Making Anesthesia a 5-year Residency?

[Spinach Dip]

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Granted, I am not the most informed person here. I am currently applying to med school, and anesthesiology is the specialty I would choose if I had to pick today.

I've heard a rumor that there is some discussion about changing anesthesiology from a 4-year to a 5-year residency. According to this rumor, the added year would be spent mainly focusing on critical care patients (such as those with multiple co-morbidities, organ failure, instability, etc).

Does this rumor have any truth behind it? And what are the chances that this will actually happen in the next few years?

 

[92122]

I don't have any "hard" info on the matter, but this is a topic that has been discussed many times over the years at the major institutions. The plan is to convert anesthesiologists into "perioperative" physicians, with an emphasis on the ICU arena. Thus, the residency programs are strongly looking into adding an additional year of training in CCM, with the goal of their graduates being double-boarded.

Keep in mind that this is often pushed as the answer to the CRNA problem by the very same people who created it by pumping them out at your expense during training. Incidentally, many of these administrative anesthesiologists didn't even do a four-year residency, and some don't even bother to re-cert.

 

[Consigliere]

My advice to you, young man, would be to choose a speciality other than anesthesiology. Being as that you're not even a med student, you'll most likely change your mind anyway.

 

[NOTJOHN]

I don't have any "hard" info on the matter, but this is a topic that has been discussed many times over the years at the major institutions. The plan is to convert anesthesiologists into "perioperative" physicians, with an emphasis on the ICU arena. Thus, the residency programs are strongly looking into adding an additional year of training in CCM, with the goal of their graduates being double-boarded.

Keep in mind that this is often pushed as the answer to the CRNA problem by the very same people who created it by pumping them out at your expense during training. Incidentally, many of these administrative anesthesiologists didn't even do a four-year residency, and some don't even bother to re-cert.

This is the most ridiculous thing I have ever heard? How many ICU jobs do you see anesthesiologist do? Very few. And even the icu fellows get general anesthesia jobs abandoning their icu training. Do you know how miserable life in the icu is?

They are also implementing TWO written exams... for board certification.. (CHA CHING)..

Stay away from anesthesia training, Do youself and your future career a favor. The 10-20 year outlook for this specialty is DISMAL.

 

[Consigliere]

This is the most ridiculous thing I have ever heard? How many ICU jobs do you see anesthesiologist do? Very few. And even the icu fellows get general anesthesia jobs abandoning their icu training. Do you know how miserable life in the icu is?

They are also implementing TWO written exams... for board certification.. (CHA CHING)..

Stay away from anesthesia training, Do youself and your future career a favor. The 10-20 year outlook for this specialty is DISMAL.

That's putting it mildly.

 

[IkeBoy18]

That's putting it mildly.

damnit... of course Im super interested in anesthesia. Im going into my 3rd year. So I wouldnt be finished with training until around 2019/2020. Would that mean the specialty would be halfway through the rough period? Trying to find a silver lining here....

 

[Untraditional]

This is the most ridiculous thing I have ever heard? How many ICU jobs do you see anesthesiologist do? Very few. And even the icu fellows get general anesthesia jobs abandoning their icu training. Do you know how miserable life in the icu is?

They are also implementing TWO written exams... for board certification.. (CHA CHING)..

Stay away from anesthesia training, Do youself and your future career a favor. The 10-20 year outlook for this specialty is DISMAL.

Are you even an Anesthesiologist? Every Anes resident I've ever met has been over-the-moon happy with their career choice.

 

[Direct Laryngoscopy]

Are you even an Anesthesiologist? Every Anes resident I've ever met has been over-the-moon happy with their career choice.

Being happy about a specialty and grim about the outlook are 2 different subjects. I like my specialty, but significant (and possibly dismal) changes are coming. Only time will tell......

 

[deleted126335]

damnit... of course Im super interested in anesthesia. Im going into my 3rd year. So I wouldnt be finished with training until around 2019/2020. Would that mean the specialty would be halfway through the rough period? Trying to find a silver lining here....

What we had in the 90s was a rough period. This looks more like a long sea change at best. Permanent at worst.

 

[urge]

And what are the chances that this will actually happen in the next few years?

No chance.

 

[Untraditional]

Being happy about a specialty and grim about the outlook are 2 different subjects. I like my specialty, but significant (and possibly dismal) changes are coming. Only time will tell......

