Well put, good perspective.Seeing as it was only a few years ago that I was a fourth year medical student deciding about anesthesiology, I guess I should give my two cents. I really like the field. Pediatric anesthesia in particular is challenging and interesting and for me pays an absurdly high amount for the satisfaction I derive from it. It's great to look forward to work!
Now do I see myself having to deal with a lower salary? Sure. But honestly I would do this job for 200k and work 50-60hrs a week. Probably even 175k. 200k in the south goes a long way...provided you invest and save/live below your means. For a single guy you can live like a king...for a family of 3-4 it's not that much worse. Plus it's easier if you send your kids to public school and don't need a mcmansion/benz. Even easier if you raise your kids right and they get scholarships to state schools lol. Working for those hours and that wage I don't see MDs going anywhere soon....particularly if you are fellowship trained and board certified....you are a bargain for the hospital in terms of the quality patient care you give compared to a CRNA.
I guess you just have to have realistic expectations...200k is decent and in all likelihood that's a low estimate for where salaries will end up. Working in a poor state and in an academic center in a children's hospital that is 80-90% medicaid I still am paid significantly higher than that. Benefits are good too. Also it's sobering to see the peds subspecialists (PICU/peds cardiology/NICU attgs etc) that work just as hard (actually harder) and make LESS. Can you imagine a interventional peds cardiologist making 175k to start? After doing SEVEN years of training! But yet the peds subspecialists I work with are fine...even happy! And no, none of them came from money or were rich outside of medicine.
I remember as a fourth year worrying about my choice so much, but in the end it worked out great. My greatest worry was having a job and making a decent wage. I definitely surpassed my expectations. I guess the only advice I would have for those pursuing the field today is just become as clinically proficient as you can in residency, consider a fellowship and of course pass your boards (preferably on the first attempt). You won't be as rich as a neurosurgeon, but you probably won't have as many ex-wives (or husbands.)