Med student interested in anesthesiology. Still worth pursuing?

[deleted162650]

Then, as we have frequently concluded, there are big geographical differences between job markets. So maybe the right question is: should I do anesthesiology if I want to live in...?

This.

Take a look at guys like @nimbus, @sevoflurane, @Noyac, and that rockstar @SaltyDog - all super happy in anesthesiology.

Now compare them to guys like @FFP, @Consigliere, etc. - not so happy.

Notice the trend (well 2 of them):

1) Geography
2) MD v. ACT

Geography leads to ACT practice, ACT leads to fear, fear leads to anger, anger leads to hate, hate leads to suffering.
-Yoda

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[GravelRider]

Geography leads to ACT practice, ACT leads to fear, fear leads to anger, anger leads to hate, hate leads to suffering.
-Yoda

Suffering leads to rebirth and resurrection.
-some hippy dude in the Middle East 2,000 years ago

 

[deleted171991]

This.

Take a look at guys like @nimbus, @sevoflurane, @Noyac, and that rockstar @SaltyDog - all super happy in anesthesiology.

Now compare them to guys like @FFP, @Consigliere, etc. - not so happy.

Notice the trend (well 2 of them):

1) Geography
2) MD v. ACT

Geography leads to ACT practice, ACT leads to fear, fear leads to anger, anger leads to hate, hate leads to suffering.
-Yoda

We'll see about sevo, too, in about 5 years. Just ask Blade.

It's the employment model that leads to burnout. I don't even believe it's solo vs ACT, more like employed vs partner in a good group. Even at group level, there are groups that are only surviving by adopting an AMC-style work model, with 6 weeks of vacation and many calls even for the partners.

There are simply too few good jobs as an employee. Employers want to suck all the profits they can out of you. I don't care that much about money, and still I can't find a job that offers me a happy life-work balance in my geographical area. I don't do locums, because the extra money would be too little (besides the bureaucratic nightmare).

It used to be that academic jobs were more lifestyle-oriented. Not anymore; they are just AMC jobs in disguise, with better benefits. Same slave drivers everywhere. I remember when I asked an academic chair what the working hours were, and I was told 7 to 5. Which meant really 6:30 to 5:10. If you "had to" (not "chose to") stay after 5, you got paid basically the same crappy rate as during the day. To me, this is not life, even without call, especially if one adds some commute to it.

There are only two kinds of businesses in anesthesiology: those who have already sold out, and those who will. For new and future grads, chances of at least getting a payday are diminishing as fast as snow melting under the spring sun.

 

[sevoflurane]

We'll see about sevo, too, in about 5 years. Just ask Blade.

It's the employment model that leads to burnout. I don't even believe it's solo vs ACT, more like employed vs partner in a good group. Even at group level, there are groups that are only surviving by adopting an AMC-style work model, with 6 weeks of vacation and many calls even for the partners.

There are simply too few good jobs as an employee. Employers want to suck all the profits they can out of you. I don't care that much about money, and still I can't find a job that offers me a happy life-work balance in my area.

It used to be that academic jobs were more lifestyle-oriented. Not anymore; they are just AMC jobs in disguise, with better benefits. Same slave drivers everywhere.

The sky is still falling isn't it FFP?.
Sevo will be just fine and so will this group. I would love to disclose our range of income on this forum post merger, but I won't.
But go ahead and live your life in fear.
I'll keep on doing what i've been doing for quite some time now... which is basically enjoying my life 200%.

 

[deleted171991]

The sky is still falling isn't it FFP?.
Sevo will be just fine and so will this group. I would love to disclose our range of income on this forum post merger, but I won't.
But go ahead and live your life in fear.
I'll keep on doing what i've been doing for quite some time now... which is basically enjoying my life 200%.

Good luck! I don't wish anything less than 200% to you.

