Is the anesthesia job market saturated?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
scutdoc

scutdoc

Full Member
Verified Member
7+ Year Member
Joined
Mar 23, 2014
Messages
46
Reaction score
30
I read this recent post from ZMD. I know I for one would be interested in hearing more opinions if anyone has any? Thanks!
Members don't see this ad.
 
One thing I don't understand is why we've increased the number of graduates at a time like this, other than for the obvious cheap labor for programs...



Is The Anesthesia Job Market Saturated?

Merritt Hawkins, the physician placement firm, has released its 2014 list of doctors in highest demand in the community. For the seventh year in a row, to no one's surprise, family medicine and other primary care fields were requested over all others. Most of the jobs in the top ten belonged to PCP's or physician extenders like PA's and NP's. It's not until the bottom half of this top twenty list do you start seeing need for specialty fields like surgery or cardiology.

I was a little surprised that anesthesiologists were not on this list of sought after doctors. It wasn't that long ago that the ASA loudly proclaimed the U.S. has a shortfall of several thousand anesthesiologists and that this situation will only get worse through the rest of the decade. If anesthesiologists are supposedly in such shortage, how come we don't see that reflected in the jobs marketplace?

In the early years of the last decade, radiology and anesthesiology were frequently the highest requested physicians in the Merritt Hawkins surveys. But starting in 2005, M-H already started noticing a downturn in demand for these two ROAD fields. In its report that year, anesthesiology had dropped to the tenth spot. The company wrote in the report, "anesthesiology is one of the few medical specialties where a significant amount of care can be provided by non-physicians, and in many cases health care organizations are recruiting certified registered nurse anesthetists (CRNA's) in lieu of anesthesiologists."

The picture continued to grow more bleak as the decade progressed. In the 2009 survey, anesthesiology placement had dropped to 19th place, with CRNA just slightly higher at 18th. Then in Merritt Hawkins's 2012 report, the bottom finally fell out of the specialty. That year M-H stated that, "for the first time since Merritt Hawkins began compiling data for this Review, anesthesiology was not among its top 20 most requested search assignments." It has not made a reappearance in the top twenty list since. In this year's report, M-H theorized that, "Inhibiting demand for anesthesiologists is the use of certified nurse anesthetists (CRNAs), who now administer 65% of all anesthetics nationwide, according to the American Association of Nurse Anesthetists (AANA) and are particularly prevalent in smaller, rural communities."

So who are you going to believe, the ASA with its interest in self promotion, or a third party company who is reading the pulse of the jobs market on a daily basis? If you peruse the job listings in the anesthesiology jobs siteGasWork, you can see that many states have few posts available. And the anesthesiologists that are requested are for very specific subspecialties like cardiac or OB anesthesia or for part time locums positions.

Are we in another downturn in the anesthesia market like the mid 1990's? Back then you couldn't give away anesthesia residency spots. No smart medical student wanted to go into a dead end residency with such a poor job prospect like anesthesiology. But soon the cycle turned and anesthesiologists experienced a boom in demand as a dearth of new anesthesia graduates were unable to fill all the job openings available. Has the bubble already popped in anesthesiology? Only time will tell.
 
scutdoc said:
I read this recent post from ZMD. I know I for one would be interested in hearing more opinions if anyone has any? Thanks!
Click to expand...
Why do you need more opinions? You have a physician placement firm with their hand on the pulse of the market. You cannot get a more objective estimate.

It's not the 90's, it's much worse. The number of CRNAs is now much higher, by degrees of magnitude. It's a sinking ship; one really has to be desperate to jump on it now.
 
Members don't see this ad :)
Is the anesthesia job market saturated? Yes.

Is it tough to find good paying jobs and/or partnership tracks? Yes

Does the outlook look bleak going forward? Yes

Will starting salaries decrease along with the opportunity to earn over $450K? Yes

Will you be able to find a job after a Residency? Yes as long as you are realistic about location, salary, call, hours, etc.

In order to improve your chance of success in this field plan on doing a fellowship in an area like Pain, Peds, Cardiac or Critical Care
 
BLADEMDA said:
Is the anesthesia job market saturated? Yes.

