Med student interested in anesthesiology. Still worth pursuing?

[Carbocation1]

Stress snipping lifespan of anaesthetists: Study

"High stress levels are taking years off anaesthetists' lives. Going by the researches conducted abroad as well as by the All-India Institute of Medical Sciences (AIIMS), the lifespan of anaesthetists is shorter when compared to medical professionals from other specialties, and this is primarily due to the stress they are under constantly."

Stress snipping lifespan of anaesthetists: Study - Times of India

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[bashwell]

Staying fit (lifting weights, running, eating healthy) makes me more productive in the rest of my life including life as a physician. I feel better, I'm mentally sharper, I can work faster and much more as a result of keeping fit. I consider the time invested in keeping fit (one hour 3-5x a week) pays off in spades in the rest of my life.

 

[anbuitachi]

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.

Compared to MD specialties anes is more sedentary. Every surgical specialty probably moves more, and spend less time sitting. EM, IM, Neuro, from my experience moves more too cause patients are scattered and with consults you are running between buildings/floors etc. Most of the running i do is between the equipment cart and the OR table.

 

[bronx43]

Compared to MD specialties anes is more sedentary. Every surgical specialty probably moves more, and spend less time sitting. EM, IM, Neuro, from my experience moves more too cause patients are scattered and with consults you are running between buildings/floors etc. Most of the running i do is between the equipment cart and the OR table.

Agreed.
When I was a hospitalist, I averaged 4-6 miles a day from walking, with at least 10 flights of stairs. In clinic now, it's about 2 on a busy day, but I'm at least on my feet.

 

[deleted171991]

"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?

Did they include reading SDN Anesthesiology in the risk factors?

 

[Arch Guillotti]

Compared to MD specialties anes is more sedentary.

Maybe during residency but when you are directing multiple rooms and myriad other tasks in all sorts of locations there can be a lot of walking.

 

[GravelRider]

Stand during the case instead of sitting. That's already better than the vast majority of the population hunched over a computer.

 

[DrfluffyMD]

When the day comes that the computer can do it better than a person, why wouldn't you want 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.

Reasons include
- Machine learning algorithum unable to properly learn from existig reports due to weakness of language processing
- awareness of radiologists in values of their reports/meta data and their refusal of sales of the said data.
- legal precedent/case law where a lawyer reviewing documents prepared by AI in seconds was judged unprofessional due to inability for a human to leverage his professional ability in seconds (translation: still need human over-read)
- Failure mode of AI which is catastrophic unlike human radiologist. Translation: AI bugg out and blantantly misss 30 cm tumor.

Oh, and lastly, anesthesia was one of the first field to see automation (sedasys), but it's so unpopular that the company took it off the market.

Oh, Enlithic, which claims ability to generate radiology report as of today, are now hiring HUMAN radiologists to generate report in order to train its AI, an effort that may be less successful than they like due to the job market improvements.

So yes, throughly debated to the death and had your ignorance in both radiology and machine learning shown in that thread.

 

[pgg]

Sedasys? Your counterxample is Sedasys? LOL. That was a predictably unpopular failure because the clinical practice of anesthesiology requires mechanical tasks that robots can't do.

None of the problems you list are unsolvable, or even require paradigm shifting technology breakthroughs. And when machines can read films better than humans, the legal and financial side will fall into place.

It's actually rather cute how you think radiologists won't sell out their specialty to help train and otherwise bring these systems into existence.

 

[DrfluffyMD]

Sedasys? Your counterxample is Sedasys? LOL. That was a predictably unpopular failure because the clinical practice of anesthesiology requires mechanical tasks that robots can't do.

None of the problems you list are unsolvable, or even require paradigm shifting technology breakthroughs. And when machines can read films better than humans, the legal and financial side will fall into place.

It's actually rather cute how you think radiologists won't sell out their specialty to help train and otherwise bring these systems into existence.

As I alluded to the other thread, the idea that your physician colleague maybe replaced by a non general AI entity demostrate ignorances, unprofessionalism and disrespect.

I've already said my piece, with source, and you have lost this debate, horribly.

You counter my argument by saying "but that's not unsolvable" rather than give any concrete examples.

The burden of proof is on YOU to show me that a narrow AI can do a radiologist's job.

Anyway, I am done with this discussion / beating dead horse. It is regretable that this opinion exist within the anesthesia community.

 

[pgg]

As I alluded to the other thread, the idea that your physician colleague maybe replaced by a non general AI entity demostrate ignorances, unprofessionalism and disrespect.

Obviously we disagree and time will tell, but there's no reason to get hurt feelings or cry disrespect over it. Maybe in 20 years we can bump this thread.