It seems I have misunderstood, and you have only merged with another group, not been acquired by an AMC. My mistake. Anyway, even in the AMC situation, the first 3-5 years post-acquisition are usually good. It's what comes after...

I just hope you realize that much of what happens to people has to do more with luck than special qualities. There is a reason we say: "better to be lucky than good", or "being at the right place at the right time". So no reason to look down on others.

Btw, I am not afraid of anything. I have seen enough crap. That's the advantage of the pessimist: s/he will have only pleasant surprises in life.

 

[sevoflurane]

What you fail to realize is that not all groups are treated the same and there is considerable differences between AMC's. Trust me, I spent the better part of a year meeting CEOs and higher ups of the different AMCs... and reading through different proposals and potential contracts.
Exactly how many groups have you talked to in regards to renegotiations after the initial term is up?
I really can go on and on... but as I've said before a lot of what happens has to do with what was there before.
Not all AMC these days are the slavedrivers you describe.
We have been very happy as we function exactly the same we have always functioned.
You have made your choices. I've made mine. So far, my career which involves 2 jobs and some locums work has been nothing less than stellar.
The sky has been falling during that entire time.

 

[Man o War]

Count me as another who is happy. I love going to work every day.
When my last job became unhappy for me, I quit. I interviewed at several groups. I am positive I would've been happy at all but one.
I can't think of a single industry or medical specialty where everyone is happy with their jobs. Hell, one of my best friends who is an ortho surgeon, the supposed "holy grail", just picked up and moved across the country because he was unhappy. Some people stay and hate it and some people quit.
As was mentioned above, being married to a location increases your chances of being stuck in a bad job, no matter what industry you're in.

 

[Arch Guillotti]

Path and Rads. No mid-level can do those fields....unless Watson is a mid-level. I'm still not convinced we want to leave cancer diagnoses to a computer.

Path job market is horrible.

 

[postbacpremed87]

Path job market is horrible.

So everyone says. Objectively it is the worst market in medicine but everyone gets a job after 1-2 fellowships. No patients whatsoever and no mid level pressure.

 

[Carbocation1]

The path fellows at my institution say there are literally less than a dozen jobs available in the entire nation right now - they are all in BFE and receive 100 applications per 1 spot.

 

[Carbocation1]

I recently attended a large radiology conference discussing AI. They clearly acknowledged the practice of radiology will cease to exist in 5 years, but had no plan other than becoming a "system engineer" of some sort overseeing the technology.

 

[AdmiralChz]

I recently attended a large radiology conference discussing AI. They clearly acknowledged the practice of radiology will cease to exist in 5 years, but had no plan other than becoming a "system engineer" of some sort overseeing the technology.

This has been discussed recently on this forum, and radiologists are absolutely worried about it. Not sure on the time frame, but new grads are appropriately concerned. Plus, they already have encroachment by tele-radiology firms.

I'm still not convinced we want to leave cancer diagnoses to a computer.

Large hospital corporations are more than happy to do this - just imagine HCA buying Watson the Radiologist to read straight forward Xrays/CTs/MRIs, it could put hundreds of radiologists' jobs in jeopardy (and think of the variable cost saving by not paying expensive doctors to read images).

That being said, when I started residency 4 years ago some academics were pretty concerned about the Sedasys machine and the implications going forward. A little over a year ago, it was pulled from the market. So just because it's possible that a computer can do it doesn't mean it will be done.

It’s game over for the robot intended to replace anesthesiologists

 

[Rocky222Balboa]

Sounds like things are pretty okay now if you're willing to look. Question is how they'll be 5-10 years down the line. Which no one can really predict.

Given the possible pressure on salaries in the future, would academic anesthesia where salaries are a little lower, but you're income is unlikely drop further, be a better option right now for folks entering the workforce?

 

[postbacpremed87]

The path fellows at my institution say there are literally only a handful of jobs available in the entire nation, and they are all in BFE and receive 100 applications per 1 spot.

