Is the future looking brighter?

[Strider_91]

I have been creeping on SDN for a while and have been turned off to anesthesia for the sole reason of people on the internet complaining of CRNA and talking about how anesthesia is going down the tubes. I obviously take this with a grain of salt but my brother is an attorney and the job market really can be as bad as people say for them. I just want to choose my specialty with open eyes. With that being said, it seems that there hasnt been as much complaining as of late in the field? Has it kind of evened out? Pay still seems relatively high in salary surveys and I dont know any anesthesiologists who are out of work. I have searched gaswork and there are plenty of jobs in my area and many of them seem to be partnership track. I didn't see a single job paying less than 300k and I dont live in BFE. I saw several jobs claiming >500k

So here is my question. Will Anesthesia be a solid field moving forward? Will you be able to work decently hard and make 350k, and if you are willing to move find a true partnership job and make well above that?

...or is AI and CRNA going to replace all anesthesiologists?

---

Members don't see this ad.

 

[Noyac]

We will never be replaced. Not completely at least.

 

[deleted50478]

I have been creeping on SDN for a while and have been turned off to anesthesia for the sole reason of people on the internet complaining of CRNA and talking about how anesthesia is going down the tubes. I obviously take this with a grain of salt but my brother is an attorney and the job market really can be as bad as people say for them. I just want to choose my specialty with open eyes. With that being said, it seems that there hasnt been as much complaining as of late in the field? Has it kind of evened out? Pay still seems relatively high in salary surveys and I dont know any anesthesiologists who are out of work. I have searched gaswork and there are plenty of jobs in my area and many of them seem to be partnership track. I didn't see a single job paying less than 300k and I dont live in BFE. I saw several jobs claiming >500k

So here is my question. Will Anesthesia be a solid field moving forward? Will you be able to work decently hard and make 350k, and if you are willing to move find a true partnership job and make well above that?

...or is AI and CRNA going to replace all anesthesiologists?

No, and CRNA’s aren’t the biggest threat to the future, exploitative Anesthesiologists and sellouts are.

 

[Strider_91]

So you are saying no it will not be a solid field moving forward?

 

[Noyac]

So you are saying no it will not be a solid field moving forward?

Depends.

 

[nimbus]

It is a solid field. Anesthesiologists will have work and make a lot of money. However, a significant minority will feel they are not being treated fairly.

 

[Noyac]

It is a solid field. Anesthesiologists will have work and make a lot of money. However, a significant minority will feel they are not being treated fairly.

Yes but the younger generation won’t kniw how things were in the “golden years” and it won’t matter. Disclaimer: not sure I know what the go,den years were like.

 

[deleted171991]

We will never be replaced. Not completely at least.

I've been thinking about this just today (while working with some very competent CRNAs), and I am not that convinced. A few thoughts:

- The main reason we are still commending physician-level salaries is CRNA non-independence. Even that is getting worse every year, with supervision ratios rising like skyscrapers. It's getting to a point where anesthesiology is a daily roulette with one's career and finances.

- The moment CRNAs become independent, we will either have to compete with them on price (and there are thousands of new CRNAs, pardon, DNPs. graduating every year), or do only the complicated, sick, risky, poorly-reimbursed Medicare patients, or difficult anesthetics (think cardiac, thoracic, open vascular etc.). There will be an acute decrease in the market demand for anesthesiologists, meaning that A LOT of us will have to work for CRNA salaries. Only the best will have decent jobs and physician-level pay. The rest will be happy to have ANY job at ANY pay. Many of us will have to be firefighters for a ****-ton of midlevels, in exchange for physician-level pay.

- The question in my mind is not IF, but WHEN will all of this happen. Will we last another decade? Maybe two? Btw, I don't see as a unique problem for anesthesia, long-term. Long-term, the healthcare megacorporations will do everything to destroy the American physician, replace him with midlevel drones, and "decrease costs" (the quotes are for sarcasm, since our salaries account for only 7% of the total healthcare costs). Except that, in other specialties, it may take decades to get to the crappy situation we are in TODAY.

- And while I am aware of the cyclical aspects of our job markets, this time it's different. This time our specialty has been invaded by locusts like never before, and they are eating at our jobs. BIG TIME.

- People should stop judging the future by how nice it is in their neighborhood NOW. It's wishful thinking. The hurricane is already building up on the East Coast, and it's just a matter of time till it will destroy a lot of anesthesiologists. Every single year, since I graduated, has been worse than the previous.

- Ergo, any smart MS who has a choice (and brains!), should not touch the specialty with a pole.

 

[DM27]

A few CRNAS where I work make more money than some Anesthesiology attendings I know practicing elsewhere. If they continue to have salary inflation they may risk pricing themselves out of the market if for tens of thousands more you can advertise being an MD only practice etc. I think that despite the doom and gloom surrounding our field at times that we have some small degree of protection from fluctuating levels of reimbursement since we are somewhat downstream and also are part of a larger aggregate.