Is it tough to find good paying jobs and/or partnership tracks? Yes

Does the outlook look bleak going forward? Yes

Will starting salaries decrease along with the opportunity to earn over $450K? Yes

Will you be able to find a job after a Residency? Yes as long as you are realistic about location, salary, call, hours, etc.

In order to improve your chance of success in this field plan on doing a fellowship in an area like Pain, Peds, Cardiac or Critical Care
Click to expand...
Blade. Very good points.

But always remember. At the end of the day. If they get rid of the 1:4 model.

Most likely it's going to be the CRNA who will be out of a job.

An MD will work for "CRNA pay" if needed.

So if hospital is paying $150-175k for 4-5 day work week and md wants to work those shifts. Who's going to be out of a job?

Think people. Unless your skills are so eroded. Chances are you will end up replacing a CRNA and the CRNA is out of a job.
 
aneftp said:
So if hospital is paying $150-175k for 4-5 day work week and md wants to work those shifts. Who's going to be out of a job?
Click to expand...
The MD. They might need you around to do cardiac or nights for the same money, though.

Long term, the (nurse) bean counters want to get rid of doctors, period. They only keep you around because the nurses can't do your job... yet. They don't need doctors to do what a nurse could do, too. That's the entire purpose of automatizing and protocolizing everything: to replace the general with the grunt. Anesthesia is just among the first of many specialties that will come under attack in the future. Because we are the most automatized, and among the safest, we are a low hanging fruit. Every time a stupid doc develops a "protocol", he's cutting another millimeter off the branch he's sitting on.

Beyond profits, this is class warfare, pure and simple; nurses (including those from the hospital administration), as a class, dislike/hate doctors as a class. Where do you think the public got the impression that nurses are angels and doctors are the bad guys?

This is until the bean counters figure out how to move parts of this offshore, for even less money, so they can pay themselves even bigger salaries and bonuses. They will always need nurses locally to wipe the patients' butts, but a lot of stuff can and will be done by telemedicine.

This has happened before, just not to healthcare. Somehow I don't remember just the workers being let go, and engineers being retained for assembly line-worker positions and salaries.

I am not against progress, which can't be avoided, just against destroying people's lives for the sake of reducing healthcare costs by 7%.
 
Last edited by a moderator:
kazuma said:


The picture continued to grow more bleak as the decade progressed. In the 2009 survey, anesthesiology placement had dropped to 19th place, with CRNA just slightly higher at 18th. Then in Merritt Hawkins's 2012 report, the bottom finally fell out of the specialty. That year M-H stated that, "for the first time since Merritt Hawkins began compiling data for this Review, anesthesiology was not among its top 20 most requested search assignments." It has not made a reappearance in the top twenty list since. In this year's report, M-H theorized that, "Inhibiting demand for anesthesiologists is the use of certified nurse anesthetists (CRNAs), who now administer 65% of all anesthetics nationwide, according to the American Association of Nurse Anesthetists (AANA) and are particularly prevalent in smaller, rural communities."

So who are you going to believe, the ASA with its interest in self promotion, or a third party company who is reading the pulse of the jobs market on a daily basis? If you peruse the job listings in the anesthesiology jobs siteGasWork, you can see that many states have few posts available. And the anesthesiologists that are requested are for very specific subspecialties like cardiac or OB anesthesia or for part time locums positions.

Are we in another downturn in the anesthesia market like the mid 1990's? Back then you couldn't give away anesthesia residency spots. No smart medical student wanted to go into a dead end residency with such a poor job prospect like anesthesiology. But soon the cycle turned and anesthesiologists experienced a boom in demand as a dearth of new anesthesia graduates were unable to fill all the job openings available. Has the bubble already popped in anesthesiology? Only time will tell.
Click to expand...

So - do we believe the ASA with its interest in self promotion quoting statistics provided by a third party company (the RAND corporation) - or the other third party company that likes to quote statistics and opinions directly from the AANA?

This "65% of all anesthetics are administered by CRNA's" concept has been floating around for as long as I can remember. The AANA would have the public believe that 65% of all anesthetics are administered by independently-acting CRNA's without the supervision/direction of an anesthesiologist. That simply isn't true.
 
aneftp said:
Blade. Very good points.