This has been discussed recently on this forum, and radiologists are absolutely worried about it. Not sure on the time frame, but new grads are appropriately concerned. Plus, they already have encroachment by tele-radiology firms.



Large hospital corporations are more than happy to do this - just imagine HCA buying Watson the Radiologist to read straight forward Xrays/CTs/MRIs, it could put hundreds of radiologists' jobs in jeopardy (and think of the variable cost saving by not paying expensive doctors to read images).

That being said, when I started residency 4 years ago some academics were pretty concerned about the Sedasys machine and the implications going forward. A little over a year ago, it was pulled from the market. So just because it's possible that a computer can do it doesn't mean it will be done.

It’s game over for the robot intended to replace anesthesiologists

I meant more for Pathology, but your point is well taken.

 

[Turtlez]

This.

Take a look at guys like @nimbus, @sevoflurane, @Noyac, and that rockstar @SaltyDog - all super happy in anesthesiology.

Now compare them to guys like @FFP, @Consigliere, etc. - not so happy.

Notice the trend (well 2 of them):

1) Geography
2) MD v. ACT

Geography leads to ACT practice, ACT leads to fear, fear leads to anger, anger leads to hate, hate leads to suffering.
-Yoda

Which states are the best?

 

[Man o War]

Sounds like things are pretty okay now if you're willing to look. Question is how they'll be 5-10 years down the line. Which no one can really predict.

Given the possible pressure on salaries in the future, would academic anesthesia where salaries are a little lower, but you're income is unlikely drop further, be a better option right now for folks entering the workforce?

Not IMO. I'd make the money while it's there to make.

 

[Noyac]

It's the employment model that leads to burnout. .

Tell me when it's supposed to happen because I've been employed for 13yrs now and I'm not burned out yet. And like Sevo, I wish I could discuss compensation but that would not be professional nor would it be wise. I will just say it is quite fair.
Yes, we have had some leave the practice. Location may have been a big part of that, not burnout. Not everyone can live in the best outdoors area in the country (my opinion). Some people need malls and shopping, I get it.
IMO, what helps is to show up for work with a good attitude and carry that forward throughout the day everyday. Do better than good work and focus on what matters. Don't get caught up in BS.
What matters:
1) outcomes
2) referrals (take care of those that feed you)
3) employer (take care of your own issues so that they never make it up the ladder to your employer, be the problem solver of the hospital and maintain an honest relationship)
4) participation (be active in hospitals affairs)if you are not sitting at the table then you might find that you are on the menu.
5) the rest pales in comparison

Number one is harder than some think mostly because those that suck at this job don't realize it. Number 2, is difficult for some people who feel the need to be in charge of every little thing. Not knowing what is important enough to argue and what isn't can cause a lot of grief. Number 3, is easy if you have strong group leaders.

 

[pgg]

Path and Rads. No mid-level can do those fields....unless Watson is a mid-level. I'm still not convinced we want to leave cancer diagnoses to a computer.

When the day comes that the computer can do it better than a person, why wouldn't you want it read by a computer? I would. Someday I will.

I recently attended a large radiology conference discussing AI. They clearly acknowledged the practice of radiology will cease to exist in 5 years, but had no plan other than becoming a "system engineer" of some sort overseeing the technology.

You should've told them to drop by the SDN anesthesia forum for a pep talk on how computers can't possibly take the low-hanging fruit of their specialty, the B&B image reads, because ... reasons. We had a thread on this very topic a couple months ago, full of people whistlin' past the graveyard.

 

[postbacpremed87]

When the day comes that the computer can do it better than a person, why wouldn't you want it read by a computer? I would. Someday I will.




You should've told them to drop by the SDN anesthesia forum for a pep talk on how computers can't possibly take the low-hanging fruit of their specialty, the B&B image reads, because ... reasons. We had a thread on this very topic a couple months ago, full of people whistlin' past the graveyard.

I do. I don't think they will for a long time given my reasons above.