A proceduralist, who likely makes more overall, has some degree of increased vulnerability in salary compared to us because a single reimbursement cut to a procedure they perform frequently can really decrease their income significantly whereas for us it usually requires a larger across the board decrease before we start to see it. Also in some of the surgical fields you start to have competition from MDs in other fields (such as between cardiothoracic surgery and cardiology) when it comes to procedures.

CRNA independence introduces a threat when it comes to a groups ability to bargain with the hospital if there is an eager army of CRNAs who can now practice independently who are willing to swoop in and be paid whatever just to increase the legitimacy of their new ability to practice. A lot of this comes down to the increased organization and solidarity that seems to exist among CRNAs compared to the relatively less action-involved MDs.

 

[Notorious T.E.E.]

I've been thinking about this just today (while working with some very competent CRNAs), and I am not that convinced. A few thoughts:

- The main reason we are still commending physician-level salaries is CRNA non-independence. Even that is getting worse every year, with supervision ratios rising like skyscrapers. It's getting to a point where anesthesiology is a daily roulette with one's career and finances.

- The moment CRNAs become independent, we will either have to compete with them on price (and there are thousands of new CRNAs, pardon, DNPs. graduating every year), or do only the complicated, sick, risky, poorly-reimbursed Medicare patients, or difficult anesthetics (think cardiac, thoracic, open vascular etc.). There will be an acute decrease in the market demand for anesthesiologists, meaning that A LOT of us will have to work for CRNA salaries. Only the best will have decent jobs and physician-level pay. The rest will be happy to have ANY job at ANY pay. Many of us will have to be firefighters for a ****-ton of midlevels, in exchange for physician-level pay.

- The question in my mind is not IF, but WHEN will all of this happen. Will we last another decade? Maybe two? Btw, I don't see as a unique problem for anesthesia, long-term. Long-term, the healthcare megacorporations will do everything to destroy the American physician, replace him with midlevel drones, and "decrease costs" (the quotes are for sarcasm, since our salaries account for only 7% of the total healthcare costs). Except that, in other specialties, it may take decades to get to the crappy situation we are in TODAY.

- And while I am aware of the cyclical aspects of our job markets, this time it's different. This time our specialty has been invaded by locusts like never before, and they are eating at our jobs. BIG TIME.

- People should stop judging the future by how nice it is in their neighborhood NOW. It's wishful thinking. The hurricane is already building up on the East Coast, and it's just a matter of time till it will destroy a lot of anesthesiologists. Every single year, since I graduated, has been worse than the previous.

- Ergo, any smart MS who has a choice (and brains!), should not touch the specialty with a pole.

I tend to agree with this. If you are practicing today you will probably be OK and have another 8-10 reasonably good years left. If you are an MS1 with 7+ years until you start in this field you would likely do better looking at other specialties.

 

[GravelRider]

I've been thinking about this just today (while working with some very competent CRNAs), and I am not that convinced. A few thoughts:

- The main reason we are still commending physician-level salaries is CRNA non-independence. Even that is getting worse every year, with supervision ratios rising like skyscrapers. It's getting to a point where anesthesiology is a daily roulette with one's career and finances.

- The moment CRNAs become independent, we will either have to compete with them on price (and there are thousands of new CRNAs, pardon, DNPs. graduating every year), or do only the complicated, sick, risky, poorly-reimbursed Medicare patients, or difficult anesthetics (think cardiac, thoracic, open vascular etc.). There will be an acute decrease in the market demand for anesthesiologists, meaning that A LOT of us will have to work for CRNA salaries. Only the best will have decent jobs and physician-level pay. The rest will be happy to have ANY job at ANY pay. Many of us will have to be firefighters for a ****-ton of midlevels, in exchange for physician-level pay.

- The question in my mind is not IF, but WHEN will all of this happen. Will we last another decade? Maybe two? Btw, I don't see as a unique problem for anesthesia, long-term. Long-term, the healthcare megacorporations will do everything to destroy the American physician, replace him with midlevel drones, and "decrease costs" (the quotes are for sarcasm, since our salaries account for only 7% of the total healthcare costs). Except that, in other specialties, it may take decades to get to the crappy situation we are in TODAY.

- And while I am aware of the cyclical aspects of our job markets, this time it's different. This time our specialty has been invaded by locusts like never before, and they are eating at our jobs. BIG TIME.

- People should stop judging the future by how nice it is in their neighborhood NOW. It's wishful thinking. The hurricane is already building up on the East Coast, and it's just a matter of time till it will destroy a lot of anesthesiologists. Every single year, since I graduated, has been worse than the previous.

- Ergo, any smart MS who has a choice (and brains!), should not touch the specialty with a pole.

