Interested in Anesthesiology

[SandyH]

As a potential student interested in anesthesiology, I am aware of the CRNA encroachment into the field. I am worried that I will be competing for employment with them in the future. I was wondering if any of the physician would still recommend the field of anesthesia to a student like me, given the job market right now?

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[anbuitachi]

As a potential student interested in anesthesiology, I am aware of the CRNA encroachment into the field. I am worried that I will be competing for employment with them in the future. I was wondering if any of the physician would still recommend the field of anesthesia to a student like me, given the job market right now?

There are thousands of anesthesiologists. Every year almost 2000 new anesthesiologists graduate i believe, i am 100% positive you will be able to find one anesthesiologist who will still recommend the field to you, probably some 70 yr old partner who worked thru the best times of anesthesiology and is now making money off the labor of the new grads.

 

[AdmiralChz]

In my early 30s, count me as someone who recommends it if you’re interested.

Get used to mid level encroachment, it’s a growing issue in nearly every specialty. *ducks*

 

[Nivens]

I've been getting a lot of these sorts of questions in PMs recently. At the end of the day, you have to find something you like. I've come in and out of thinking that's contrarian to that sentiment, but have come to believe as a guiding principle to clarify some of these complex decisions, it holds.

Ortho looks great now, but in 5 years, CMS could decide all non-trauma ortho care (scopes, spines, joints) is a sham or not cost-effective, and kill the field. I'm not saying it's likely, but it could happen.

The truth is, we're all just forecasting.

 

[anbuitachi]

I've been getting a lot of these sorts of questions in PMs recently. At the end of the day, you have to find something you like. I've come in and out of thinking that's contrarian to that sentiment, but have come to believe as a guiding principle to clarify some of these complex decisions, it holds.

Ortho looks great now, but in 5 years, CMS could decide all non-trauma ortho care (scopes, spines, joints) is a sham or not cost-effective, and kill the field. I'm not saying it's likely, but it could happen.

The truth is, we're all just forecasting.

It's all a game of probability, right now the probability is not in our fields favor, especially as new and better drugs come into play.

What you said of Ortho is true but there is a very very low probability of that happening to all those things in Ortho. Most likely one area of a field may be affected like that, and the specialists will just all go do another area. That's a bit different from mid level take over because our reimbursement for different procedures are also constantly changing. (eg the big cut for colonoscopies)

 

[Nivens]

It's all a game of probability, right now the probability is not in our fields favor, especially as new and better drugs come into play.

What you said of Ortho is true but there is a very very low probability of that happening to all those things in Ortho. Most likely one area of a field may be affected like that, and the specialists will just all go do another area. That's a bit different from mid level take over because our reimbursement for different procedures are also constantly changing. (eg the big cut for colonoscopies)

Don't necessarily disagree with your assessment, though I personally feel the uncertainty surrounding surgical subspecialties is often underestimated, in no small part because they have "farther to fall". It isn't difficult for me to imagine a future where many surgeons are expected to spend almost 100% of their time in operating rooms, operating on patients selected for them pre-op and followed for them post-op, because that's where the money is made. The seeds of this are already being planted: at our hospital, reliance on ancillary services (a diabetes management team, a post-operative pain team, an army of PAs) is breeding a generation of surgeons uncomfortable with post-operative care.

One could argue that the money has already been squeezed from the low-hanging fruit (service-oriented specialties like ours, rads, ER, etc), and it's only a matter of time before the suits begin climbing the trees...

 

[Nivens]

The point is not to say "don't pick this, pick that." I just think it's misguided to pick a specialty because of perceived "security", though I think that would be a reasonable way to break a tie between two things a prospective applicant finds stimulating.

 

[It's lupus!]

Following as someone interested in Anesthesia as a route to and balance with critical care

 

[BLADEMDA]

I tell prospective Med Students that the newly minted DNP CRNA can do most of the basic stuff. Unlike others on this Board I see the DNP taking over the main role of the general Anesthesiologist in terms of stool sitting. The amount of time and effort you spent on your education and training needs to keep the DNP CRNA encroachment at bay. So, I recommend a subspecialty or two. If you are too lazy to do the extra time for fellowship (or two like Nivens) then choose something else like Neurology.

 

[BLADEMDA]

Following as someone interested in Anesthesia as a route to and balance with critical care

Critical Care plus Cardiac Anesthesiology with Board Certification in TEE. PM Nivens for his point of view.

