Get out of anesthesia or cardiac , ccm fellowship

[2win]

Just a friendly reminder for the high IQ physicians here.
It will not get better.
Browsing the ASA letters I realized that they look desperate - almost as trying to justify the benefit of having a physician anesthesiologist in charge.
That's sad - we shouldn't be at this point.
Blame on - previous greedy anesthesiologists including your chair....
If you are in anesthesia program - CCM or cardiac.
If you are a mediocre physician stay in anesthesia.
On the other side if you really love this field, $$$ don't matter, neither your personal ego - then you should stay in.
Again the ASA is pathetic.
Sorry,
2win

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[scudrunner]

Typical 2win lament- including the classic ****ty grammar and punctuation. I guess this is how the high IQ anesthesiologists communicate with each other.

 

[Mad Jack]

Typical 2win lament- including the classic ****ty grammar and punctuation. I guess this is how the high IQ anesthesiologist communicate with each other.

I feel like there are implied grunts between every other sentence. Doesn't mean he's entirely wrong though- anesthesia is in a bad spot right now. Sucks, cause I really love the field, but as a medical student I just can't justify the uncertainty matching to anesthesia would bring to my life.

 

[2win]

Typical 2win lament- including the classic ****ty grammar and punctuation. I guess this is how the high IQ anesthesiologist communicate with each other.

Typical response from a 3 drugs pusher.
Are you sure that you remember propofol, fentanyl and roc? LOL
Get a 3 board certification, speak 4 languages and make some $$$ before to open your mouth.
Oh YEA!
Push the bed on the hallway and swallow your condition. LOL

 

[2win]

I feel like there are implied grunts between every other sentence. Doesn't mean he's entirely wrong though- anesthesia is in a bad spot right now. Sucks, cause I really love the field, but as a medical student I just can't justify the uncertainty matching to anesthesia would bring to my life.

Let's talk numbers, work, satisfaction and future.
Could be a good start point.
2win

 

[2win]

Typical 2win lament- including the classic ****ty grammar and punctuation. I guess this is how the high IQ anesthesiologist communicate with each other.

Aren't you the guy with a tatoo on the finger seeking advice? LOL

 

[Carbocation1]

How is a dual fellowship in Cardiac & CCM looking these days? I'd imagine a large community hospital would kill to have those services offered by a single physician. Total training time is the same as General Cardiology (i.e. Family Practice 2.0).

 

[Planktonmd]

Unfortunately 2win is absolutely right!

 

[BLADEMDA]

Plenty of jobs available on Gaswork. If a Resident does a Cards or Peds Fellowship even more job opportunities are out there. Of course, the job market is not the same as 10 or even 5 years ago when you could literally print money by doing Gas. These days salaries are in the $350-$450 range for a fellowship trained Anesthesiologist. While this represents a paradigm shift in terms of how some view this field (as it should) the glass is still half full (or half empty).

In terms of lifestyle and money one could do much better than Gas in terms of specialty choice but I suspect the next batch of Anesthesiologists will quickly find that out.

 

[pgg]

This thread is about an inch away from getting closed.

It started with some concern trolling and started to degenerate quickly.

Be civil, or y'all'll have to be content with one of the other 7,000 threads about the gloomy hellscape future of anesthesiology.

 

[2win]

This thread is about an inch away from getting closed.

It started with some concern trolling and started to degenerate quickly.

Be civil, or y'all'll have to be content with one of the other 7,000 threads about the gloomy hellscape future of anesthesiology.

Where should I report you for this useless post?

 

[amyl]

I have to agree... Back to ccm for me from pp

 

[scudrunner]

Aren't you the guy with a tatoo on the finger seeking advice? LOL

Haha, what??? I have no such tattoo and I'm not seeking your advice.

 

[donkeykong1]

Plenty of jobs available on Gaswork. If a Resident does a Cards or Peds Fellowship even more job opportunities are out there. Of course, the job market is not the same as 10 or even 5 years ago when you could literally print money by doing Gas. These days salaries are in the $350-$450 range for a fellowship trained Anesthesiologist. While this represents a paradigm shift in terms of how some view this field (as it should) the glass is still half full (or half empty).

In terms of lifestyle and money one could do much better than Gas in terms of specialty choice but I suspect the next batch of Anesthesiologists will quickly find that out.

I've thought about the "flashier" alternatives..