I would actually go a step further and dissuade people from entering medical school because, as you say, this is coming to all specialties. I think people who are in practice now will be able to finish a career, but I think beyond that...think 15-20 years...the future is not bright. Each specialty will have its own timeline, but it will be driven by the megacorporations that are now in charge of healthcare. My advice to people pursuing a medical career these days is to strongly consider nursing school because it is the more economical choice.

 

[AdmiralChz]

AI may be a concern in the distant future... but the random and chaotic nature of the operating room make anesthesia a poor target. Other specialties will have to fight the AI battle (starting with Radiology?) way, way before we will.

 

[hfzballer11]

It's interesting how anesthesiology comes to mind first when discussing midlevel encroachment, when it is one of the more complex fields. If you go outside any academic center, PA/NPs are doing all the consults, seeing patients in clinic, etc. Where I am now I don't remember the last time I consulted a service and got a physician to come see the patient. They just sign off on the note remotely. How is this any different than what goes on with CRNA's and anesthesiologists?

As a med student I saw a plastic surgeon who would do breast reductions with a PA, they would simultaneously work on once breast each, essentially doing the same thing. In countless hospitals, PAs run the ICU at night and do the ICU consults during the daytime. There are entire specialties who's day to day tasks are so repetitive and logistical, it can easily be done by a PA/NP. Anesthesia is far from the only specialty with this issue.

I think the problem is anesthesiologists generally are more passive people. They like to do a good job and go home - this is what makes them unnoticed and the target for these kinds of things. But if motivated and intelligent medical students enter the field with a mindset to advocate for the field, expand it, and demonstrate their worth instead of just getting a paycheck and going home, we have a fighting chance. After all its because of the hard work and research of previous anesthesiologists, that it has become safe enough for non-physicians to practice to some extent.

Just my two cents and ramblings.

 

[AdmiralChz]

If you think Anes is the only specialty dealing with mid level encroachment, you’re not paying attention. We’ve had the issue for much longer then the other specialties and deal with it reasonably well - the failures of primary care loom large and EM is the next frontier for mid level encroachment and “supervising”

 

[Man o War]

One of the CRNAs from my old group just put her notice in to go work at a hospital independently making 325k. Independent CRNAs are not cheaper than docs on average. And this is a BFE hospital doing non complicated cases.
And let’s be real, the vast majority of CRNAs aren’t going to be safe in that environment.

 

[T. Ricochet]

MS2 here... I've been asking lots of people this question and they keep telling me that there's no way CRNA's would want to work without physician supervision. Then I get on SDN and read that I'm going to school for no good reason. Lol. To each his own. I have enjoyed my experience shadowing anesthesia. I hope it's around for many years to come.

 

[deleted171991]

If you think Anes is the only specialty dealing with mid level encroachment, you’re not paying attention. We’ve had the issue for much longer then the other specialties and deal with it reasonably well - the failures of primary care loom large and EM is the next frontier for mid level encroachment and “supervising”

Nobody denies that primary care is going the way of the toilet, and that more and more hospices hospitals use midlevels where they shouldn't, but there are still plenty of specialties where a doctor is a doctor, and one could even practice solo if one can put up with a lower income.

The entire system is rigged against the physicians, starting with the BS "privileging" (I am board-certified, I have had zero malpractice issues, my state licenses are up-to-date, anything else should be GFY). While I believe America has always been great, we need to make American healthcare great again, and get rid of all these administrative parasites, beginning with the joint-smoking commission for wasting taxpayer money and other similar bureaucracies.

 

[Strider_91]

One of the CRNAs from my old group just put her notice in to go work at a hospital independently making 325k. Independent CRNAs are not cheaper than docs on average. And this is a BFE hospital doing non complicated cases.
And let’s be real, the vast majority of CRNAs aren’t going to be safe in that environment.

That’s the interesting thing. CRNAs make more than physicians in a lot of other specialties these days. Seems to me like worst case scenario is you make CRNa level salaries and they price themselves out. I would much rather make crna money and be an anesthesiologist than go into family medicine.

Right now my dilemma is Anes va EM and idk if the future looks much brighter in EM than Anes to have future job market speculation shape my decision

 

[deleted50478]

It's interesting how anesthesiology comes to mind first when discussing midlevel encroachment, when it is one of the more complex fields. If you go outside any academic center, PA/NPs are doing all the consults, seeing patients in clinic, etc. Where I am now I don't remember the last time I consulted a service and got a physician to come see the patient. They just sign off on the note remotely. How is this any different than what goes on with CRNA's and anesthesiologists?

As a med student I saw a plastic surgeon who would do breast reductions with a PA, they would simultaneously work on once breast each, essentially doing the same thing. In countless hospitals, PAs run the ICU at night and do the ICU consults during the daytime. There are entire specialties who's day to day tasks are so repetitive and logistical, it can easily be done by a PA/NP. Anesthesia is far from the only specialty with this issue.