The opinions are so overwhelmingly negative. I can't help but wonder if the comments are just concentrated due to SDNs sampling bias.

 

[Spinach Dip]

I don't have any "hard" info on the matter, but this is a topic that has been discussed many times over the years at the major institutions. The plan is to convert anesthesiologists into "perioperative" physicians, with an emphasis on the ICU arena. Thus, the residency programs are strongly looking into adding an additional year of training in CCM, with the goal of their graduates being double-boarded.

Keep in mind that this is often pushed as the answer to the CRNA problem by the very same people who created it by pumping them out at your expense during training. Incidentally, many of these administrative anesthesiologists didn't even do a four-year residency, and some don't even bother to re-cert.

No chance.

Thanks, guys. Good to know.



Oh, and to the rest of you: I am leaning towards anesthesiology right now, but I will keep my mind open. If I decide to go for another residency, it will NOT be because of some negative comments posted anonymously on the internet -- although I thank you for voicing your opinions.

 

[NOTJOHN]

Are you even an Anesthesiologist? Every Anes resident I've ever met has been over-the-moon happy with their career choice.

There is a difference between a resident and an attending. Do you even know the difference?

Lots of things happen between the two. More exposure opens eyes. The current climate is abysmal. It may be true for all specialties but Anesthesia is taking it hard and will take it hard for years to come from all angles it seems. I think you are just upset because you are in denial... I on the other hand am not in denial. I see reality crystal clear.

 

[Untraditional]

There is a difference between a resident and an attending. Do you even know the difference?

Are you an attending physician? Nothing in your post implies that you are.

Lots of things happen between the two. More exposure opens eyes. The current climate is abysmal. It may be true for all specialties but Anesthesia is taking it hard and will take it hard for years to come from all angles it seems. I think you are just upset because you are in denial... I on the other hand am not in denial. I see reality crystal clear.

Clarity apparently includes trial-sized belligerence! 🙄

I'm curious what your career plans are at this point since you're so down on the specialty. Are you planning to weather the storm to retirement? Change your practice style? What is your advice to young Anes residents who are "too far in" to change their career trajectory? What specialty would you choose, knowing what you know, if you were a 4th-year thinking about the 2014 match?

 

[LIDO]

Are you an attending physician? Nothing in your post implies that you are.



Clarity apparently includes trial-sized belligerence! 🙄

I'm curious what your career plans are at this point since you're so down on the specialty. Are you planning to weather the storm to retirement? Change your practice style? What is your advice to young Anes residents who are "too far in" to change their career trajectory? What specialty would you choose, knowing what you know, if you were a 4th-year thinking about the 2014 match?

How many times is this same exact question going to be asked? Nothing has changed since the last 1,345,283 posts on this exact question. Including what specialty you "should" pick.

 

[BigMAC3]

Come on people, this gloom and doom is getting ridiculous.

Personally, I wouldn't take career advice from an "Acute Care Nurse Practitioner Intensivist" who has hundreds of posts telling people not to go into anesthesiology and has said that the only criteria for residency admission these days is "a pulse." But that's just me.

Rotate through all your rotations with an open mind, chose what you love, and be the best you can be. Don't let other people tell you what you "should" do.

 

[NOTJOHN]

Are you an attending physician? Nothing in your post implies that you are.



Clarity apparently includes trial-sized belligerence! 🙄

I'm curious what your career plans are at this point since you're so down on the specialty. Are you planning to weather the storm to retirement? Change your practice style? What is your advice to young Anes residents who are "too far in" to change their career trajectory? What specialty would you choose, knowing what you know, if you were a 4th-year thinking about the 2014 match?

There is NOTHING FOR ME to do at this point. Im 47 years old, I cant switch now. I can take the abuse and beatings until its time to retire and hope things change..

If I am a ca1 or less, knowing what I know now about anesthesia, I would look hard to switch either into ER and if i cannot do ER i would do Internal medicine. WHo ever is an internist in 15 years will have everyone by the balls in my opinion.
If you dont mind being stuck out in BFE with your family with no hopes of being able to relocate.. fine stick with anesthesia..
Those that are TOO FAR into it to look back do what the douches at the asa recomment. Keep doing fellowships until there are no more fellowships to do. Start with cardiac, then do regional then do ICU... Still they will find a way to screw you in the end.