Cards-wouldn't want to take STEMI call at 2am nor would I want to manage htn in a morbidly obese redneck with a hx MI x 2, CABG x 3 etc..
GI-count me out for probing rectum all day everyday to keep my practice afloat
Pulm/cc-pretty much identical to anesthesia/cc combo without the ability to do bronchs or manage smokers/asthmatics in clinic if thats your thing
Interventional Rads-pretty cool stuff, just didn't do a rads rotation
ENT, Uro, Plastics, Ortho-not into cutting
Derm-I didn't go through med school for this. sorry.

 

[scudrunner]

No meaningful or useful conversation can possibly ensue on the pulverized topic. I can't understand why folks who **** on anesthesia browse this site. It's anesthesia stuff, it should be like garlic to a vampire.

 

[2win]

Haha, what??? I have no such tattoo and I'm not seeking your advice.

Are you so good in anesthesia?
Seems that you're good to point to grammatical errors .
Let's see how good you are.
8 pm eastern time - pgg will find 20 questions.
We'll answer in real time.
Let me wake you up from the ...hole that you're living in. Or maybe you live in a nice suburb - the same ...hole IMO.
Give you some perspective.
We can work it out also - one question me, one question you.
Are you up too?
If not - 3 drug man.
Cheers,
2win

 

[scudrunner]

Are you so good in anesthesia?
Seems that you're good to point to grammatical errors .
Let's see how good you are.
8 pm eastern time - pgg will find 20 questions.
We'll answer in real time.
Let me wake you up from the ...hole that you're living in. Or maybe you live in a nice suburb - the same ...hole IMO.
Give you some perspective.
We can work it out also - one question me, one question you.
Are you up too?
If not - 3 drug man.
Cheers,
2win

WTF

 

[pgg]

Dude. What on earth are you going on about?

You've been gone what, 18 months or thereabouts, and you pop in today causing all this ruckus?

Only Jet is allowed to act like that! 😉

 

[scudrunner]

Only Jet is allowed to act like that! 😉

And this dude

AIN'T NO JET!!!

 

[2win]

Dude. What on earth are you going on about?

You've been gone what, 18 months or thereabouts, and you pop in today causing all this ruckus?

Only Jet is allowed to act like that! 😉

I miss Jet - and I am not better than him, neither in OR or writing!
Especially writing...
PGG - is pissing me out to see all these wetting pants , tatoo advice seekers posting here.
F. sucks!
Ruckus is great - wakes you up from the dormant reptilian state.
8 pm seems that is a remote time now - I'll get the Elijah B. at 7 - you guys be safe!

 

[2win]

I've thought about the "flashier" alternatives..

Cards-wouldn't want to take STEMI call at 2am nor would I want to manage htn in a morbidly obese redneck with a hx MI x 2, CABG x 3 etc..
GI-count me out for probing rectum all day everyday to keep my practice afloat
Pulm/cc-pretty much identical to anesthesia/cc combo without the ability to do bronchs or manage smokers/asthmatics in clinic if thats your thing
Interventional Rads-pretty cool stuff, just didn't do a rads rotation
ENT, Uro, Plastics, Ortho-not into cutting
Derm-I didn't go through med school for this. sorry.

"Pulm/cc-pretty much identical to anesthesia/cc combo without the ability to do bronchs or manage smokers/asthmatics in clinic if"
What?????

 

[Arch Guillotti]

Where should I report you for this useless post?

 

[2win]

"Pulm/cc-pretty much identical to anesthesia/cc combo without the ability to do bronchs or manage smokers/asthmatics in clinic if"
What?????

My time is expensive - see you in few months.

 

[Stank811]

I am going to chalk this one up to a bad day. Anesthesia is a great speciality of medicine to enter. Would I recommend a fellowship...yes. But please once you have done a fellowship in cardiac, CC, peds etc....remember you are an anesthesiologist first and try not to put yourself on a pedestal higher than your colleagues who made the independent decision to do an anesthesiology residency without a fellowship.

 

[2win]

I am going to chalk this one up to a bad day. Anesthesia is a great speciality of medicine to enter. Would I recommend a fellowship...yes. But please once you have done a fellowship in cardiac, CC, peds etc....remember you are an anesthesiologist first and try not to put yourself on a pedestal higher than your colleagues who made the independent decision to do an anesthesiology residency without a fellowship.