I think the problem is anesthesiologists generally are more passive people. They like to do a good job and go home - this is what makes them unnoticed and the target for these kinds of things. But if motivated and intelligent medical students enter the field with a mindset to advocate for the field, expand it, and demonstrate their worth instead of just getting a paycheck and going home, we have a fighting chance. After all its because of the hard work and research of previous anesthesiologists, that it has become safe enough for non-physicians to practice to some extent.

Just my two cents and ramblings.

Your third paragraph is utter nonsense. Every batch of med students thinks they are bigger faster stronger and they are going to save the day. Every batch of med students is mistaken.

 

[AdmiralChz]

Right now my dilemma is Anes va EM and idk if the future looks much brighter in EM than Anes to have future job market speculation shape my decision

I encourage you to speak with attendings in both fields about your concerns and get some advice... in the real world. Similar problems affect both specialties. It’s easy for me to speculate on the issues EM has, but it’s better to hear directly from someone doing it each day.

 

[deleted126335]

We have the longest history of conflict with midlevels. But in some ways we are protected. The fact that this is a specialty where people go bad in seconds and can die in minutes gives surgeons and administrators pause. Primary care docs and even specialty docs who have significant office practices will have multiple opportunities over extended time periods to correct an oversight or mistake. While midlevels in large numbers are relatively late to the game for many specialties, this inherent attribute makes office based work relatively easy pickings.

 

[pgg]

While I believe America has always been great, we need to make American healthcare great again, and get rid of all these administrative parasites, beginning with the joint-smoking commission for wasting taxpayer money and other similar bureaucracies.

Although I loathe the very sight of anyone from JCAHO, after my recent journeys I will grudgingly concede that there's a need for someone to walk through hospitals looking for things to cite.

Electrical safety:

Skipping machine checks and doing cases no backup O2 cylinder, O2 sensor, or capnograph. I'm not sure if they did this case with an FiO2 of 100% or 21%. The ventilator was working, so presumably there was wall O2 driving the bellows, even though the machine failed to detect it. So probably 100%.

 

[Money Moniker]

That’s the interesting thing. CRNAs make more than physicians in a lot of other specialties these days. Seems to me like worst case scenario is you make CRNa level salaries and they price themselves out. I would much rather make crna money and be an anesthesiologist than go into family medicine.

lmao you clearly have no idea what you're talking about. How will CRNAs "price themselves out," you think they will make steady income gains until one day they hit the magic number of $400k or whatever and get kicked out of the anesthesia game to flip burgers at McDonald's? That's not how it works bud, what matters is the total supply of anesthesia providers versus demand for their services, nobody is going to be "priced out" as that is a nonsensical concept that does not occur in the real world since people will work for less if they have no other choice. Rather what will happen is salaries of anesthesiologists and CRNAs will plummet if supply exceeds demand.

Anesthesiologist income will live or die based on whether demand for anesthesia services is growing faster or slower than the supply of CRNAs. That CRNA incomes keep going up is evidence that demand still exceeds supply by a healthy amount. I'm just surprised that for all the threads discussing this topic ad nauseum, nobody has dug up the numbers on CRNA training slot growth, as that is literally THE BIGGEST factor that will determine the future of anesthesia salaries. Nurse practitioner slots for example are growing exponentially so specialties like FM and EM are totally ****ed in the future, it's actually possible anesthesia will survive longer than they do depending on whether CRNA slots are growing slower than NP slots. Again, I find it strange nobody in this subforum has ever bothered to dig into the data on CRNA training slot growth as that will tell you 90% of the tale of anesthesiology's future.

 

[Stank811]

Go back 10yrs on this forum and You can find people predicting the specialty would be dead within 5-7 yrs.

Anesthesiologist do not equal CRNAs. Anesthesiologist are far superior in skill set and knowledge coming out of training. Once you understand how we are not a commodity you will have a better understanding why this profession will continue to be great.

 

[bronx43]

We have the longest history of conflict with midlevels. But in some ways we are protected. The fact that this is a specialty where people go bad in seconds and can die in minutes gives surgeons and administrators pause. Primary care docs and even specialty docs who have significant office practices will have multiple opportunities over extended time periods to correct an oversight or mistake. While midlevels in large numbers are relatively late to the game for many specialties, this inherent attribute makes office based work relatively easy pickings.

As a medical subspecialist, I would say that there are features of both fields which can both attract and impede complete midlevel take over. As you mentioned, anesthesiology is somewhat protected by the high stakes and rapid pace. However, it is also relatively protocolized. The medical specialist, on the other hand, has time to correct errors or oversights should they occur. However, being a patient facing specialty, we are largely protected simply by patient demand, as the vast majority of people (outside of the ghetto or BFE) won't seek out an independent midlevel for specialty care. Primary care and EM? Sure. But not a specialist. Not yet anyways. Midlevels are starting to show up in my field, but most patients want nothing to do with one.

