student loans and were looking to start a complete new life in US?

Thanks in advance and it would really mean a lot to me if someone helps me with their answers.
 

dr doze

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Given that you have ties to another country and the low level of satisfaction in American physicians, I strongly advise you to proactively consider a path that would allow you to return to Germany and practice should your feelings change in the future.
 

CUBR

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Hards to give any advice without learning more about what your desires are. Pretty different mindsets and skillsets.

It generally takes longer to become a cardiologist (3 yrs IM +3 yrs cards) than an anesthesiologist (4years). Based on random surveys, an average cardiologist makes more an average anesthesiologist. Cards have their own patients, we don't. Cards work in an office, we work in an OR.
 
OP
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Given that you have ties to another country and the low level of satisfaction in American physicians, I strongly advise you to proactively consider a path that would allow you to return to Germany and practice should your feelings change in the future.
Graduating from a german university, i can come back whenever i want, can get my residency in the states accredited which would lead to getting the licence in the matter of a few months and start practicing. So coming back wouldn't be a problem.


Hards to give any advice without learning more about what your desires are. Pretty different mindsets and skillsets.

It generally takes longer to become a cardiologist (3 yrs IM +3 yrs cards) than an anesthesiologist (4years). Based on random surveys, an average cardiologist makes more an average anesthesiologist. Cards have their own patients, we don't. Cards work in an office, we work in an OR.
My Mindset is quite different from my friends here. I am quite chill, ridiculously notorious for my outgoing nature, dont take life that seriously and tend to do things on my own. The only thing i want in my life to have sufficient time for my family and have 300k after taxes, so that i can have a chill life and do some serious charity work especially in the South Asian region(Nepal). Have already been doing some volunteer work in my semester break.

The only thing i don't like about Medicine in Germany is that we are paid almost 4800 dollars a month and this sum increases only by 150 a year. Even as an attending you are making only 6500, which after taxes are close to 4000. Living hand to mouth all your life isnt my dream
 

IMGASMD

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Graduating from a german university, i can come back whenever i want, can get my residency in the states accredited which would lead to getting the licence in the matter of a few months and start practicing. So coming back wouldn't be a problem.




My Mindset is quite different from my friends here. I am quite chill, ridiculously notorious for my outgoing nature, dont take life that seriously and tend to do things on my own. The only thing i want in my life to have sufficient time for my family and have 300k after taxes, so that i can have a chill life and do some serious charity work especially in the South Asian region(Nepal). Have already been doing some volunteer work in my semester break.

The only thing i don't like about Medicine in Germany is that we are paid almost 4800 dollars a month and this sum increases only by 150 a year. Even as an attending you are making only 6500, which after taxes are close to 4000. Living hand to mouth all your life isnt my dream
IM is easier to get into. But cards is not. Anesthesia is a little harder to get in. You need to take your steps before you can have a meaningful discussion. Why do you deserve a spot when you have no ties to this country, other than you think you should make more? It’s a question that you should have a better answers for.
 
OP
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Mar 27, 2019
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IM is easier to get into. But cards is not. Anesthesia is a little harder to get in. You need to take your steps before you can have a meaningful discussion. Why do you deserve a spot when you have no ties to this country, other than you think you should make more? It’s a question that you should have a better answers for.
I think US is one of the very few countries in the world which doesnt discriminate on the basis of where you are from, allowing everyone (who is capable and willing to reach something) to succeed.
As for the steps, yeah you are right. My Step1 is 238 which is not that good, i will soon start with step 2 and hope i could do better this time.
 

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The only thing i don't like about Medicine in Germany is that we are paid almost 4800 dollars a month and this sum increases only by 150 a year. Even as an attending you are making only 6500, which after taxes are close to 4000. Living hand to mouth all your life isnt my dream
That is a low salary vs a cardiologist salary in the United States, but I wonder what kind of things people get in Germany for free/cheap versus here in the United State. For example, education for your children. As a physician in this country (US), depending on where you live, you will probably want to put you children in private school to get them a good, quality education. Is that the same in Germany or is the public school system quality? Also here you pay for health insurance, especially good insurance, in order to get you and your family quality health care? Again, is that the same in Germany? I know many of us Americans have our theories about European healthcare and how we should use it as a model, but you knowing first hand can tell us if we're right or wrong. So while in Germany you may have a heavier tax burden which is lowering your physician salary, the taxes you pay may get you more than it does here in the US. Many people pay taxes which supports public schools and public hospitals and then pay extra for private school and to go to better hospitals (via paying for better insurance whether out of pocket or with an employer). It's just something to think about.