 

[pgg]

I'd rather do anesthesia for $200K than ER for $300K or internal medicine for $400K. Not that I believe for a second that $200K or less will ever become the norm for anesthesia.

 

[Dwindlin]

Come on people, this gloom and doom is getting ridiculous.

Personally, I wouldn't take career advice from an "Acute Care Nurse Practitioner Intensivist" who has hundreds of posts telling people not to go into anesthesiology and has said that the only criteria for residency admission these days is "a pulse." But that's just me.

Rotate through all your rotations with an open mind, chose what you love, and be the best you can be. Don't let other people tell you what you "should" do.

He's a PP Attending Anesthesiologist. His signature is factious.

 

[IlDestriero]

I'd rather do anesthesia for $200K than ER for $300K or internal medicine for $400K. Not that I believe for a second that $200K or less will ever become the norm for anesthesia.

x2.
The sky is falling...

 

[gasattack3]

x2.
The sky is falling...

Same for me but I could do exclusively OUTpatient IM in a small practice somewhere.

 

[NOTJOHN]

I'd rather do anesthesia for $200K than ER for $300K or internal medicine for $400K. Not that I believe for a second that $200K or less will ever become the norm for anesthesia.

If you are making 300 k as an er attending that is like 16 weeks off per year. I can handle that .. I could not make 200k in anesthesia with 6 weeks off. The liability is too great. Any badness i am to blame.We all deal with this daily. i need more money than that. Its getting to the point where i may look elsewwhere if it gets any worse. Let the crnas deal with it without ME for 185K than obama will be happy

 

[imfrankie]

x2.
The sky is falling...

x3
I'll do 7am - 1pm 3 days a week for 2hun

 

[EtherBunny]

I've heard of the discussions regarding extension of the anesthesiology residency program to 5 years, with the last year devoted to critical care. From my perspective, I think it's a good idea. Anesthesiologists are perfectly suited to take on the role of intensivists--after all, we essentially do critical care everyday in the OR!

If you look at our colleagues in Australia and Europe, it's clear that the field lends itself well to critical care. Over there, anesthesiologists run the vast majority of ICUs and play an absolutely central role in critical care as a result.

I absolutely hate the ICU. I tried to enjoy it but I can't stand the setting. Nonetheless, transforming anesthesia training such that anesthesiologists truly become perioperative physicians with special expertise in critical care is a good idea. It will solve a lot of problems facing this specialty in the next 10 years or so (declining reimbursement for OR services, CRNA encroachment, etc.).

Just my $0.02.

Oh, and don't pay too much attention to all the doomsday talk on these forums. You have to choose a specialty that you enjoy. If anesthesiology is the specialty for you, then go for it. I know tons of residents, fellows, and attendings in this field who love their job.

 

[Untraditional]

I could not make 200k in anesthesia with 6 weeks off. The liability is too great. Any badness i am to blame. Let the crnas deal with it without ME for 185K than obama will be happy

What %age of your income goes to your liability insurance? Your situation sounds suboptimal to say the least.

 

[pgg]

If you are making 300 k as an er attending that is like 16 weeks off per year. I can handle that .. I could not make 200k in anesthesia with 6 weeks off. The liability is too great. Any badness i am to blame.We all deal with this daily. i need more money than that. Its getting to the point where i may look elsewwhere if it gets any worse. Let the crnas deal with it without ME for 185K than obama will be happy

Data suggests that our liability really isn't all that high, particularly when compared to EM:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204310/

They'd have to pay me quite a premium to get me to put up with ER shift work, slogging through the drunken dregs of society at 2 AM. My brother's an ER doc and loves it, but he never was quite right in the head.

What %age of your income goes to your liability insurance? Your situation sounds suboptimal to say the least.

Don't know about him, but I have an individual policy to cover my moonlighting outside the military. I cover the annual cost of my claims-made policy with a weekend of pager call from home. (Next year @ maturity the policy will cost about a weekend of pager call from home, plus an 8-hr weekday.) Depending on how much I work in a given year, the cost is between 3-8% or so of my moonlighting income. Pretax, of course. Eventually tail will be due, 240% of annual premium. Tort reform state.

 

[NOTJOHN]

Data suggests that our liability really isn't all that high, particularly when compared to EM:

They'd have to pay me quite a premium to get me to put up with ER shift work, slogging through the drunken dregs of society at 2 AM. My brother's an ER doc and loves it, but he never was quite right in the head.

that graph is answering the wrong question..