 

[deleted171991]

lmao you clearly have no idea what you're talking about. How will CRNAs "price themselves out," you think they will make steady income gains until one day they hit the magic number of $400k or whatever and get kicked out of the anesthesia game to flip burgers at McDonald's? That's not how it works bud, what matters is the total supply of anesthesia providers versus demand for their services, nobody is going to be "priced out" as that is a nonsensical concept that does not occur in the real world since people will work for less if they have no other choice. Rather what will happen is salaries of anesthesiologists and CRNAs will plummet if supply exceeds demand.

Anesthesiologist income will live or die based on whether demand for anesthesia services is growing faster or slower than the supply of CRNAs. That CRNA incomes keep going up is evidence that demand still exceeds supply by a healthy amount. I'm just surprised that for all the threads discussing this topic ad nauseum, nobody has dug up the numbers on CRNA training slot growth, as that is literally THE BIGGEST factor that will determine the future of anesthesia salaries. Nurse practitioner slots for example are growing exponentially so specialties like FM and EM are totally ****ed in the future, it's actually possible anesthesia will survive longer than they do depending on whether CRNA slots are growing slower than NP slots. Again, I find it strange nobody in this subforum has ever bothered to dig into the data on CRNA training slot growth as that will tell you 90% of the tale of anesthesiology's future.

Here's your tale: there are 2400+ new CRNAs graduating every year (per the AANA), and the numbers keep going up. Just to give perspective, there will be about 1700 anesthesiology graduates in 2020 (based on the 2016 match numbers).

Don't fool yourselves: THESE PEOPLE ARE COMPETING FOR THE SAME JOBS! If they didn't exist, we would still have solo MD anesthesia, as in certain parts of the US (e.g. West Coast).

@bronx43 is right about the protocolization of anesthesia. Most patients are not sick, and will be perfectly comfortable with the idea of a firefighter-only MD that is around, for "when seconds matter". They don't think about general anesthesia as a life-threatening induced coma. It's "sleep", remember? And it's become so safe even a nurse anesthetist can do it. That's how patients think.

Contrast that with critical care. There are tons of midlevels in critical care, and more coming, but nobody in their right mind would let their family member be taken care by an even semi-independent midlevel. YET! When the patient is sick, the family wants a REAL doctor, not PhD, DNP, MS in bull feces. One has the same situation in anesthesia, for the really sick patients or complicated surgeries, but I wouldn't want to spend my life supervising inexperienced or militant (too many among the experienced) CRNAs in those cases. Or even doing complicated cases solo every single day. In that case, critical care is a much better deal. See my post about "scratching my butt".

We haven't seen yet what will happen when CRNAs will be allowed to practice INDEPENDENTLY in non-rural hospitals, as in the military. That's when the anesthesiologist market in that respective state will crumble. It's a matter of supply-demand, simple fourth grade math. Let's put it bluntly: as long as anesthesia is safe enough, most patients won't know the difference between a doc and a CRNA. What's maybe worse, NEITHER DO SURGEONS!

To many surgeons, the best anesthesia provider is the one who makes the case happen, even when it shouldn't. The anesthesia provider exists to allow them to operate, and take the blame if anything goes wrong. Nothing more. The main reason most surgeons still want some kind of anesthesiologist supervision for the CRNAs is malpractice, not patient welfare. As malpractice reform and caps spread, the incentives to pay somebody a physician-level salary to supervise/provide anesthesia will diminish.

 

[bronx43]

Here's your tale: there are 2400+ new CRNAs graduating every year (per the AANA), and the numbers keep going up. Just to give perspective, there will be about 1700 anesthesiology graduates in 2020 (based on the 2016 match numbers).

Wait really??? My mind is blown.

 

[AdmiralChz]

Here's your tale: there are 2400+ new CRNAs graduating every year (per the AANA), and the numbers keep going up. Just to give perspective, there will be about 1700 anesthesiology graduates in 2020 (based on the 2016 match numbers).

Don't fool yourselves: THESE PEOPLE ARE COMPETING FOR THE SAME JOBS! If they didn't exist, we would still have solo MD anesthesia, as in certain parts of the US (e.g. West Coast).

@bronx43 is right about the protocolization of anesthesia. Most patients are not sick, and will be perfectly comfortable with the idea of a firefighter-only MD that is around, for "when seconds matter". They don't think about general anesthesia as a life-threatening induced coma. It's "sleep", remember? And it's become so safe even a nurse anesthetist can do it. That's how patients think.