I'm reading for people to come raining down on how crazy I sound.
 

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I think US is one of the very few countries in the world which doesnt discriminate on the basis of where you are from, allowing everyone (who is capable and willing to reach something) to succeed.
And who do you think elected Trump?:lol:

So you're coming here for the money. I am sure everybody will just stand in line to hire you. Every time I see a young doc from a developed country, I think: another frackup (unless it's through marriage). Especially since an EU doc could have gone to another EU country, where his/her diplomas would have been automatically recognized.
The only thing i want in my life to have sufficient time for my family and have 300k after taxes, so that i can have a chill life and do some serious charity work especially in the South Asian region(Nepal).
To make 300K net, one needs to make about 450-475 gross. That's incompatible with a "chill life". Another naive Ausländer.

 
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The public schools are quite good here, no need for private ones.

College is free, but there is a small fee for a semester like 400 euros which also gets you a bus ticket for the city for the whole semester.

Health insurance is a huge topic to explain here at once but i'll shoot in some basics. There are public and private insurances. Public ones are good but the problem is with the waiting times, i for example had to wait for 5 months just to get an appointment with a dermatologist. Many family doctors have no more slots for new patients with public insurance but the private insured get treated right away. You pay 7,9%( max 450 euros or sth) of your pay for the health insurance. Private insurances are quite similar to those in the US, they are a struggle, you have to pay for the treatments yourself at first, after going over the bill, they choose what is going to be covered or not. Other big factor is that their costs/premiums go up the older you get or depending upon how often you get sick.
The Health System used to be tremendous but now its getting worse.
But its only my basic information, i have my classes on the insurance system next semester, then i can comment thoroughly on this topic.
 
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And who do you think elected Trump?:lol:

Friggin' naive Ausländer! So you're coming here for the money. I am sure everybody will just stand in line to hire you. Every time I see a doc from a developed EU country, I think: another frackup (unless it's through marriage). Especially since they could have gone to another EU country, where their diplomas would have been automatically recognized.
Hahaha. I will ignore you. Have a nice day.
 
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That is a low salary vs a cardiologist salary in the United States, but I wonder what kind of things people get in Germany for free/cheap versus here in the United State. For example, education for your children. As a physician in this country (US), depending on where you live, you will probably want to put you children in private school to get them a good, quality education. Is that the same in Germany or is the public school system quality? Also here you pay for health insurance, especially good insurance, in order to get you and your family quality health care? Again, is that the same in Germany? I know many of us Americans have our theories about European healthcare and how we should use it as a model, but you knowing first hand can tell us if we're right or wrong. So while in Germany you may have a heavier tax burden which is lowering your physician salary, the taxes you pay may get you more than it does here in the US. Many people pay taxes which supports public schools and public hospitals and then pay extra for private school and to go to better hospitals (via paying for better insurance whether out of pocket or with an employer). It's just something to think about.

I'm reading for people to come raining down on how crazy I sound.

Can i send you a PM? Would like to ask you some questions. :))
 

FFP

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Hahaha. I will ignore you. Have a nice day.
Please do. I obviously have no idea what I am talking about. I am just envious of a nobody, who still has a tons of years and exams to go to be able to treat me as an equal.
 
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Jan 22, 2019
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Do whatever you want... Your step1 score is ok for IM and anesthesia... But getting a card fellowship might not be easy since you will be an IMG... If you are stuck in IM, it will not be easy to make 300k post taxes... 200k post taxes is more doable as an IM doc here.


I came to the US after high school and attended a US med school. We are all free to do whatever pleases us as long as it's ethical.
 
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Jesus that is low. Even by European standards. Do all German docs get a handful of free cyanide capsules to bite down on once they realize the s*** sandwich they’re swallowing. I don’t even think the free tuition, HC, public transit, and more leisure time really make up for it but to each his own.
 

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Don't believe everything you read on the Internet. ;)

For example, that could be a starting employed GP salary, for less than 40 hours and the American level of healthcare productivity, no calls or weekends.
 