But always remember. At the end of the day. If they get rid of the 1:4 model.

Most likely it's going to be the CRNA who will be out of a job.

An MD will work for "CRNA pay" if needed.

So if hospital is paying $150-175k for 4-5 day work week and md wants to work those shifts. Who's going to be out of a job?

Think people. Unless your skills are so eroded. Chances are you will end up replacing a CRNA and the CRNA is out of a job.
Click to expand...

Is there talk of getting rid of the 4:1 model? I haven't read anything about that.

Skill erosion is a very real problem for SOME people that supervise. I see it nearly everyday as a resident. If you don't use it you will lose it.
 
No. No one is getting rid of the 4:1 model.

What many of you don't realize is reimbursement is going up not down, billing efficiency is improving, and there is still a lot of money in anesthesia. The people controlling that money are just being f'ing greedy and not willing to share it with you.

There is a huge need still in anesthesia providers in certain areas. These jobs are not necessarily advertised. But there is a sh*tload of guys who want to retire in the next 5-10 years. The age range of providers is bi-modal with a dirth of providers in the 45-55 years of age range. The answer is not to fill these spots with less qualified providers and stretching resources too thin. When this becomes problematic for hospitals, things will change.
 
Members don't see this ad :)
FFP said:
Yes. And bringing in the 1:5 model. 😛

Seriously, anything above 1:3, or above 1:2 for short cases, means that the CRNA does whatever the F she wants with your patient. You're just their preop monkey.
Click to expand...

Yeah, and you are still on the hook if anything goes wrong.

Turn 'em loose. Make them do their own pre-ops. Make them get consent. Let 'em run around and do all the bull**** too and not just sit in the OR thinking they "don't need us" and that they're the ****.
 
BuzzPhreed said:
No. No one is getting rid of the 4:1 model.

What many of you don't realize is reimbursement is going up not down, billing efficiency is improving, and there is still a lot of money in anesthesia. The people controlling that money are just being f'ing greedy and not willing to share it with you.

There is a huge need still in anesthesia providers in certain areas. These jobs are not necessarily advertised. But there is a sh*tload of guys who want to retire in the next 5-10 years. The age range of providers is bi-modal with a dirth of providers in the 45-55 years of age range. The answer is not to fill these spots with less qualified providers and stretching resources too thin. When this becomes problematic for hospitals, things will change.
Click to expand...

I personally predict that many who want to retire will just work less for longer than they had planned. The old guys will job share, e.g. 4 guys fill three FTE slots, etc.
 
dr doze said:
I personally predict that many who want to retire will just work less for longer than they had planned. The old guys will job share, e.g. 4 guys fill three FTE slots, etc.
Click to expand...

Nerf herders. All of them.
 
dr doze said:
I hope to be one in a few years. 😉
Click to expand...

That's fine. Just make sure that you're not in charge of my anesthesia if I need an operation. Might I also suggest that you limit your practice to Medicare/Medicaid patients or people who otherwise aren't personally paying in some way for their own care.
 
BuzzPhreed said:
That's fine. Just make sure that you're not in charge of my anesthesia if I need an operation. Might I also suggest that you limit your practice to Medicare/Medicaid patients or people who otherwise aren't personally paying in some way for their own care.
Click to expand...

Interesting how you are able to judge skill based solely on somebody choosing to slow down a little after a 25 year career of 55-60 hour weeks. I am sure that there are plenty of 30 something's as well as 40 something's who would happily slow down now if they could.
 
dr doze said:
Interesting how you are able to judge skill based solely on somebody choosing to slow down a little after a 25 year career of 55-60 hour weeks. I am sure that there are plenty of 30 something's as well as 40 something's who would happily slow down now if they could.
Click to expand...

No, no, no.

If you're going to turn into a nerf herder, this means that you're just going to sign charts, fill out forms, sit back and relax, and let the nurses do all the heavy lifting.

I've met plenty of those. They've cashed out. They don't care ultimately about anything but how much they're getting paid at the end of the day. The patient? Eh. Just a means to an end. They're off their game. They're done. But because they still have a medical license they can serve some function by simply putting their pen to paper.