 

[NightNight]

that graph is answering the wrong question..

The right question would be....? I'm seriously wondering

 

[pgg]

that graph is answering the wrong question..

Which is?

We have a stressful, high risk job. I'm not disputing that. (Though in all honesty, a lot lower risk than it was 30 years ago. Anesthesia really is as safe as we tell our patients, usually.) I just wouldn't flee to EM to get away from sue-happy patients.


As for looking elsewhere if it gets worse, what are you going to do? Even in the horror story scenario of median $200K anesthesia jobs, which I don't believe will happen, what are you going to do? Start over, earning $50K as a resident in another specialty for 3+ years? Perhaps only to find that the grass isn't much greener, and you're 3+ years older, having missed out on $500K of income while you climbed the hill?

 

[dhb]

If you look at our colleagues in Australia and Europe, it's clear that the field lends itself well to critical care. Over there, anesthesiologists run the vast majority of ICUs and play an absolutely central role in critical care as a result.

Not quite true few people do both especially in PP. In Belgium to be certified for the ICU you need to do a 6th year of residency and after that work >40% of your time in an ICU.
There will always be a push for longer training because it's almost free labor but if residency is well structured 4 year is enough, keep the icu as a fellowship.

 

[Consigliere]

Come on people, this gloom and doom is getting ridiculous.

Personally, I wouldn't take career advice from an "Acute Care Nurse Practitioner Intensivist" who has hundreds of posts telling people not to go into anesthesiology and has said that the only criteria for residency admission these days is "a pulse." But that's just me.

Rotate through all your rotations with an open mind, chose what you love, and be the best you can be. Don't let other people tell you what you "should" do.

The tagline on my posts is meant as a tongue-in-cheek reference that you are obviously too stupid to get. The comment about having a pulse being the prerequisite for obtaining a residency was made only in regards to family practice.

You should do whatever you want - I'm just trying to give folks an idea of the REALITY that they'll face vs. all the naive optimism spewed by f_ucksticks such as yourself who obviously haven't a clue.

 

[Untraditional]

Don't know about him, but I have an individual policy to cover my moonlighting outside the military. I cover the annual cost of my claims-made policy with a weekend of pager call from home. (Next year @ maturity the policy will cost about a weekend of pager call from home, plus an 8-hr weekday.) Depending on how much I work in a given year, the cost is between 3-8% or so of my moonlighting income. Pretax, of course. Eventually tail will be due, 240% of annual premium. Tort reform state.

At the risk of forking the thread, does your rate scale with your time worked? Since you're military your moonlighting is part time I bet and I wonder if that affects your premium.

I hear OBs have the worst tail, 18 years after last delivery. How long into retirement do you need to keep coverage as Anes / Surgery / other proceduralist?

 

[pgg]

At the risk of forking the thread, does your rate scale with your time worked? Since you're military your moonlighting is part time I bet and I wonder if that affects your premium.

My individual policy covers me for part time work, yes. Premiums from my carrier are 1/2 the full time rate.

When I'm not deployed I typically moonlight about 1 weekend per month, plus 2-4 weekdays (some holidays, some are days I take .mil vacation time). Even with this schedule, far less than 1/2 time, the malpractice premiums are not a burden. CA is a tort reform state though, with punitive damages capped at $250K. I'm sure that has something to do with the reasonableness of it.

Attached below is a partial screenshot of my original premium quote in 2009 when I finished residency. This was for a full-time policy. I paid the discounted rate in parentheses for year 1. Subsequent years have also been at a 50% discount.

Over the last few years, the rates have adjusted somewhat, and are less than quoted. I think I paid about $3400 for year 3, and $3800 for year 4 (which is complicated by a temporary no-cost suspension during deployment).

Tail will be 240% of the most recent (discounted) premium, so I'm expecting to owe about $11K when that day comes.

I don't know what other states are like, but here's my one data point for you to judge how expensive anesthesia coverage is.

I hear OBs have the worst tail, 18 years after last delivery. How long into retirement do you need to keep coverage as Anes / Surgery / other proceduralist?

Tail coverage is tail coverage. You pay the tail premium, you're insured whether you get sued a year later, or 18 years later. I suppose the OBs have the worst of it from a peace of mind perspective, since they're more likely to be sued much later into the tail period. But I think that's pretty unusual in the real world.