Yea - I put myself on a pedestal against anybody who has less degrees in this field than me.
I didn't spent years of fellowships training just to be equal with the average Joe anesthesiologist.
And I believe that is fair.
Joe was making $$$ passing gas - me nada
Joe remained ignorant in multiple ways - me not
Joe knows 3 drugs - sorry for him
"Remember that you are an anesthesiologist first" - yea ...sure...
Good night

 

[Stank811]

Fortunately most anesthesia departments don't function as solo providers. Majority function as teams with generalists and specialist with everyone dependent on each other.

 

[scudrunner]

Yea - I put myself on a pedestal against anybody who has less degrees in this field than me.
I didn't spent years of fellowships training just to be equal with the average Joe anesthesiologist.
And I believe that is fair.
Joe was making $$$ passing gas - me nada
Joe remained ignorant in multiple ways - me not
Joe knows 3 drugs - sorry for him
"Remember that you are an anesthesiologist first" - yea ...sure...
Good night

http://www.mayoclinic.org/diseases-...ality-disorder/basics/definition/con-20025568

Get some help, dude.

 

[tvelocity514]

Plenty of jobs available on Gaswork. If a Resident does a Cards or Peds Fellowship even more job opportunities are out there. Of course, the job market is not the same as 10 or even 5 years ago when you could literally print money by doing Gas. These days salaries are in the $350-$450 range for a fellowship trained Anesthesiologist. While this represents a paradigm shift in terms of how some view this field (as it should) the glass is still half full (or half empty).

In terms of lifestyle and money one could do much better than Gas in terms of specialty choice but I suspect the next batch of Anesthesiologists will quickly find that out.

Besides dermatology, which specialties are you talking about that have a better lifestyle and money? Just wondering because I though anesthesia was nice for lifestyle/decent pay for the hours? (I know early mornings but the not on call once you're done is nice).

jw if anyone can help me out please but where on the 350-450 do the peds anesthesiologists fall usually?

Also, I met a crna the other day at an event and she said they do cardiac and kids also? I was just wondering how these fields are more protected. Obviously she wouldn't tell me any short comings she had in regards to lack of knowledge etc in those fields if she had them. I'm asking bc I actually like anesthesia (and always wanted to do a fellowship in peds in whatever field I go into) and was wondering how these fields are deemed safer.

Thanks for the help!

 

[nimbus]

I've thought about the "flashier" alternatives..

Cards-wouldn't want to take STEMI call at 2am nor would I want to manage htn in a morbidly obese redneck with a hx MI x 2, CABG x 3 etc..

You'll be cardiac call at 3am for fat redneck, mix2, cabgx3 now with jacked up left main on iabp/norepi/vasopressin half dead for salvage redo cabg.


GI-count me out for probing rectum all day everyday to keep my practice afloat

You'll be pushing propofol for $1500/day while the GI guy pushes the scope for $5k/day. Work is work.


Pulm/cc-pretty much identical to anesthesia/cc combo without the ability to do bronchs or manage smokers/asthmatics in clinic if thats your thing

Agree pulm/cc sucks. Worse than anesthesia.


Interventional Rads-pretty cool stuff, just didn't do a rads rotation

Agree cool specialty. Creative solutions to save lives. Good $$....sh*tty lifestyle.


ENT, Uro, Plastics, Ortho-not into cutting

More control, more money. People kiss your ass. You're not kissing theirs. Ortho guys working 4days/week make more than me working 6. In some cases a LOT more.


Derm-I didn't go through med school for this. sorry.

To each his own.

 

[Man o War]

Besides dermatology, which specialties are you talking about that have a better lifestyle and money? Just wondering because I though anesthesia was nice for lifestyle/decent pay for the hours? (I know early mornings but the not on call once you're done is nice).

jw if anyone can help me out please but where on the 350-450 do the peds anesthesiologists fall usually?

Also, I met a crna the other day at an event and she said they do cardiac and kids also? I was just wondering how these fields are more protected. Obviously she wouldn't tell me any short comings she had in regards to lack of knowledge etc in those fields if she had them. I'm asking bc I actually like anesthesia (and always wanted to do a fellowship in peds in whatever field I go into) and was wondering how these fields are deemed safer.

Thanks for the help!