Contrast that with critical care. There are tons of midlevels in critical care, and more coming, but nobody in their right mind would let their family member be taken care by an even semi-independent midlevel. YET! When the patient is sick, the family wants a REAL doctor, not PhD, DNP, MS in bull feces. One has the same situation in anesthesia, for the really sick patients or complicated surgeries, but I wouldn't want to spend my life supervising inexperienced or militant (too many among the experienced) CRNAs in those cases. Or even doing complicated cases solo every single day. In that case, critical care is a much better deal. See my post about "scratching my butt".

We haven't seen yet what will happen when CRNAs will be allowed to practice INDEPENDENTLY in non-rural hospitals, as in the military. That's when the anesthesiologist market in that respective state will crumble. It's a matter of supply-demand, simple fourth grade math. Let's put it bluntly: as long as anesthesia is safe enough, most patients won't know the difference between a doc and a CRNA. What's maybe worse, NEITHER DO SURGEONS!

To many surgeons, the best anesthesia provider is the one who makes the case happen, even when it shouldn't. The anesthesia provider exists to allow them to operate, and take the blame if anything goes wrong. Nothing more. The main reason most surgeons still want some kind of anesthesiologist supervision for the CRNAs is malpractice, not patient welfare. As malpractice reform and caps spread, the incentives to pay somebody a physician-level salary to supervise/provide anesthesia will diminish.

But you’d somehow argue PSYCH is the better specialty. I’d rather be doing anything, ANYTHING else. I’m sure I’m not alone.

I’m enjoying my PP job, I don’t work a ton, get great benefits and make better money than most of my graduating med school classmates. It could be oh so much worse. Should I lament not having to sit the stool (too often) for a 12 hour ENT flap case? No thanks - instead I can take a 100 foot view and manage the big picture stuff and not want to gouge my eyes out daily. Or maybe I’m just some idiot Lemming/Sheep that just keeps the wheels moving - I’ll take that for $450K

This is the same, tired and repetitive thread. Go back 10 years and you find exactly the same. Threads like this will one day totally turn me off to SDN, just too much negativity.

 

[deleted171991]

But you’d somehow argue PSYCH is the better specialty. I’d rather be doing anything, ANYTHING else. I’m sure I’m not alone.

I’m enjoying my PP job, I don’t work a ton, get great benefits and make better money than most of my graduating med school classmates. It could be oh so much worse. Should I lament not having to sit the stool (too often) for a 12 hour ENT flap case? No thanks - instead I can take a 100 foot view and manage the big picture stuff and not want to gouge my eyes out daily. Or maybe I’m just some idiot Lemming/Sheep that just keeps the wheels moving - I’ll take that for $450K

This is the same, tired and repetitive thread. Go back 10 years and you find exactly the same. Threads like this will one day totally turn me off to SDN, just too much negativity.

I would completely agree with you. Except that, 10 years ago, my residency program used to have 1 CRNA. Today they have 100+. Where we agree is that we have a ****ton of these threads already, and we should automatically close the new ones.

 

[Steve_Zissou]

So if I'm interested in EM and Anesthesia am I ****ed?

 

[deleted171991]

So if I'm interested in EM and Anesthesia am I ****ed?

Sooner or later, more or less, one way or another.

 

[Steve_Zissou]

Sooner or later, more or less, one way or another.

I imagine sub-specializing probably increases your chances of securing a relatively midlevel-creep free job? Pain medicine or critical care or something?

 

[deleted171991]

I imagine sub-specializing probably increases your chances of securing a relatively midlevel-creep free job? Pain medicine or critical care or something?

The only guarantee is that there are no guarantees.

 

[AdmiralChz]

I imagine sub-specializing probably increases your chances of securing a relatively midlevel-creep free job? Pain medicine or critical care or something?

Nope. Maybe if one day physicians man up as a whole to push back. Had an opportunity with the primary care push with NPs and folded, so don’t see it coming. Organizations like the AMA are more concerned with staying proper on their political message rather than on the ground action. And their gigantic drop in donors the last 10 years reflect it.

 

[Stank811]

Here's your tale: there are 2400+ new CRNAs graduating every year (per the AANA), and the numbers keep going up. Just to give perspective, there will be about 1700 anesthesiology graduates in 2020 (based on the 2016 match numbers).

Don't fool yourselves: THESE PEOPLE ARE COMPETING FOR THE SAME JOBS! If they didn't exist, we would still have solo MD anesthesia, as in certain parts of the US (e.g. West Coast).

@bronx43 is right about the protocolization of anesthesia. Most patients are not sick, and will be perfectly comfortable with the idea of a firefighter-only MD that is around, for "when seconds matter". They don't think about general anesthesia as a life-threatening induced coma. It's "sleep", remember? And it's become so safe even a nurse anesthetist can do it. That's how patients think.