 

[BLADEMDA]

In my early 30s, count me as someone who recommends it if you’re interested.

Get used to mid level encroachment, it’s a growing issue in nearly every specialty. *ducks*

Customized Training

Choose a Fellowship like Pain, Peds, Cardiac or Critical Care

 

[BLADEMDA]

My honest opinion here: Either subspecialize or choose another field. My comment isn't about the money but about the future encroachment of the DNP CRNA. My friends that day has arrived and the need for General Anesthesiologists will dwindle. Hence, for those looking out 2 or 3 decades please choose carefully.



I'm truly worried for my AA friends out there. I hope the ASA won't desert them on the battle field once the AANA achieves victory. These providers deserve the right to practice just like CRNAs IMHO.

Faculty

 

[AdmiralChz]

Or quote the wide array of PA/NP critical care “fellowships” - an eICU model with an intensivist covering/“overseeing” several units staffed by “specialized” PA/NPs is easily within the realm of possibility.

 

[BLADEMDA]

CRNA Regional Fellowship

 

[BLADEMDA]

Or quote the wide array of PA/NP critical care “fellowships” - an eICU model with an intensivist covering/“overseeing” several units staffed by “specialized” PA/NPs is easily within the realm of possibility.

I see your point. But those areas are "brand new" for NPs and they won't be running the unit Independently any time soon.

 

[BLADEMDA]

Watch 14:20-15:45

 

[anbuitachi]

Don't necessarily disagree with your assessment, though I personally feel the uncertainty surrounding surgical subspecialties is often underestimated, in no small part because they have "farther to fall". It isn't difficult for me to imagine a future where many surgeons are expected to spend almost 100% of their time in operating rooms, operating on patients selected for them pre-op and followed for them post-op, because that's where the money is made. The seeds of this are already being planted: at our hospital, reliance on ancillary services (a diabetes management team, a post-operative pain team, an army of PAs) is breeding a generation of surgeons uncomfortable with post-operative care.

One could argue that the money has already been squeezed from the low-hanging fruit (service-oriented specialties like ours, rads, ER, etc), and it's only a matter of time before the suits begin climbing the trees...

Perhaps farrr into the future. I do not think that will happen anytime in the next few decades simply because we have a huge shortage in surgeons and it takes a long time to train surgeons, so they still have a lot of pull. Furthermore, they can just band together and create their own practice outside of the hospital. They aren't tied down to a hospital/center like we are. But from what I have seen, most surgeons PREFER to be in the OR than in clinic or rounding on their patients! And yes many of them are real bad at post op managing so they just call the consults, but it really doesn't seem like they care about that stuff

 

[AdmiralChz]

Furthermore, they can just band together and create their own practice outside of the hospital. They aren't tied down to a hospital/center like we are

And yet more and more their PP groups are being gobbled up by hospital systems - CT surgeons back home are now hospital employees along with the urologists. Grass isn’t always greener, it’s not easy to uproot a family either...

 

[BLADEMDA]

And yet more and more their PP groups are being gobbled up by hospital systems - CT surgeons back home are now hospital employees along with the urologists. Grass isn’t always greener, it’s not easy to uproot a family either...

hospital employee possible yes vs AMC employee which is likely No

 

[BLADEMDA]

As a potential student interested in anesthesiology, I am aware of the CRNA encroachment into the field. I am worried that I will be competing for employment with them in the future. I was wondering if any of the physician would still recommend the field of anesthesia to a student like me, given the job market right now?

JANUARY 26, 2018
Anesthesiology Careers Among Highest-Paying Jobs in U.S.



The field of anesthesiology produced two of the highest-paying jobs in the country as both anesthesiologists and nurse anesthetists landed in the top 11 of the U.S. News & World Report rankings for 2018?

Anesthesiologists ranked first overall with a median annual salary of $208,000 and a 0.5% unemployment rate. The rankings cited the importance of the field and the difficulty of performing the job as reasons for the spots. It was also projected that anesthesiology will add 5,900 new positions by 2026, an 18% rate of growth. In addition, the field was rated as the 13th career in the Best Jobs category, which takes into account many factors beyond salary. Anesthesiologists narrowly edged out surgeons as the best-paying field, according to the report.

In addition to anesthesiologists, nurse anesthetists were rated as the 11th best-paying job, with a median annual salary of $160,270 and a 2.7% unemployment rate. The position is expected to experience even greater growth as 6,700 new jobs—a 16% increase—are projected by 2026.