By the time my career is done, the value of radiologists won't be in reading CXRs or CTs. There's no disrespect in admitting that technology changes medicine. Only foolishness in pretending it can't, won't, and isn't.

Some changes are more predictable than others. Computers reading path slides and digital images is one of them. It'll start with those systems being tools for pathologists and radiologists. In time those tasks will be as automated as platelet counts.

But go ahead and declare victory in the debate. The fact that you're correct today entirely misses the point.

 

[Twiggidy]

Stand during the case instead of sitting. That's already better than the vast majority of the population hunched over a computer.

I was just about to post this. There's no rule against standing or pacing in the OR. Sure sitting at the cpu and surfing SDN is more fun but I've actually made a conscious effort to stand and walk more especially if it's a long case. I also try to take the elevator as little as possible. I found myself "Netflixing and chilling" a little to much at home post call so I take my iPad to the gym which has wifi. Pump some iron and watch an episode of House of Cards on the cardio machines.

Do whatever you can by any means.

 

[Twiggidy]

Obviously we disagree and time will tell, but there's no reason to get hurt feelings or cry disrespect over it. Maybe in 20 years we can bump this thread.

By the time my career is done, the value of radiologists won't be in reading CXRs or CTs. There's no disrespect in admitting that technology changes medicine. Only foolishness in pretending it can't, won't, and isn't.

Some changes are more predictable than others. Computers reading path slides and digital images is one of them. It'll start with those systems being tools for pathologists and radiologists. In time those tasks will be as automated as platelet counts.

But go ahead and declare victory in the debate. The fact that you're correct today entirely misses the point.

I can't deny where PGG is going with this thread within a thread. Outside of intubation and placing lines, when you really think about what we do in the OR it's not far fetched that some sort of mechanical system can replace it is one, two, or three generations. (insert the comparison of CRNAs to robots comment here). Technology can't to the hands on aspect, but as far as maintaining a depth of anesthetic and keeping vitals in place I definitely envision of a day where a single anesthesiologist (or someone) sits at a single control room monitoring 8-10 cases pushing buttons and maybe another person around simply for intubating/extubating/placing lines. I mean, even look at the DaVinci. We're so close to not even having a surgeon in the OR in some cases. Just someone to put in trochars (sp?) Sorry....no disrespect to my colleagues in year 2130.

 

[JPSmyth]

I don't want to start a new thread but I have a separate question now.

If I do an anesthesia residency and then pain management fellowship and work in a clinic setting doing interventional pain management procedures, this is not a role that can be filled by nurses in the future right?

I guess I could do a PM&R residency too before a pain fellowship too since I heard that residency lifestyle is pretty relaxed

 

[aneftp]

I don't want to start a new thread but I have a separate question now.

If I do an anesthesia residency and then pain management fellowship and work in a clinic setting doing interventional pain management procedures, this is not a role that can be filled by nurses in the future right?

I guess I could do a PM&R residency too before a pain fellowship too since I heard that residency lifestyle is pretty relaxed

Yes. Go ahead. Do PMR. NPs are invading that speciality as well. After all they can do it cheaper. And are authorized to practice to the "full limits" of their nursing license

 

[JPSmyth]

Yes. Go ahead. Do PMR. NPs are invading that speciality as well. After all they can do it cheaper. And are authorized to practice to the "full limits" of their nursing license

So soon orthopedic surgeons are going to be in trouble too because NPs are going to be doing knee and hip replacements?

What specialties are "safe" then

 

[aneftp]

So soon orthopedic surgeons are going to be in trouble too because NPs are going to be doing knee and hip replacements?

What specialties are "safe" then

Ortho, ent , derm are safe

 

[Nikj]

So soon orthopedic surgeons are going to be in trouble too because NPs are going to be doing knee and hip replacements?

What specialties are "safe" then

IR, probably any interventional specialty actually, and most surgical specialties.

 

[JPSmyth]

Ortho, ent , derm are safe

three fields out of 20+ specialties, and those three are some of, if not THE most competitive

 

[JPSmyth]

IR, probably any interventional specialty actually, and most surgical specialties.

"interventional" pain management, can NPs perform interventional pain procedures?

and its funny because in radiology they say IR is screwed because interventional cards, neurosurg, and other specialties are taking over their procedures

What about rad onc and heme/onc? I know there are NPs in each field but I would imagine that patients want an MD overseeing their care and having those life/death conversations with them

 

[BLADEMDA]

I don't want to start a new thread but I have a separate question now.

If I do an anesthesia residency and then pain management fellowship and work in a clinic setting doing interventional pain management procedures, this is not a role that can be filled by nurses in the future right?

I guess I could do a PM&R residency too before a pain fellowship too since I heard that residency lifestyle is pretty relaxed

As long as patients can choose their Physician and understand what it is you do the NPs won't be as big an issue. That's why Family physicians aren't going anywhere even if the NPs get "full practice authority." Patients will still prefer to see a Physician.