Contrast that with critical care. There are tons of midlevels in critical care, and more coming, but nobody in their right mind would let their family member be taken care by an even semi-independent midlevel. YET! When the patient is sick, the family wants a REAL doctor, not PhD, DNP, MS in bull feces. One has the same situation in anesthesia, for the really sick patients or complicated surgeries, but I wouldn't want to spend my life supervising inexperienced or militant (too many among the experienced) CRNAs in those cases. Or even doing complicated cases solo every single day. In that case, critical care is a much better deal. See my post about "scratching my butt".

We haven't seen yet what will happen when CRNAs will be allowed to practice INDEPENDENTLY in non-rural hospitals, as in the military. That's when the anesthesiologist market in that respective state will crumble. It's a matter of supply-demand, simple fourth grade math. Let's put it bluntly: as long as anesthesia is safe enough, most patients won't know the difference between a doc and a CRNA. .

The state I practice in has had independent CRNA practice for a decade. The trend over the last 5 yrs has been away from independent CRNA practice in rural hospitals towards asking physician groups to help cover and take over management. How do you explain the trend I see in an opt out state.

 

[Man o War]

The state I practice in has had independent CRNA practice for a decade. The trend over the last 5 yrs has been away from independent CRNA practice in rural hospitals towards asking physician groups to help cover and take over management. How do you explain the trend I see in an opt out state.

Same in my state. Independent practice allowed, still tons of good jobs for docs and most hospitals still require anesthesiologists.
One hospital an hour from me just announced RFT process. They’re switching to a model with anesthesiologists, currently independent CRNAs.
I’m also aware of a hospital in New York that switched from CRNAs only to anesthesiologist supervision last year.

 

[deleted126335]

Same in my state. Independent practice allowed, still tons of good jobs for docs and most hospitals still require anesthesiologists.
One hospital an hour from me just announced RFT process. They’re switching to a model with anesthesiologists, currently independent CRNAs.
I’m also aware of a hospital in New York that switched from CRNAs only to anesthesiologist supervision last year.

The most likely model will be how few anesthesiologists can we get away with? How little anesthesiologist input do we need to supervise a bunch of CRNAs? Is phone consult or Skype enough? How much liability can we off load to the "supervising" doc? The surgeons and administrators know the difference, they just don't want to acknowledge it or pay up for it.

 

[Twiggidy]

Or maybe I’m just some idiot Lemming/Sheep that just keeps the wheels moving - I’ll take that for $450K

I think ALL medicine is like this, outside of being a surgeon. The threat to surgeons is decreased reimbursement, but they'll always eat as long as people eat, drink, smoke, break stuff, and get cancer. Every other field is at the mercy of the medical field having it's eye on the bottom dollar. The more nurses become involved in everyday care, the less hospitals/AMCs realize they need to spend. Whether you have RN or MD after your name, if the machine keeps moving and the dollars keep coming in that's all that matter. I think the caveat for anesthesiology is that patients are sicker and living longer, so where some CRNAs can practice cookbook anesthesia with the ASA 1 hernia repair, when these cases start to involve an ASA 4, cardiomyopathy with an AICD, renal failure, PVD, blah blah blah, you'll need someone who knows how to think on their feet in the room because that case can turn the corner quick.

So I have a negative outlook on the field of anesthesioloyg? Maybe only when it comes to pay but at the rate I'm getting cold calls for jobs from recruiters it seems to me there will always be WORK.

As stated in the quote, I'm wrestling with how much do I actually need to be there sitting the stool to keep the machine running, when I can be 100 ft away and monitoring the big picture. Both scenarios come with their own stresses.

 

[Twiggidy]

So if I'm interested in EM and Anesthesia am I ****ed?

It honestly depends on what you're looking for in a career. If it's money and glory, then yeah, you may be, but if it's just a job with a wage and you keep yourself within your means, you'll be alright.

 

[Steve_Zissou]

It honestly depends on what you're looking for in a career. If it's money and glory, then yeah, you may be, but if it's just a job with a wage and you keep yourself within your means, you'll be alright.

I'm looking to do something procedure based, can keep a relatively regular schedule (why I'm leaning towards anesthesia over EM), have time to see my family, and can still contribute. I don't expect to become ultra-wealthy, just do well and do a job I enjoy.

 

[nimbus]

So here is my question. Will Anesthesia be a solid field moving forward? Will you be able to work decently hard and make 350k, and if you are willing to move find a true partnership job and make well above that?

...or is AI and CRNA going to replace all anesthesiologists?

Yes. Yes. Yes.

No.

If you feel like you’d enjoy the work, I encourage you to go for it. Demand for our services only keeps going up.

My state allows independent CRNAs too but I haven’t seen a CRNA in real life since 1997.

 

[Twiggidy]

I'm looking to do something procedure based, can keep a relatively regular schedule (why I'm leaning towards anesthesia over EM), have time to see my family, and can still contribute. I don't expect to become ultra-wealthy, just do well and do a job I enjoy.

