Personally if I had the will or desire to go back and do another residency as opposed to a fellowship after internal medicine, I'd do opthalmology or radiation oncology. I would not do anesthesia. There is a risk. Yes, there is demand, but at the same time, demand is being met by hordes of CRNAs entering the market. Hospitals and surgeons do not care about quality, efficiency or outcomes. They care mostly about $$$$.
Just to give you some reference. These are the working hours of an opthalmologist I know:
Monday9:00 am - 5:00 pm
Tuesday9:00 am - 5:00 pm
Wednesday 9:00 am to 1 pm
Thursday9:00 am to 5:00 pm
Friday9:00 am - 12 pm
Saturday - off
Sunday - off
Total hours: 31 hours with 5 hours of lunch.
He definitely earns more than I. And I earn above average for my market with a pretty decent lifestyle. His Exercise/sleep/family life all intact. No 6 am starts. No late afternoon cases or waiting on surgeons etc etc.
No way in anesthesia you can have that schedule and make the income you're looking for. You wont have any census of patients which has inherent value. Hard for anesthesiologists to own equity in buildings or ASCs (unless you do Pain).
Do not be blinded by current locums rates. No one does locums long term. Its not sustainable. The higher per hour pay comes with compromise on stability.
Things will change a lot by the time you finish residency. I feel that a lot of anesthesia departments would be in-house for fixed pay with no or very little further re-imbursement for production. Thats the ultimate goal of CMS. To reduce surgeries.
Keep in mind that salaries and income guarantees in general give a sense of false security to physicians and it comes with a ceiling. AMCs will typically give you a nice package and then run lean and over work you. Thats the only way they can make a margin. Its no different that hospitalist gigs you're used to. The 7 on 7 off gigs seemed nice, but I know so many of my friends that could not hack it after 2-3 years due to burn out and working half the year weekends.
The best and fairest way to earn is via production. Those opportunities may not be available if we all become hospital employed.
Consider all of that before making a decision. Life decisions need to be nuanced and financially viable. There is an opportunity cost (time plus money) to doing a 3 year residency also. And no, it will not be possible to do moonlighting as an internist while doing anesthesia. Its usually frowned upon by the programs, and secondly, it will be nearly impossible to find the time and motivation to do it and keep up with residency schedule and commitments.