Ironically the CRNAs they work with hate them more than their doc colleagues. If that's you, then I don't want you to be involved in my care. That's all.
 
anbuitachi said:
back in 1990s, they couldn't give away spots? i thought there are always IMGs to take your spots...
Click to expand...

One big difference between now and then is the number of US grads is going up, DO schools are opening up in many areas and MD schools are expanding. There may soon come a time when there simply aren't enough residency spots for every US grad even. At that point getting into something will look better than being unemployed. Then begins a downward spiral...
 
BuzzPhreed said:
No, no, no.

If you're going to turn into a nerf herder, this means that you're just going to sign charts, fill out forms, sit back and relax, and let the nurses do all the heavy lifting.

I've met plenty of those. They've cashed out. They don't care ultimately about anything but how much they're getting paid at the end of the day. The patient? Eh. Just a means to an end. They're off their game. They're done. But because they still have a medical license they can serve some function by simply putting their pen to paper.

Ironically the CRNAs they work with hate them more than their doc colleagues. If that's you, then I don't want you to be involved in my care. That's all.
Click to expand...

Sorry, I misunderstood the term "nerfherder" I just took it as a slam against anybody who wanted to go part time.
 
BuzzPhreed said:
No. No one is getting rid of the 4:1 model.

What many of you don't realize is reimbursement is going up not down, billing efficiency is improving, and there is still a lot of money in anesthesia. The people controlling that money are just being f'ing greedy and not willing to share it with you.

There is a huge need still in anesthesia providers in certain areas. These jobs are not necessarily advertised. But there is a sh*tload of guys who want to retire in the next 5-10 years. The age range of providers is bi-modal with a dirth of providers in the 45-55 years of age range. The answer is not to fill these spots with less qualified providers and stretching resources too thin. When this becomes problematic for hospitals, things will change.
Click to expand...

Billing efficiency isn't going to last for long.

There is a reason the govt released Medicare billing data a couple of months ago. To shame some of the greedy docs.

Saying all that. As ACA expands (and it will). These narrow networks (remember individual market only makes up 5% of USA population). As these narrow networks expand. It's estimated they will hit 25% in less than 5-6 years. They will start demanding even less from providers.

If that's not bad enough. ACOs are just in it's infancy. Anesthesia will be the low hanging fruit it ACOs expand. Although one of my residency classmates from 10 years ago has said management companies have low balled and tried to only take 3-5% of the total bills. Usually anesthesia fees are about 8-12% of operation in outpatient setting.

Goldman Sachs, HIG capital (surgery partners) just to name a couple along with other venture capitalist are going to see short term profits in anesthesia.

True. I do agree they are taking way too much off the top with their billing profits these days. But I don't think this gravy train for these companies will last
Longer than 3 years before the tide turns. That's why they are called investment banks and venture capitalist. They see short term profits and than run and take the money and leave.
 
kazuma said:
Is there talk of getting rid of the 4:1 model? I haven't read anything about that.

Skill erosion is a very real problem for SOME people that supervise. I see it nearly everyday as a resident. If you don't use it you will lose it.
Click to expand...

AANA has been proposing the "collaboration model" where md does own cases and CRNA does own cases. MD is around for "consultation".

Aana telling lawmakers lone supervising anesthesiologist not cost effective enough.

Eventually I do sell having one md available for pacu/emergencies and everyone doing their own cases.

My brother group and also my sister group (both all md). One on east coast. One on west coast. Both hospitals administrator require free MD during normal 7-5pm weekday for "emergencies".

Of course since both of them work in major metro areas with no subsidy. Their group eats the cost of that free Md
 
BuzzPhreed said:
No. No one is getting rid of the 4:1 model.

What many of you don't realize is reimbursement is going up not down, billing efficiency is improving, and there is still a lot of money in anesthesia. The people controlling that money are just being f'ing greedy and not willing to share it with you.