At the same time that the field of anesthesiology ranked highly among the best-paying jobs, the medical field at large dominated the rankings. All of the top 11 jobs listed were related to health care, and operating room–based positions comprised the top four.

 

[anbuitachi]

JANUARY 26, 2018
Anesthesiology Careers Among Highest-Paying Jobs in U.S.



The field of anesthesiology produced two of the highest-paying jobs in the country as both anesthesiologists and nurse anesthetists landed in the top 11 of the U.S. News & World Report rankings for 2018?

Anesthesiologists ranked first overall with a median annual salary of $208,000 and a 0.5% unemployment rate. The rankings cited the importance of the field and the difficulty of performing the job as reasons for the spots. It was also projected that anesthesiology will add 5,900 new positions by 2026, an 18% rate of growth. In addition, the field was rated as the 13th career in the Best Jobs category, which takes into account many factors beyond salary. Anesthesiologists narrowly edged out surgeons as the best-paying field, according to the report.

In addition to anesthesiologists, nurse anesthetists were rated as the 11th best-paying job, with a median annual salary of $160,270 and a 2.7% unemployment rate. The position is expected to experience even greater growth as 6,700 new jobs—a 16% increase—are projected by 2026.

At the same time that the field of anesthesiology ranked highly among the best-paying jobs, the medical field at large dominated the rankings. All of the top 11 jobs listed were related to health care, and operating room–based positions comprised the top four.

So it looks like demand for CRNAs > anesthesiologists

 

[anbuitachi]

And yet more and more their PP groups are being gobbled up by hospital systems - CT surgeons back home are now hospital employees along with the urologists. Grass isn’t always greener, it’s not easy to uproot a family either...

They are paying them well?

 

[spacegun]

They aren't tied down to a hospital/center like we are.

Ignorant med student, is it possible to escape dependence on hospitals/centers in anesthesia? All the fellowships except pain seem like they're dependent on hospitals too.

 

[anbuitachi]

Ignorant med student, is it possible to escape dependence on hospitals/centers in anesthesia? All the fellowships except pain seem like they're dependent on hospitals too.

I would say realistically the answer is no. Insurance aren't going to pay you for providing anesthesia when a surgery isn't involved!

 

[Cryc_to_the_point]

I see the argument for NPs in primary care, but can anyone tell me why a provider with no gross anatomy and little in the way of additional pharm or physio has business working in an ICU? I can see how PAs would be, but they're at least prepared in the relevant topics. Also, I've asked a few frequent posters on the Critical Care world in Anesthesia, I'm still surprised that MICU coverage by Anesthesia isn't the norm. Anyone want to weigh in on where you can expect to practice within the hospital as a Anesthesiologist/CCM?

 

[spacegun]

I see the argument for NPs in primary care, but can anyone tell me why a provider with no gross anatomy and little in the way of additional pharm or physio has business working in an ICU? I can see how PAs would be, but they're at least prepared in the relevant topics. Also, I've asked a few frequent posters on the Critical Care world in Anesthesia, I'm still surprised that MICU coverage by Anesthesia isn't the norm. Anyone want to weigh in on where you can expect to practice within the hospital as a Anesthesiologist/CCM?

I think SICU, maybe CVICU? But isn't the surgeon normally in charge at most SICU's?

 

[It's lupus!]

Like Cryc I'm a little confused how CRNA/NPs are able to practice even in super specialized fields. If it takes a physician 5 to 8 years post graduate training why is it that CRNAs can spend 2-3 years in school and then autonomously practice in the same areas. I struggle to grasp how that happens. Is it that the level of education a CRNA receives is all thats necessary to do the job safely an appropriately? If not, then how did the medical community allow this to happen in the first place?

 

[Cryc_to_the_point]

I think SICU, maybe CVICU? But isn't the surgeon normally in charge at most SICU's?

That was my understanding. I'm also a bit curious as to why a surgeon is in charge of ICU patients (presuming they aren't CCM), but honestly that's probably just my own student lack of understanding.

 

[anbuitachi]

I see the argument for NPs in primary care, but can anyone tell me why a provider with no gross anatomy and little in the way of additional pharm or physio has business working in an ICU? I can see how PAs would be, but they're at least prepared in the relevant topics. Also, I've asked a few frequent posters on the Critical Care world in Anesthesia, I'm still surprised that MICU coverage by Anesthesia isn't the norm. Anyone want to weigh in on where you can expect to practice within the hospital as a Anesthesiologist/CCM?