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Getting a better attitude about why you want to come to the US will help. Sadly folks like you give many other IMGs a terrible reputation.
 

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Anesthesiology in the U.S. is different than what you see in Europe, and although the training is great the specialty does not have the same respect other specialties enjoy. This unfortunate Image of Anesthesiology in the U.S. is mainly caused by the ongoing political war with nurse anesthetists and their organization. A war that we are losing on many levels.
So if you want to be a "Doctor", in the European sense of the word, do yourself a favor and either do anesthesiology in Germany, or come to the U.S. and do something else.
 
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IMGASMD

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He wants to be a “Mister”.

Edit: maybe not. Only surgeons? One of my attending in training has been called Mister too.... whatevs......
 

Twiggidy

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I don’t even think the free tuition, HC, public transit, and more leisure time really make up for it but to each his own.
Yes it does. As FFP is sort of implying, you don't see many EU docs flocking to the US for a reason. If I were OP I'd stay in Germany. Overall lifestyle will probably be better there.
 
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Twiggidy

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i have my classes on the insurance system next semester, then i can comment thoroughly on this topic.
That's interesting. We don't even get Health Insurance education. You basically learn the best you can when you're an attending.
 

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Hey Greifswalder, I'll be happy to give you some advice. I'm a Spaniard who decided to relocate to the US despite being a vascular surgeon in my country. Coming to the States means retraining so due to my personal circumstances I decided to switch fields and went into anesthesia. After 7 years here I can definitely give you some input. No matter what your career goals are this is a great country to achieve them. Feel free to PM me if interested. Best regards.
 
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nimbus

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In cardiac anesthesia, Mackenson at UW and Muehlschlegel at Brigham are both from Germany. OP might consider reaching out to them for advice.
 
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To make 300K net, one needs to make about 450-475 gross. That's incompatible with a "chill life". Another naive Ausländer.
General Cards mean per 2018 MGMA is 495k. Making less than MGMA mean in gen cards probably entails 50 hours a week with a few days of call per month. Sounds pretty chill.
 

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General Cards mean per 2018 MGMA is 495k. Making less than MGMA mean in gen cards probably entails 50 hours a week with a few days of call per month. Sounds pretty chill.
The cardiologist around my hospital have it pretty chill, as far as on call in hospital work is concerned (i speculate) but given the mentality most of us anesthesiologists have, I bet clinic is a nightmare
 

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General Cards mean per 2018 MGMA is 495k. Making less than MGMA mean in gen cards probably entails 50 hours a week with a few days of call per month. Sounds pretty chill.
Except that it's almost impossible to get into cards as a FMG with a Step 1 of 238. Heck, s/he will have trouble even getting into a good university-based IM residency (which is the path to cards). As a FMG, one should have scores that are 20 points higher than the cutoff for AMGs, or an impressive CV/American recommendation letter. Especially when coming from a G-7 country (which begs the question: what the heck is wrong with this candidate?).

America may be very generous to its immigrants (when compared to most countries), but still AMG >>> FMG. Even as an attending, AMG > FMG. It's just human nature.

As an FMG, I would guess it's much easier to become a cardiac anesthesiologist than to get into cards.
 
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nimbus

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Except that it's almost impossible to get into cards as a FMG with a Step 1 of 238. Heck, s/he will have trouble even getting into a good university-based IM residency (which is the path to cards). As a FMG, one should have scores that are 20 points higher than the cutoff for AMGs, or an impressive CV/American recommendation letter. Especially when coming from a G-7 country (which begs the question: what the heck is wrong with this candidate?).

America may be very generous to its immigrants (when compared to most countries), but still AMG >>> FMG. Even as an attending, AMG > FMG. It's just human nature.

As an FMG, I would guess it's much easier to become a cardiac anesthesiologist than to get into cards.
Seems like half their staff cardiologists are FMGs, many of them recently trained.

 
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Twiggidy

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As an FMG, I would guess it's much easier to become a cardiac anesthesiologist than to get into cards.
Not sure about that. About right around the time I finished cardiac no one was really interested so it may have been true then. Now, there are job posted everywhere for “cardiac anesthesiologists” even when it doesn’t involve doing hearts (sneaky recruiter). I the AMGs seen a cardiac fellowship as a way to get more job opportunities so it’s gotten more competitive.