Do CRNAs do peds and hearts? Yes. Will they ever do them without an anesthesiologist supervisor (I'm talking on a regular basis, fairly sick patients, not in BFE where they literally can't find an anesthesiologist to work there)? Doubt it. Cardiac surgeons are notoriously uptight and particular about who's on the other side of the drape. In the market I'm in and many others I interviewed in, CRNAs aren't even allowed in the cardiac ORs at any of the hospitals except the teaching ones, and they are only allowed in those 1:1 with an attending, and only if the fellows are not available. I just don't see that changing any time soon (CRNAs totally independent in cardiac/peds rooms).

 

[fiveccsyringe]

How is a dual fellowship in Cardiac & CCM looking these days? I'd imagine a large community hospital would kill to have those services offered by a single physician. Total training time is the same as General Cardiology (i.e. Family Practice 2.0).

the more your know...the more you are abused

 

[13132]

Can any resident or attending direct me to some reputable sources or suggest a starting place for researching the state of anesthesia?

Anesthesia is far and away my favorite specialty, and I get really nervous about the job market. I want to get as educated as I can on this ASAP. I lurk in these forums, but I never seem to get any good information. I think a lot of extreme positions are taken and worst case scenarios are discussed, so its very hard for me to get an idea of what things are really like int he field. I try to talk to faculty at my school, but of course they are always encouraging and paint a rosy picture. They aren't going to tell a medical student to avoid their specialty.

 

[Planktonmd]

Can any resident or attending direct me to some reputable sources or suggest a starting place for researching the state of anesthesia?

Anesthesia is far and away my favorite specialty, and I get really nervous about the job market. I want to get as educated as I can on this ASAP. I lurk in these forums, but I never seem to get any good information. I think a lot of extreme positions are taken and worst case scenarios are discussed, so its very hard for me to get an idea of what things are really like int he field. I try to talk to faculty at my school, but of course they are always encouraging and paint a rosy picture. They are going to tell a medical student to avoid their specialty.

Here is the short version:
The traditional specialty of Anesthesiology in the united states which used to mean taking care of surgical patients in the immediate perioperative period is rapidly becoming a nursing discipline.
The future anesthesia providers in this country are going to be mainly nurses.
A new specialty is currently emerging, you could more accurately call it perioperative medicine, and it's basically a mixture of internal medicine, intensive care and hospital based medicine.
It's currently struggling and fighting for turf, and only the future could tell how successful this new specialty will be. So if you feel up for the challenge and willing to be a pioneer in uncharted territory then go for it.
There are plenty of resources addressing this new specialty, just do a google search on the "surgical home" project.
Good luck!

 

[13132]

Here is the short version:
The traditional specialty of Anesthesiology in the united states which used to mean taking care of surgical patients in the immediate perioperative period is rapidly becoming a nursing discipline.
The future anesthesia providers in this country are going to be mainly nurses.
A new specialty is currently emerging, you could more accurately call it perioperative medicine, and it's basically a mixture of internal medicine, intensive care and hospital based medicine.
It's currently struggling and fighting for turf, and only the future could tell how successful this new specialty will be. So if you feel up for the challenge and willing to be a pioneer in uncharted territory then go for it.
There are plenty of resources addressing this new specialty, just do a google search on the "surgical home" project.
Good luck!

Thanks! That is very helpful.

 

[Nivens]

The traditional specialty of Anesthesiology in the united states which used to mean taking care of surgical patients in the immediate perioperative period is rapidly becoming a nursing discipline.
The future anesthesia providers in this country are going to be mainly nurses.

I still have a really hard time envisioning this in cardiac.

 

[ERRES2288]

Things happen so slowly in medicine that I envision this surgical home is 20 years out from full implementation, and that's IF it even pans out to the way people think it will currently.

 

[Psai]

Here is the short version:
The traditional specialty of Anesthesiology in the united states which used to mean taking care of surgical patients in the immediate perioperative period is rapidly becoming a nursing discipline.
The future anesthesia providers in this country are going to be mainly nurses.
A new specialty is currently emerging, you could more accurately call it perioperative medicine, and it's basically a mixture of internal medicine, intensive care and hospital based medicine.
It's currently struggling and fighting for turf, and only the future could tell how successful this new specialty will be. So if you feel up for the challenge and willing to be a pioneer in uncharted territory then go for it.
There are plenty of resources addressing this new specialty, just do a google search on the "surgical home" project.
Good luck!

The surgical home is a nonstarter imo. It asks anesthesiologists to do what they went into anesthesia to avoid which makes no sense.