 

[deleted162650]

Which states are the best?

Cross reference a list of states with no state income tax with a list of states that have malpractice tort reform. Then go rural and west of the Rockies.

 

[bashwell]

Cross reference a list of states with no state income tax with a list of states that have malpractice tort reform. Then go rural and west of the Rockies.

This is from about 10 minutes of Googling, so caveat emptor!

States with no individual state income tax
Alaska
Florida
New Hampshire*
Nevada
South Dakota
Tennessee*
Texas
Washington
Wyoming
*Limited individual income tax (i.e., tax on dividend and interest income, not earned income)

States (taken from only the ones above) with malpractice tort reform (non-economic damages cap)
Alaska - $250,000 ($400,000 if severe impairment higher than 70% and if wrongful death)
Florida - $500,000
Nevada - $350,000
South Dakota - $500,000
Tennessee - $750,000 ($1 million if catastrophic injury)
Texas - $250,000 ($500,000 if against more than one party)

States (taken from only the ones above) west of the Rockies
Alaska
Nevada

This is a slimmer list than I expected, but maybe we can expand to states with low state income taxes?

 

[deleted162650]

This is from about 10 minutes of Googling, so caveat emptor!

States with no individual state income tax
Alaska
Florida
New Hampshire*
Nevada
South Dakota
Tennessee*
Texas
Washington
Wyoming
*Limited individual income tax (i.e., tax on dividend and interest income, not earned income)

States (taken from only the ones above) with malpractice tort reform (non-economic damages cap)
Alaska - $250,000 ($400,000 if severe impairment higher than 70% and if wrongful death)
Florida - $500,000
Nevada - $350,000
South Dakota - $500,000
Tennessee - $750,000 ($1 million if catastrophic injury)
Texas - $250,000 ($500,000 if against more than one party)

States (taken from only the ones above) west of the Rockies
Alaska
Nevada

This is a slimmer list than I expected, but maybe we can expand to states with low state income taxes?

It's safe to expand a bit into the Rocky Mountain states and Midwest as well. Wyoming can be excellent for example.

 

[Brahnold Bloodaxe]

Given the possible pressure on salaries in the future, would academic anesthesia where salaries are a little lower, but you're income is unlikely drop further, be a better option right now for folks entering the workforce?

No way will academic salaries stay steady if salaries available outside of academics drop. The salary in academics is as "high" as it is only because of the salaries available elsewhere that they have to compete against for staff. Academics will always pay less than other models, so if salaries in other models go down, the salary in academics will drop right along with them. You will make half to two thirds of what you'll make in private practice regardless of whether private practice makes 500k or 50k.

 

[GravelRider]

Isn't it an indictment of the specialty when the answer to how to find a sustainable job is always to move west of the Rockies? That leaves an awful lot of very populated real estate where your chances of finding a decent job are pretty low.

Setting (low) expectations for med students interested in the specialty and educating people on how many different ways they are being taken advantage of is the only chance to fix the practice environment. Physician burnout is a problem in all specialties and the fix is pretty easy, yet physicians are increasingly no longer in charge of their own fate.

 

[Man o War]

I don't understand the current fascination with EM if pay is a main factor....
1) hospital based
2) don't own their patients
3) heavily subsidized/crappy payer mix
4) midlevel encroachment
6) management companies

This is a specialty ripe for pay cuts even if $300 per hour is the going rate. Don't get me wrong, all my physician colleagues deserve at least that level of pay, but EM is very low hanging fruit IMO.

 

[nimbus]

I don't understand the current fascination with EM if pay is a main factor....
1) hospital based
2) don't own their patients
3) heavily subsidized/crappy payer mix
4) midlevel encroachment
6) management companies

This is a specialty ripe for pay cuts even if $300 per hour is the going rate. Don't get me wrong, all my physician colleagues deserve at least that level of pay, but EM is very low hanging fruit IMO.