I think SICU, maybe CVICU? But isn't the surgeon normally in charge at most SICU's?

As an anesthesiologist you will mainly practice in the OR. As anesthesiology CCM you will mainly be in SICU and CTICU.
Here, we our intensivists in CTICU/SICU is a mix of anesthesiology and surgery trained. I believe SICU also has pulm crit trained as well.

Like Cryc I'm a little confused how CRNA/NPs are able to practice even in super specialized fields. If it takes a physician 5 to 8 years post graduate training why is it that CRNAs can spend 2-3 years in school and then autonomously practice in the same areas. I struggle to grasp how that happens. Is it that the level of education a CRNA receives is all thats necessary to do the job safely an appropriately? If not, then how did the medical community allow this to happen in the first place?

Doctors these days are just employees. Administrators call the shots. In a field like anesthesiology, it's easy to be replaced since you don't own patients. If a hospital starts integrating CRNAs into the system, those doctors who don't like it can quit but they'll be able to hire new employees eventually.

That was my understanding. I'm also a bit curious as to why a surgeon is in charge of ICU patients (presuming they aren't CCM), but honestly that's probably just my own student lack of understanding.

Some ICUs depending on the hospital are either open or closed. It's just hospital design I guess.. Here most of the ICUs are closed so the intensivist makes the final decision.

 

[AdmiralChz]

They are paying them well?

Apparently nothing changed for the first few years on the contract, but now that that's up the hospital is pushing more for better OR utilization or risk losing block time to other services with backlogs (namely Ortho, but also ENT and general surgery). CT Surgery has their own ORs and just signed with the hospital so who knows there, they tend to be a little more fickle bunch and actually will move en masse cross country to follow better jobs (anecdotal experience, happened at my residency where all but one left over 3 years).

Like Cryc I'm a little confused how CRNA/NPs are able to practice even in super specialized fields. If it takes a physician 5 to 8 years post graduate training why is it that CRNAs can spend 2-3 years in school and then autonomously practice in the same areas. I struggle to grasp how that happens. Is it that the level of education a CRNA receives is all thats necessary to do the job safely an appropriately? If not, then how did the medical community allow this to happen in the first place?

Eh, if you ask them they will say there is "no evidence" that full MD training is better (my good friend who's a newly-minted DNP claims they do better at primary care...), and that on the job experience is what counts. Plus they claim the "same" training as a "critical care fellow" as anesthesiology critical care. I think it's ridiculous, and Blade is right it's far off for the specialty as a whole particularly for higher-acuity units like a MICU or CVICU. I'd be more worried for EM, but that's a separate conversation.

Specific examples from "big name" institutions:

Surgical & Critical Care Nurse Practitioner Fellowship - University of California, San Francisco - - Surgical & Critical Care Nurse Practitioner Fellowship

AGACNP Critical Care Fellowship | DNP | School of Nursing | Vanderbilt University

Emory Critical Care Center NP/PA Post Graduate Residency | Woodruff Health Sciences Center | Emory University

Nurse Practitioner or Physician Assistant Critical Care Fellowship (Minnesota) - Mayo Clinic School of Health Sciences - Mayo Clinic

UPMC Critical Care Medicine Advanced Practice Provider Residency | University of Pittsburgh Department of Critical Care Medicine

 

[anbuitachi]

Apparently nothing changed for the first few years on the contract, but now that that's up the hospital is pushing more for better OR utilization or risk losing block time to other services with backlogs (namely Ortho, but also ENT and general surgery). CT Surgery has their own ORs and just signed with the hospital so who knows there, they tend to be a little more fickle bunch and actually will move en masse cross country to follow better jobs (anecdotal experience, happened at my residency where all but one left over 3 years).



Eh, if you ask them they will say there is "no evidence" that full MD training is better (my good friend who's a newly-minted DNP claims they do better at primary care...), and that on the job experience is what counts. Plus they claim the "same" training as a "critical care fellow" as anesthesiology critical care. I think it's ridiculous, and Blade is right it's far off for the specialty as a whole particularly for higher-acuity units like a MICU or CVICU. I'd be more worried for EM, but that's a separate conversation.