 

[BLADEMDA]

 

[deleted171991]

As long as patients can choose their Physician and understand what it is you do the NPs won't be as big an issue. That's why Family physicians aren't going anywhere even if the NPs get "full practice authority." Patients will still prefer to see a Physician.

For a while. Most of them don't even know that their "doctor" is an APRN. People are stupid uninformed.

 

[Nikj]

"interventional" pain management, can NPs perform interventional pain procedures?

and its funny because in radiology they say IR is screwed because interventional cards, neurosurg, and other specialties are taking over their procedures

What about rad onc and heme/onc? I know there are NPs in each field but I would imagine that patients want an MD overseeing their care and having those life/death conversations with them

I don't know enough about pain management to comment, but IR has definitely carved out some of its own procedures. Additionally as IR orients itself as to controlling patient flow, instead of just being referred to, they will secure themselves.

IR is also really unique in that it has a huge potential to continue to create novel treatments/technologies and I'm pretty sure that they won't make the same mistake of giving up those procedure like they have with a lot of what they invented.

Really any specialty that holds the potential for real growth through research and advancement of care is immune from midlevels. Anyone can try and replicate what doctors do, but most of them cannot do the science behind what goes into those decisions/procedures/etc. Being able to understand that science, and contributing to a persons respective field, is what has and will always separate physicians from all other healthcare providers.

 

[anbuitachi]

IR is huge. It's growing at a huge rate.

 

[bronx43]

Really any specialty that holds the potential for real growth through research and advancement of care is immune from midlevels. Anyone can try and replicate what doctors do, but most of them cannot do the science behind what goes into those decisions/procedures/etc. Being able to understand that science, and contributing to a persons respective field, is what has and will always separate physicians from all other healthcare providers.

This only applies to procedures that can be done by a specialty. Most medical advancement doesn't come in the form of procedures. If a oncology physician scientist discovers the next cancer therapy, it doesn't really protect the field from mid-level encroachment. If a pulmonary critical care guy comes up with a novel approach to sepsis treatment, it will still be the NPs carrying out those orders.

 

[bronx43]

IR is huge. It's growing at a huge rate.

Really? What are the newest advancements in IR? I'm just curious. Don't really come across many IR guys.

 

[deleted171991]

I don't know enough about pain management to comment, but IR has definitely carved out some of its own procedures. Additionally as IR orients itself as to controlling patient flow, instead of just being referred to, they will secure themselves.

IR is also really unique in that it has a huge potential to continue to create novel treatments/technologies and I'm pretty sure that they won't make the same mistake of giving up those procedure like they have with a lot of what they invented.

Really any specialty that holds the potential for real growth through research and advancement of care is immune from midlevels. Anyone can try and replicate what doctors do, but most of them cannot do the science behind what goes into those decisions/procedures/etc. Being able to understand that science, and contributing to a persons respective field, is what has and will always separate physicians from all other healthcare providers.

Respectfully, that's sooo wishful thinking. Anything that's monkey see monkey do can be replicated. There is nothing special about IR. It's not surgery. It's not that complicated. Pain procedures are IR. Line placement is IR. Cardiac cath is IR. You could teach a midlevel to do any of those and then just supervise her. There is no rocket science here. All they need is access to a "fellowship". That will come, in a decade or so. They are already planning critical care fellowships for midlevels, for Pete's sake. Money, money, money!

Also, any research and knowledge that's public can and will be replicated. Information disseminates in days or weeks, not months or years like before. Especially if there is no measurable difference in outcomes, nobody will care about who's doing the procedure, they will care about the price. As time passes, midlevel encroachment will increase everywhere. The bean counters have gotten greedy.

The only way one could be protected from market forces is by patenting a treatment. That's not possible, except for the substances or the machines, but not for the ideas. If somebody came up with research that a certain medication cocktail cures cancer, every midlevel could prescribe that cocktail for cancer. There is little moat to protect most medical specialties.

 

[deleted171991]

IR is huge. It's growing at a huge rate.

Obviously. It's a form of minimally invasive surgery. It will keep stealing from other procedural specialties, but that doesn't mean it will be protected from market forces.

 

[Twiggidy]

The only thing keep us and some other specialties from having RNs invade the field is SKILL. I"ve seen some poorly skilled nurses coming in and out of the hospital and nothing gets done and patients dont do well when simple things can't be accomplished. In certain aspects of anesthesia we're just better skilled and no nurse can replace that.