There is a huge need still in anesthesia providers in certain areas. These jobs are not necessarily advertised. But there is a sh*tload of guys who want to retire in the next 5-10 years. The age range of providers is bi-modal with a dirth of providers in the 45-55 years of age range. The answer is not to fill these spots with less qualified providers and stretching resources too thin. When this becomes problematic for hospitals, things will change.
Click to expand...
How do you know the age range is bimodal? I've heard this somewhere else before. I'm seriously interested. What's your source?
 
aneftp said:
AANA has been proposing the "collaboration model" where md does own cases and CRNA does own cases. MD is around for "consultation".

Aana telling lawmakers lone supervising anesthesiologist not cost effective enough.

Eventually I do sell having one md available for pacu/emergencies and everyone doing their own cases.

My brother group and also my sister group (both all md). One on east coast. One on west coast. Both hospitals administrator require free MD during normal 7-5pm weekday for "emergencies".

Of course since both of them work in major metro areas with no subsidy. Their group eats the cost of that free Md
Click to expand...

There are models like that in the state I live in. One of my attendings took at PP gig and was telling me that CRNAs do ASA 1-2 cases, MDs do 3-6E. It's an opt-out state.
 
aneftp said:
AANA has been proposing the "collaboration model" where md does own cases and CRNA does own cases. MD is around for "consultation".
Click to expand...

F**K that!

So, they're going to sit around and pick all the low-hanging fruit? And then only call us when there is a problem simply to enjoin us in their lawsuit?

They're either equivalent. Or they're not. Turn 'em loose. Let the chips fall.
 
BuzzPhreed said:
F**K that!

So, they're going to sit around and pick all the low-hanging fruit? And then only call us when there is a problem simply to enjoin us in their lawsuit?

They're either equivalent. Or they're not. Turn 'em loose. Let the chips fall.
Click to expand...

Yeah, that fairly well describes the system as it stands in the Army, and why I hate my "consultant" days. Any case for which I am 'consulted' preop, I handle like a regular supervision case, and comply with all aspects of TEFRA, its the post- or intra-op consultations that suck balls, because I'm not involved until something already went pear-shaped. One down, three to go.
 
psychbender said:
Yeah, that fairly well describes the system as it stands in the Army, and why I hate my "consultant" days. Any case for which I am 'consulted' preop, I handle like a regular supervision case, and comply with all aspects of TEFRA, its the post- or intra-op consultations that suck balls, because I'm not involved until something already went pear-shaped. One down, three to go.
Click to expand...

In the Army your superiors can order you to do it that way.

In the civilian world your contract determines who can boss you around.

That's the difference. Make good contractual decisions. I've been on this forum for almost 8 months. I'm sounding like a broken record.
 
As a guy who just graduated and went through the job search, I can say there is plenty of opportunity in my state. Graduates landed in every major metropolitan area within the state. I not only got to go to my first choice of city, but I am very pleased with my contract and set-up.
 
Ignatius J said:
As a guy who just graduated and went through the job search, I can say there is plenty of opportunity in my state. Graduates landed in every major metropolitan area within the state. I not only got to go to my first choice of city, but I am very pleased with my contract and set-up.
Click to expand...

what state is that??
 
Ignatius

Texas, yeah right!

Dallas and Houston both just went down the drain because the two biggest groups in those cities both sold out to US Anesthesia (they actually founded this AMC with another group in Florida)

Austin, best and biggest group there sold out to American Anesthesia

Everything else is just small groups that are not going to survive much longer or hospital employed.

Anesthesia in Texas is on its way down the drain my friend


Good luck
 
If by saturated you mean only 500 jobs on gaswork instead of 3000, then yes. It's totally saturated.
 
ravanbj said:
Ignatius

Texas, yeah right!

Dallas and Houston both just went down the drain because the two biggest groups in those cities both sold out to US Anesthesia (they actually founded this AMC with another group in Florida)

Austin, best and biggest group there sold out to American Anesthesia

Everything else is just small groups that are not going to survive much longer or hospital employed.

Anesthesia in Texas is on its way down the drain my friend


Good luck
Click to expand...
I looked into TX as well in my initial job search because of all the hype and was not impressed with the opportunities there. Definitely a changing landscape. Except for the San Antonio market, but I was not interested in living there.
 