It's simply supply and demand. Anesthesia could command $300/hr if the programs didn't expand so much over the past 10 years.

 

[GravelRider]

I don't understand the current fascination with EM if pay is a main factor....
1) hospital based
2) don't own their patients
3) heavily subsidized/crappy payer mix
4) midlevel encroachment
6) management companies

This is a specialty ripe for pay cuts even if $300 per hour is the going rate. Don't get me wrong, all my physician colleagues deserve at least that level of pay, but EM is very low hanging fruit IMO.

I think the benefit in EM is that they've been shift workers from the beginning. Having clear understanding of what your hourly rate is has been baked into job negotiations from the beginning. That's not the same in anesthesia. Many of the employed anesthesia jobs are not upfront with you about pay to workload ratio. We all know that two jobs paying 400k salary can be very different in terms of workload.

 

[Twiggidy]

Thanks. I would enjoy anesthesiology as a specialty, but future salary is a concern of mine as my loans will be almost 300k by the time I am done and I don't want to be drowning in debt. I certainly hope that physicians don't become government employees making 100k per year, otherwise I'm screwed

Don't worry about salary in your case because with 300k of loans one of my main priorities would be finding ways to get someone to pay back my loans. Honestly, no matter what field you choose, you should take a strong look at the Navy to get some loan repayment. Our salaries are good compared to the majority of Americans but when you enter real life and start adding mortgages, kids, private schools, car payments, etc, that 300k is going to be a nightmare no matter where you live or what you make.

 

[Twiggidy]

For $350/hr and the number of shifts they work? You bet.

Especially EM at a community hospital

And FFP is correct in another post, the future won't be about what branch of medicine you practice....it will be WHERE you practice that branch of medicine

 

[JPSmyth]

Don't worry about salary in your case because with 300k of loans one of my main priorities would be finding ways to get someone to pay back my loans. Honestly, no matter what field you choose, you should take a strong look at the Navy to get some loan repayment. Our salaries are good compared to the majority of Americans but when you enter real life and start adding mortgages, kids, private schools, car payments, etc, that 300k is going to be a nightmare no matter where you live or what you make.

Freedom before money any day for me, I have talked to recruiters and thought about it. Just not for me

 

[anbuitachi]

300k+ debt is pretty common among med students.. if you went to a Ivy league or equivalent which many did, thats 200k right there. Med school is easily another 200k+

 

[deleted171991]

Freedom before money any day for me, I have talked to recruiters and thought about it. Just not for me

Money is freedom. It's the freedom to retire early, while you're still healthy enough to enjoy life.

 

[Stank811]

Isn't it an indictment of the specialty when the answer to how to find a sustainable job is always to move west of the Rockies? That leaves an awful lot of very populated real estate where your chances of finding a decent job are pretty low.

Setting (low) expectations for med students interested in the specialty and educating people on how many different ways they are being taken advantage of is the only chance to fix the practice environment. Physician burnout is a problem in all specialties and the fix is pretty easy, yet physicians are increasingly no longer in charge of their own fate.

Plenty of great groups east of the Rockies as well.

 

[GravelRider]

Plenty of great groups east of the Rockies as well.

Plenty? As in plentiful? As in an abundance?

 

[Carbocation1]

Money is freedom. It's the freedom to retire early, while you're still healthy enough to enjoy life.

Are anesthesiologists less healthy than other people in healthcare? If so, is there anything specific that can be done - perhaps take a job that doesn't require supervision, or just work less hours? Anecdotally, I know a few anesthesiologists (and CRNAs too) who have had massive MIs in the past. If I recall correctly, I remember reading in some anesthesia textbook that the life expectancy of anesthesiologists is lowest out any specialty.

 

[deleted171991]

Are anesthesiologists less healthy than other people in healthcare? If so, is there anything specific that can be done - perhaps take a job that doesn't require supervision, or just work less hours? Anecdotally, I know a few anesthesiologists (and CRNAs too) who have had massive MIs in the past. If I recall correctly, I remember reading in some anesthesia textbook that the life expectancy of anesthesiologists is lowest out any specialty.