I will agree with you they in the US we’re probably easier on immigrant doctors. I would speculate that it would be easier for me (maybe me) to be an American doctor in Germany, especially if I can speak German, than it is to be an immigrant doctor in Germany. This is all speculation of course.
 

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Seems like half their staff cardiologists are FMGs, many of them recently trained.

I am not saying it's impossible. Given the huge number of FMGs in IM, of course some will make it into cardiology. But not the 238 on Step 1 people.
 

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I will agree with you they in the US we’re probably easier on immigrant doctors. I would speculate that it would be easier for me (maybe me) to be an American doctor in Germany, especially if I can speak German, than it is to be an immigrant doctor in Germany. This is all speculation of course.
Yes, we are. We are also easier on immigrants, in general, than many European countries.

However, immigrants tend to have this dreamy, immature, attitude about the United States, especially if they have never lived here before. I used to be like that. They confuse American politeness, fake smiles, and friendliness with love for immigrants. And though American capitalism is more meritocratic than a more nationalist society (i.e. Germany), we are not who we were 15-20 years ago either.

America is going through the natural whiplash of any society where some elite idiots are trying to push change way too fast. There is way too much immigration from countries that don't assimilate well. There is way too much political correctness toward everybody who's not a white male. There is way too much socialism in the air. Hence less tolerance, hence Trump.
 
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Twiggidy

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Yes, we are. We are also easier on immigrants, in general, than many European countries.

However, immigrants tend to have this dreamy, immature, attitude about the United States, especially if they have never lived here before. I know, I've been like that. They confuse American politeness, fake smiles, and friendliness with love for immigrants. And though American capitalism is more meritocratic than a more nationalist society (i.e. Germany), we are not who we were 15-20 years ago either.

America is going through the natural whiplash of any society where some elite idiots are trying to push change way too fast. There is way too much immigration from countries that don't assimilate well. There is way too much political correctness toward everybody who's not a white male. There is way too much socialism in the air. Hence less tolerance, hence Trump.
That's pretty accurate
 
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Jesus that is low. Even by European standards. Do all German docs get a handful of free cyanide capsules to bite down on once they realize the s*** sandwich they’re swallowing. I don’t even think the free tuition, HC, public transit, and more leisure time really make up for it but to each his own.
Well, it's a big upgrade from getting 1000-1500 euros a month, which I would be getting had I stayed in my homecountry (Greece) instead of Germany. But yeah I agree that you have to put this into context. Germany is a welfare state. You get very decent healthcare and above decent education without having to spend more, and the taxes decrease the more kids you have. I don't know any doctor that doesn't have a comfortable life here, they anyways make more than most here in Germany, and probably have more time to enjoy life than their U.S. colleagues. For me the US is not worth the hassle. EU all the way. Unless it involves innovation and cutting edge research, then Europe nowhere near the Mecca of medical research that is the US.
 
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Jan 22, 2019
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Well, it's a big upgrade from getting 1000-1500 euros a month, which I would be getting had I stayed in my homecountry (Greece) instead of Germany. But yeah I agree that you have to put this into context. Germany is a welfare state. You get very decent healthcare and above decent education without having to spend more, and the taxes decrease the more kids you have. I don't know any doctor that doesn't have a comfortable life here, they anyways make more than most here in Germany, and probably have more time to enjoy life than their U.S. colleagues. For me the US is not worth the hassle. EU all the way. Unless it involves innovation and cutting edge research, then Europe nowhere near the Mecca of medical research that is the US.
It's a cultural thing... Most doctors here can have time to enjoy their life if they want to, but they prefer to make 250k+ instead of 150k/year. You gotta put in the hours if you want to make a lot of money as a physician here.

I actually know a family doc that is semi-retired in his early 40s... He worked hard for the first 10 yrs to pay off his house and student loan and getting a decent saving and now working 3 days/wk (24 hrs) making 130k+.

Unlike the US, physicians in Europe do not mind living like middle-class individuals. Here in the US, we want to live in the best neighborhood in a 4000+ sqft home while driving a 70k+ car every 5 years.
 
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It's a cultural thing... Most doctors here can have time to enjoy their life if they want to, but they prefer to make 250k+ instead of 150k/year. You gotta put in the hours if you want to make a lot of money as a physician here.