Specific examples from "big name" institutions:

Surgical & Critical Care Nurse Practitioner Fellowship - University of California, San Francisco - - Surgical & Critical Care Nurse Practitioner Fellowship

AGACNP Critical Care Fellowship | DNP | School of Nursing | Vanderbilt University

Emory Critical Care Center NP/PA Post Graduate Residency | Woodruff Health Sciences Center | Emory University

Nurse Practitioner or Physician Assistant Critical Care Fellowship (Minnesota) - Mayo Clinic School of Health Sciences - Mayo Clinic

UPMC Critical Care Medicine Advanced Practice Provider Residency | University of Pittsburgh Department of Critical Care Medicine

Are there actually hospitals that let 'critical care' NPs or PAs run the unit without MD supervision?!

 

[Psai]

The way they steal our terminology for their caricature of medical training is just absurd and galling.

 

[LunchMD]

I think SICU, maybe CVICU? But isn't the surgeon normally in charge at most SICU's?

At my program, anesthesia runs (ie the medical directors are anesthesiologists) both the CVICU and the SICU (at one of the hospitals). Where I did my internship anesthesia ran a brand new closed MICU/SICU

 

[It's lupus!]

Eh, if you ask them they will say there is "no evidence" that full MD training is better (my good friend who's a newly-minted DNP claims they do better at primary care...), and that on the job experience is what counts. Plus they claim the "same" training as a "critical care fellow" as anesthesiology critical care. I think it's ridiculous, and Blade is right it's far off for the specialty as a whole particularly for higher-acuity units like a MICU or CVICU. I'd be more worried for EM, but that's a separate conversation.

So I shouldn't be discouraged from anesthesia-ccm? I don't, at this point in my life, necessarily care what CRNAs are doing (ignorance plays a large role here), and so long as I can pay my bills and live reasonably the salary is inconsequential to me. What does matter is my ability to have direct contact with patients, do procedures, and have opportunities to work complex cases. Of course, it should go without saying, and make a positive difference in people's lives.

 

[Nivens]

So I shouldn't be discouraged from anesthesia-ccm? I don't, at this point in my life, necessarily care what CRNAs are doing (ignorance plays a large role here), and so long as I can pay my bills and live reasonably the salary is inconsequential to me. What does matter is my ability to have direct contact with patients, do procedures, and have opportunities to work complex cases. Of course, it should go without saying, and make a positive difference in people's lives.

I would strongly consider medicine if you KNOW you want to do ccm, but I'll be honest, I don't usually take medical students' interest in critical care that seriously. Reason being, critical care makes for a great medical student rotation (no real call, low census, lots of staff around to teach, acuity, procedures, etc), but the reality as a resident/attending is much different. Based on our applicant surveys, well over 85% apply to our program with a strong interest in critical care, but only 1-2 residents per class on average go on to do the fellowship. Maybe you will be one of the exceptions, but statistically speaking it's smarter to pick the base specialty you'd be happier in if you decided against critical care.

 

[It's lupus!]

I would strongly consider medicine if you KNOW you want to do ccm, but I'll be honest, I don't usually take medical students' interest in critical care that seriously. Reason being, critical care makes for a great medical student rotation (no real call, low census, lots of staff around to teach, acuity, procedures, etc), but the reality as a resident/attending is much different. Based on our applicant surveys, well over 85% apply to our program with a strong interest in critical care, but only 1-2 residents per class on average go on to do the fellowship. Maybe you will be one of the exceptions, but statistically speaking it's smarter to pick the base specialty you'd be happier in if you decided against critical care.

I definitely understand. That's why I am looking at the anesthesia route. The base specialty as far as I can tell looks fantastic, but if the future of anesthesia as my base is hands off patients then it may not be right. You'd be correct in that while I find ccm very interesting I'm not sure if by the time I get there that there isn't something I would prefer to do more. SDN often makes it implied that Anesthesiologist don't really do anesthesia but rather supervise CRNAs doing anesthesia. It further follows the concerns of autonomous CRNAs which is where career options seem worrisome. Im extremely enthusiastic about the specialty but if by the time I get there my main job isn't to actually work with patients I would fear I made the wrong choice. As usual though this all ties into the large level of ignorance I have for all this.