Interventional Radiology. No joke, if I could go back to my 3rd-4th year of medical school it's probably what I would do to have a procedure based career that doesn't need a patient base like surgery.

 

[nimbus]

Interventional Radiology. No joke, if I could go back to my 3rd-4th year of medical school it's probably what I would do to have a procedure based career that doesn't need a patient base like surgery.

Our IR guys have lifestyles as bad as ours. Middle of the night TEVARs, liver and uterine embos. Busy all day every weekend. But I agree it’s a great field except the lifestyle.

 

[Twiggidy]

I'm looking to do something procedure based, can keep a relatively regular schedule (why I'm leaning towards anesthesia over EM), have time to see my family, and can still contribute. I don't expect to become ultra-wealthy, just do well and do a job I enjoy.

Although IR can have some bad reimbursement as well. The money in anesthesia tends to be good (depend on where you work and the payor mix) because it’s time based/unit based. Someone getting paid per unit at a high volume heart center with good unit value can make a killing

 

[Steve_Zissou]

Interventional Radiology. No joke, if I could go back to my 3rd-4th year of medical school it's probably what I would do to have a procedure based career that doesn't need a patient base like surgery.

Seems interesting but the average matched step 1 is pretty high. Guess it depends on how well I do come boards time

 

[Twiggidy]

Our IR guys have lifestyles as bad as ours. Middle of the night TEVARs, liver and uterine embos. Busy all day every weekend. But I agree it’s a great field except the lifestyle.

Agree. It’s an option that gets overlooked if you want a career vaguely similar to anesthesia but not deal with some of our anesthesia BS. You still have to play nice and get consults and yes you will be working a lot but the only thing they really do is procedures and maybe the occasional general radiology coverage

 

[kidthor]

IR also probably has less geographic flexibility compared to us... but it does seem like a very cool field.

 

[bronx43]

I think ALL medicine is like this, outside of being a surgeon. The threat to surgeons is decreased reimbursement, but they'll always eat as long as people eat, drink, smoke, break stuff, and get cancer. Every other field is at the mercy of the medical field having it's eye on the bottom dollar. The more nurses become involved in everyday care, the less hospitals/AMCs realize they need to spend. Whether you have RN or MD after your name, if the machine keeps moving and the dollars keep coming in that's all that matter. I think the caveat for anesthesiology is that patients are sicker and living longer, so where some CRNAs can practice cookbook anesthesia with the ASA 1 hernia repair, when these cases start to involve an ASA 4, cardiomyopathy with an AICD, renal failure, PVD, blah blah blah, you'll need someone who knows how to think on their feet in the room because that case can turn the corner quick.

So I have a negative outlook on the field of anesthesioloyg? Maybe only when it comes to pay but at the rate I'm getting cold calls for jobs from recruiters it seems to me there will always be WORK.

As stated in the quote, I'm wrestling with how much do I actually need to be there sitting the stool to keep the machine running, when I can be 100 ft away and monitoring the big picture. Both scenarios come with their own stresses.

I don't understand. Why are you separating surgeons from the rest of the medical profession? If you mean that they're protected due to their procedures, then it really applies to any procedural specialty that hasn't let midlevels in - which involves gastroenterology, interventional cardiology, electrophysiology, IR, pain medicine, etc. Even some non-procedural specialties which involve very nuanced and specialized training like diagnostic radiology, neurology, rheumatology, radiation oncology, pathology, etc are completely or significantly insulated from complete takeover by lesser trained "providers."

 

[Twiggidy]

I don't understand. Why are you separating surgeons from the rest of the medical profession? If you mean that they're protected due to their procedures, then it really applies to any procedural specialty that hasn't let midlevels in - which involves gastroenterology, interventional cardiology, electrophysiology, IR, pain medicine, etc. Even some non-procedural specialties which involve very nuanced and specialized training like diagnostic radiology, neurology, rheumatology, radiation oncology, etc are completely or significantly insulated from complete takeover by lesser trained "providers."

I didn't think of the other "proceduralist" because I'm quite literally tired from working all night but yes, IR, interventional cards, etc tend to be protected, especially since there's no history of teaching mid-levels procedures so they can cover multiple spots (ahem...anesthesiology) outside of teaching closures. The later fields you speak of I would argue are ripe for the picking it just hasn't happened as fast as anesthesiology. I argue some aspects of anesthesiology (CV, peds) are more protected than being a Generalist, thus the spike in people doing Cardiac and Peds fellowships

 

[GravelRider]

I’ve witnessed IR guys teaching PAs some of their bread and butter procedures and basically leaving the room after timeout. That’s with procedures where anesthesia is involved, so who knows what’s happening on non-anesthesia cases.