 

[deleted171991]

The surgical home is a nonstarter imo. It asks anesthesiologists to do what they went into anesthesia to avoid which makes no sense.

It's not about what jobs anesthesiologists will want to do. It's about what jobs will be available for them, and for what salaries. 😉

 

[deleted171991]

Things happen so slowly in medicine that I envision this surgical home is 20 years out from full implementation, and that's IF it even pans out to the way people think it will currently.

Things happened extremely fast in anesthesia during the last 10 years, especially since Obamacare. 10 years ago, the place where I trained had 2 CRNAs; today they have around 50. 15 years ago, there were no opt-out states; there are 17 now. The rural Medicare exemption has been a death blow to anesthesiologists in those parts. Etc.

Any student who chooses anesthesia today should plan for a much worse situation by the time they graduate fellowship. To be more accurate: anybody who chooses anesthesia today had better like critical care (and the idea of being some kind of periop, not just intraop, physician). This is not anymore a recommended specialty for people who don't like "owning" patients.

 

[BLADEMDA]

I highly recommend a fellowship in one of the following areas or don't go into Anesthesiology (that's my opinion of course):

1. Peds
2. Cardiac
3. CCM
4. Pain

Those who think the generalist will survive "as is" for the next 2 decades are mistaken. Do the extra year (or 2) for the insurance as my hunch is you will need it.

 

[Stank811]

I have learned most things are regional. I work in an opt out state and it really has no effect on our practice. In fact many traditionally critical access hospitals are dumping their employed crnas and asking private groups to cover the locations since they are loosing money on the independent crna model

 

[nimbus]

I have learned most things are regional. I work in an opt out state and it really has no effect on our practice. In fact many traditionally critical access hospitals are dumping their employed crnas and asking private groups to cover the locations since they are loosing money on the independent crna model

But can the volume/payor mix at those facilities support a decent anesthesia practice? Can they attract quality anesthesiologists?

 

[criticalelement]

Cardiac surgeons are notoriously uptight and particular about who's on the other side of the drape.

LOL..

This is what surgeons see when they look over the drape.

 

[Man o War]

LOL..

This is what surgeons see when they look over the drape.

This has been your experience in transplant rooms and hospitals with big heart programs? It's not been mine. I've seen groups lose contracts because the cardiac surgeons were not comfortable with their cardiac anesthesia services. I've also seen an AMC get a contract, and quickly lose it because the cardiac surgeons threw a fit and refused to work with their cardiac anesthesiologists that they deemed subpar.

 

[Stank811]

But can the volume/payor mix at those facilities support a decent anesthesia practice? Can they attract quality anesthesiologists?

The payor mix was fine but the OR schedule was being mismanaged for the volume present and they payed the crnas to large of a salary for essentially working part time.

 

[criticalelement]

This is what crnaflorida twitter account thinks we do while supervising four rooms. I dont know about you, if i ever had a job supervising four barely competent crnas (which lets be honest.. most of them) I would have a coronary.

 

[Nivens]

I highly recommend a fellowship in one of the following areas or don't go into Anesthesiology (that's my opinion of course):

1. Peds
2. Cardiac
3. CCM
4. Pain

I'm assuming this is in order? If so that's an interesting ranking. Just my observations from a big tertiary care center, but peds seems to have a huge crna presence...

 

[Man o War]

I have learned most things are regional. I work in an opt out state and it really has no effect on our practice. In fact many traditionally critical access hospitals are dumping their employed crnas and asking private groups to cover the locations since they are loosing money on the independent crna model

This is exactly why independent CRNA practices make no sense to me. When you actually add in all the call and after hours stuff that CRNAs are used to getting paid extra for, they really aren't cheaper than a private group owned by the MDs. Plus, you get the added benefit of actual MDs and not nurses who think they're MDs.

 

[Ignatius J]

Put people to sleep. Have fun. Work with good people (most of the time- see my thread from last week). Laugh. Joke. Go home and think I've made a difference. Life is good.

Some people are just potatos and will get mad if you give them a winning lottery ticket.

 

[BLADEMDA]

I'm assuming this is in order? If so that's an interesting ranking. Just my observations from a big tertiary care center, but peds seems to have a huge crna presence...

No. I listed 1-4 randomly. You pick the area that interests you the most. If you don't like any of those 4 go with Cardiac to improve your job prospects for the future.