Sent from my Pixel XL using SDN mobile

 

[AdmiralChz]

I definitely understand. That's why I am looking at the anesthesia route. The base specialty as far as I can tell looks fantastic, but if the future of anesthesia as my base is hands off patients then it may not be right. You'd be correct in that while I find ccm very interesting I'm not sure if by the time I get there that there isn't something I would prefer to do more. SDN often makes it implied that Anesthesiologist don't really do anesthesia but rather supervise CRNAs doing anesthesia. It further follows the concerns of autonomous CRNAs which is where career options seem worrisome. Im extremely enthusiastic about the specialty but if by the time I get there my main job isn't to actually work with patients I would fear I made the wrong choice. As usual though this all ties into the large level of ignorance I have for all this.

Sent from my Pixel XL using SDN mobile

Nivens is correct on this, tons of medical students have an interest in CCM because they often feel like part of the team and can participate more in rounds than in the OR. This wanes in residency when you get a better feel for what it’s like to be a physician, to be honest. I was one of these idealistic med students, I later saw the light ;-)

It’s smart to reach out, but remember to take what you hear here with a grain of salt. SDN for almost all specialties has a large contingent of disgruntled staff that’s angry at their situation/job and has a degree of burnout. If I were you, I’d reach out to anesthesiologists at your medical school and discuss with them their thoughts on the matter and what their experience has been.

 

[anbuitachi]

Nivens is correct on this, tons of medical students have an interest in CCM because they often feel like part of the team and can participate more in rounds than in the OR. This wanes in residency when you get a better feel for what it’s like to be a physician, to be honest. I was one of these idealistic med students, I later saw the light ;-)

It’s smart to reach out, but remember to take what you hear here with a grain of salt. SDN for almost all specialties has a large contingent of disgruntled staff that’s angry at their situation/job and has a degree of burnout. If I were you, I’d reach out to anesthesiologists at your medical school and discuss with them their thoughts on the matter and what their experience has been.

Not sure why med students felt that way. I never felt that way when i was a med student in the ICU. I felt more useless in the ICU than on the floor. The med student wont be the one actively treating the patients...

 

[Nivens]

Not sure why med students felt that way. I never felt that way when i was a med student in the ICU. I felt more useless in the ICU than on the floor. The med student wont be the one actively treating the patients...

It’s all relative. Much easier to make the med student feel included when you’re on an overstaffed ICU service collectively taking care of 8 patients than it is when you’re covering 20 floor patients by yourself, running around like a chicken without a head.

 

[Neopolymath]

In my inexperienced opinion, I think it would be most important for potential applicants to see what private practice in the ACT model means because that is what we will be doing unless you stay in academics your whole career. It seems like a lot of students don't actually know how medicine works in non-academic hospitals so I don't see how anesthesia would be any different.

 

[Twiggidy]

My wife told me an interesting story the other day.

She was talking at her friends high school about the medical field and her friend said a pathologist spoke to them before she did. When asked about going to medical school the pathologist said, “Look a lab tech can make six figures and they only have to do one more year of training after college”

Valid point.

Med school (and college) is expensive and salaries are decreasing. My advice is always:

1) Go to the school that will give you the most money
2) Choose the career that you enjoy doing, not what pays the most.
I get paid well but I hate about 70% of my work week.

I enjoyed science in college and I probably should’ve gotten a PHD (which they pay you to get in most cases) and just want and worked in a lab doing experiments. Probably would’ve enjoyed my work more despite the paycut.

Moral is, if you think anesthesia is something you’ll enjoy then do it and don’t think about “mid level encroachment” because you’ll enjoy your work regardless. Otherwise evaluate the reason why you think you think you want to do anesthesia.

 

[deleted162650]

I get paid well but I hate about 70% of my work week.

I enjoyed science in college and I probably should’ve gotten a PHD (which they pay you to get in most cases) and just want and worked in a lab doing experiments. Probably would’ve enjoyed my work more despite the paycut.

Why not go academic and start working your way into a research track? Life's too short to hate 70% of your work week which comprises the vast majority of your waking hours.

 

[Twiggidy]

Why not go academic and start working your way into a research track? Life's too short to hate 70% of your work week which comprises the vast majority of your waking hours.

For the type of research I’d want to do I’d probably have to go back and get a PhD and then likely do a post doc. At this point we’re talking about big lifestyle changes. Best I can do is make my current situation better but easier said than done

That’s why my answer to the OP is “do anesthesia only if you would still do it for next to nothing” otherwise it’s just a job, and ...

“a job is nothing but work” -Marlon Wayans “Mo’ Money”