Physicians (including many anesthesiologists) work stressful jobs and lead sedentary lifestyles, so some of them may not be that healthy at 65. Especially those who do a lot of stool-sitting. Regardless, most people will be much healthier at 45-50 than at 65.

 

[Man o War]

I'm certain the midlevels will soon be doing EM fellowships and the supply will catch up with the demand.

 

[Stank811]

Plenty? As in plentiful? As in an abundance?

As in you should not have a hard time finding a great job...but you have to be willing to pull yourself from the coast

 

[AdmiralChz]

I'm certain the midlevels will soon be doing EM fellowships and the supply will catch up with the demand.

My shop offers NP "fellowships" in critical care and emergency medicine. They get special lectures as well during the day, the residents have to cover during this time. It's very unpopular around here, particularly with EM.

 

[waterbottle10]

Are anesthesiologists less healthy than other people in healthcare? If so, is there anything specific that can be done - perhaps take a job that doesn't require supervision, or just work less hours? Anecdotally, I know a few anesthesiologists (and CRNAs too) who have had massive MIs in the past. If I recall correctly, I remember reading in some anesthesia textbook that the life expectancy of anesthesiologists is lowest out any specialty.

I'd imagine so. It's a high stress field. And less movement. When I was doing Anes I averaged 7k or so steps a day at work. On medicine I averaged 10k and with more stair climbing. I gained almost 10lbs on anesthesiology

 

[DetectiveAlonzo]

I'd imagine so. It's a high stress field. And less movement. When I was doing Anes I averaged 7k or so steps a day at work. On medicine I averaged 10k and with more stair climbing. I gained almost 10lbs on anesthesiology

****. I have family history of MI that resulted in one member passing away. Looks like gas ain't for me. I wonder how many gas docs hit the gym 4-5 times a week

 

[nimbus]

Sedentary lifestyle is a choice. Plenty of anesthesiologists are EXTREMELY active.

 

[postbacpremed87]

Sedentary lifestyle is a choice. Plenty of anesthesiologists are EXTREMELY active.

It's not as bad as Pathology. You sit at the scope for HOURS.

 

[waterbottle10]

Sedentary lifestyle is a choice. Plenty of anesthesiologists are EXTREMELY active.

Yea but work wise anesthesiology is one of the more sedentary ones. Unless you work out in the OR or something

 

[AdmiralChz]

****. I have family history of MI that resulted in one member passing away. Looks like gas ain't for me. I wonder how many gas docs hit the gym 4-5 times a week

I hate to speak for him, but Sevo often talks about spending ample time in the great outdoors in the pacific NW. He seems incredibly happy.

 

[Consigliere]

****. I have family history of MI that resulted in one member passing away. Looks like gas ain't for me. I wonder how many gas docs hit the gym 4-5 times a week

Not me. I hit the gym 5-6 times a week. And the road 4X/week.

 

[nimbus]

Yea but work wise anesthesiology is one of the more sedentary ones. Unless you work out in the OR or something

Unless you're a gardener or construction worker or the like, you're gonna have a sedentary job. Most people do. Work out when you're off. Even in the winter months when I get out after dark I can still go out for a run......that's what headlamps are for.

 

[Bru]

I like the direction this thread has taken!

 

[BLADEMDA]

Even working 60 hours per week You can make time for exercise. Your life depends on it.

 

[Carbocation1]

"In a large and seemingly well-done American study, the cause-specific mortality between 1979 and 1995 for about 40 000 anesthesiologists was compared with that of a gender- and age-comparable sample of internists... anesthesiologists had increased risks of death from cerebrovascular disease, suicide, drug abuse, and other external causes."

Scandinavian Journal of Work, Environment & Health - Is the life expectancy of anesthesiologists decreased?