Regarding Texas, the question isn't the type of set up, it's whether the market is saturated, and there are a lot of jobs to be had in Houston and Dallas, regardless of the set up of the group.

If the question is: 'Do I have job security in Texas in anesthesia?' The answer is unequivocally yes.

If the question is: 'Am I going to be a shareholder, make a bunch of bucks, have a great lifestyle, and live exactly where I want to?', then the answer is probably no. But I can't think of a lot of specialties that enjoy those stipulations.

The bottom line is that in Texas you can find a job as a practicing anesthesiologist pretty much anywhere you look, except for Austin which will gouge you just like every other job sector in that city.
 
Last edited:
The fact anyone can mislead Residents and Medical students about the job market is appalling. AMCs/Hospital Employee will represent 70-75% of the job market by the time a PGY-1 finishes his/her Residency. These "Employers" will certainly be hiring new graduate employees.

So yes you can find a job as a practicing Anesthesiologist working as an employee with no hope of ever making partner.
 
BLADEMDA said:
The fact anyone can mislead Residents and Medical students about the job market is appalling. AMCs/Hospital Employee will represent 70-75% of the job market by the time a PGY-1 finishes his/her Residency. These "Employers" will certainly be hiring new graduate employees.

So yes you can find a job as a practicing Anesthesiologist working as an employee with no hope of ever making partner.
Click to expand...

I think you have a good point. So is this a midlevel encroachment problem or are we eating our own? I think anesthesiologists have been among the worst specialties at protecting the practice for future generations.

Regardless, the question is "saturation". No, the market isn't saturated. Well, yes, it's saturated with people willing to sell out and turn future generations into mill workers. But the actual jobs are not saturated.

I really wish there were laws to protect corporate takeovers in medicine at the rate we're seeing. Eventually, there needs to be some anti-trust lawsuit against these types.
 
Is the market saturated? No. Everyone finds jobs without much difficulty and good people will have multiple offers. Are the most desirable locations difficult to get jobs in? Yes, and that is not a new trend.
The market is changing, incomes may shift, Maobama may drive us into a government system, and you'll still have a job and unless scarred by red flags, the ability to relocate almost anywhere.
 
Last edited:
IlDestriero said:
The preoccupation on this board with income is disturbing.
Click to expand...

No.

It's the current income maldistribution that's disturbing. The seniors are circling the wagons and aren't sharing the pie. Reimbursements across the board are going up, not down. The more bargaining power, the more money those who hold the reins will make.

That's the issue.
 
BuzzPhreed said:
No.

It's the current income maldistribution that's disturbing. The seniors are circling the wagons and aren't sharing the pie. Reimbursements across the board are going up, not down. The more bargaining power, the more money those who hold the reins will make.

That's the issue.
Click to expand...

Did you mean down, not up?
 
Hey, look, it's Chicken Little! Except now he's falling with the sky.....instead of being pummeled by it!

skydiving-with-chickens-poster-website-v2.jpg
 
BuzzPhreed said:
REIMBURSMENTS are going up. The amount getting paid per unit is going up. Not down.
Click to expand...

So why are people always talking about lower reimbursements then?

I hear that all the time--"lower reimbursements." What gives?
 
Silent Cool said:
So why are people always talking about lower reimbursements then?

I hear that all the time--"Lower reimbursements." What gives?
Click to expand...

They're not. They're talking about lower salaries. They're talking about more administration and people using your medical license to make money for themselves.

There has been a medicare/medicaid correction (published in 2011) that increased reimbursement for anesthesia services, not cut it. (I'm looking for the link now. Info is available on ASA website.)
 
You must log in or register to reply here.

Similar threads

T
Job market in Denver ?
Replies
18
Views
2K
nimbus
nimbus
T
What’s the job market in Atlanta ?
Replies
5
Views
2K
dmk5n
dmk5n
S
Maryland Job Market
2
Replies
69
Views
7K
aneftp
A
S
Phoenix job market?
2
Replies
53
Views
6K
Dawkter
Dawkter
N
Anesthesia as a Career for Physicians is Over!
Replies
16
Views
1K
teacher2md
T
Top