I actually know a family doc that is semi-retired in his early 40s... He worked hard for the first 10 yrs to pay off his house and student loan and getting a decent saving and now working 3 days/wk (24 hrs) making 130k+.

Unlike the US, physicians in Europe do not mind living like middle-class individuals. Here in the US, we want to live in the best neighborhood in a 4000+ sqft home while driving a 70k+ car every 5 years.
Yes, western Europe is mostly made up of social democracies. Even our right wing governments are more left leaning than U.S. democrats. Taxation in Germany is at 42 percent after 14 years of Merkel's conservative party ruling. I definitely don't mind making money, but I don't think I need a mansion to live happily. I'm satisfied if I'm able to afford a nice flat and a few trips back to Greece and some new place every year. Early retirement does sound pretty awesome though, I give you that. Not sure which country is better, but I would guess it's worse to be poor in the U.S. than in western Europe.
 

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OP, I get why you want to practice in the US, but I want to advise you to reconsider. Yes, you make more money here but remember that you have to pay a ridiculous amount of money for malpractice, health insurance, life in general here is more expensive (starting with basic things like fresh veggies and fruits....I know, sounds ridiculous), college for your kids (if you ever wish to have some). Plus, practicing here might be a different, more complicated animal because of the healthcare system here. Not to mention the crazy hours you will have to work in order to make the amount of money you are looking at. Doctors here sometimes work 80-100h/week and are "not allowed" to complain. In Germany, doctors complain about 50h weeks. Oh- and before I forget...say bye to 30 days of annual, paid leave. I think here you get what...10 days? I don't know if sick days are included.

All of this is after residency. During residency.....completely different story. But I can sum it up by saying that you should be ready to work insane hours for barely any money. Probably coming out below poverty level.

I'm sure I can come up with more if I took more time to think. But I know that Germany is having a shortage of doctors too- or maybe more a distribution problem. So, if you do your residency there and open a practice in an area that is short on doctors you can also make ~160k (in Euros!) as a Hausarzt. :)
 
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dhb

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Unlike the US, physicians in Europe do not mind living like middle-class individuals. Here in the US, we want to live in the best neighborhood in a 4000+ sqft home while driving a 70k+ car every 5 years.
I always smile at the generalizations made on each side of the Atlantic about the other side
 

nimbus

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OP, I get why you want to practice in the US, but I want to advise you to reconsider. Yes, you make more money here but remember that you have to pay a ridiculous amount of money for malpractice, health insurance, life in general here is more expensive (starting with basic things like fresh veggies and fruits....I know, sounds ridiculous), college for your kids (if you ever wish to have some). Plus, practicing here might be a different, more complicated animal because of the healthcare system here. Not to mention the crazy hours you will have to work in order to make the amount of money you are looking at. Doctors here sometimes work 80-100h/week and are "not allowed" to complain. In Germany, doctors complain about 50h weeks. Oh- and before I forget...say bye to 30 days of annual, paid leave. I think here you get what...10 days? I don't know if sick days are included.

All of this is after residency. During residency.....completely different story. But I can sum it up by saying that you should be ready to work insane hours for barely any money. Probably coming out below poverty level.

I'm sure I can come up with more if I took more time to think. But I know that Germany is having a shortage of doctors too- or maybe more a distribution problem. So, if you do your residency there and open a practice in an area that is short on doctors you can also make ~160k (in Euros!) as a Hausarzt. :)

I think you are painting an unrealistically dark picture of anesthesia practice in the USA. I would say 400k for 50hrs/week and 8 weeks vacation is the norm here.
 
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ddsdreamcatcher

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I think you are painting an unrealistically dark picture of anesthesia practice in the USA. I would say 400k for 50hrs/week and 8 weeks vacation is the norm here.
Well, it depends not he field. That might be right for anesthesia, but what about cardio? Also, at this stage in medical school many students change their desired field so many times. I thought it makes more sense to describe the norm rather than the few fields where you can actually have a work life balance :) Sorry if I came off too negative haha
 

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I think you are painting an unrealistically dark picture of anesthesia practice in the USA. I would say 400k for 50hrs/week and 8 weeks vacation is the norm here.
It depends on the geographical area.