But that's where our field needs to get adamant about not teaching skills. In my residency, a group of attendings said nurses were there to give breaks and that's it. You wouldn't see one doing an epidural or placing invasive lines. The lazier we get and the more we teach those things, the faster the field falls into their hands. 2c

 

[deleted171991]

But that's where our field needs to get adamant about not teaching skills. In my residency, a group of attendings said nurses were there to give breaks and that's it. You wouldn't see one doing an epidural or placing invasive lines. The lazier we get and the more we teach those things, the faster the field falls into their hands. 2c

Unfortunately, the greedy bastards in PP think otherwise. You should see SRNAs learning how to place a-lines. While a fellow, I got reported for refusing to explain a procedure to an APRN student who was watching. We are not allowed to tell nurses: that's not your job, that's none of your concern. We are expected to teach our replacements. Ridiculous, castrated profession!

Not that it changes anything. They just go on Youtube. It's full of sucker MDs teaching everybody everything... because we are soooo smart that nobody can replace us. Most doctors think short-term; the older they are, the less they give a damn about the profession, and the more about themselves.

 

[Nikj]

Respectfully, that's sooo wishful thinking. Anything that's monkey see monkey do can be replicated. There is nothing special about IR. It's not surgery. It's not that complicated. Pain procedures are IR. Line placement is IR. Cardiac cath is IR. You could teach a midlevel to do any of those and then just supervise her. There is no rocket science here. All they need is access to a "fellowship". That will come, in a decade or so. They are already planning critical care fellowships for midlevels, for Pete's sake. Money, money, money!

Also, any research and knowledge that's public can and will be replicated. Information disseminates in days or weeks, not months or years like before. Especially if there is no measurable difference in outcomes, nobody will care about who's doing the procedure, they will care about the price. As time passes, midlevel encroachment will increase everywhere. The bean counters have gotten greedy.

The only way one could be protected from market forces is by patenting a treatment. That's not possible, except for the substances or the machines, but not for the ideas. If somebody came up with research that a certain medication cocktail cures cancer, every midlevel could prescribe that cocktail for cancer. There is little moat to protect most medical specialties.

At the end of the day there are really only so many ways this can all go down. If midlevels reach the point were they have the exact same practice rights as physicians, then physicians will gradually move into the private sector and be reduced in number, and will basically be paid as experts by those who can afford it. Why would anyone who can afford insurance/have the money be seen/treated by a midlevel.

Also, as I always say I'm just premed, but are you IR or Vascular(out of curiosity, not doubt)? I'm pretty sure a lot of those procedures that involve live imaging w/ contrast and all are actually pretty difficult and require some solid experience with reading radiographs to ensure you are treating the right vessels/body areas. I highly doubt a PA or NP could ever be comfortable at looking at those live CT/xray images.

 

[DrfluffyMD]

At the end of the day there are really only so many ways this can all go down. If midlevels reach the point were they have the exact same practice rights as physicians, then physicians will gradually move into the private sector and be reduced in number, and will basically be paid as experts by those who can afford it. Why would anyone who can afford insurance/have the money be seen/treated by a midlevel.

Also, as I always say I'm just premed, but are you IR or Vascular(out of curiosity, not doubt)? I'm pretty sure a lot of those procedures that involve live imaging w/ contrast and all are actually pretty difficult and require some solid experience with reading radiographs to ensure you are treating the right vessels/body areas. I highly doubt a PA or NP could ever be comfortable at looking at those live CT/xray images.

Resident here who have matched into a top 10 IR fellowship here.

Many bread and butter IR procedures can be taught to a mid level, but the practice of IR requires a lot of "thinking of your feet", and not in a way of put in x med if y happens, but geniune trouble shooting.

High end IR procedures like UAE, prostate embo, or tips/BRTO are solo procedures (dont need assistants) and have a very high skill floor.

More over, most IR departments realized training our replacement is a big mistake and no longer train mid levels or other specialists.

 

[anbuitachi]

Really? What are the newest advancements in IR? I'm just curious. Don't really come across many IR guys.

I mean i can't tell you the latest advances cause i dont follow IR. But anything thats not in the brain/CNS or heart for intervention cards/neuro, is pretty much done by IR here. So liver, kidneys, lungs, bleeds. They have a lot of volume.

 

[DrfluffyMD]

I mean i can't tell you the latest advances cause i dont follow IR. But anything thats not in the brain/CNS or heart for intervention cards/neuro, is pretty much done by IR here. So liver, kidneys, lungs, bleeds. They have a lot of volume.

Just a couple things off my head, Y90 segmentectomy and prostate artery embolization.

 

[deleted171991]

At the end of the day there are really only so many ways this can all go down. If midlevels reach the point were they have the exact same practice rights as physicians, then physicians will gradually move into the private sector and be reduced in number, and will basically be paid as experts by those who can afford it. Why would anyone who can afford insurance/have the money be seen/treated by a midlevel.

Because that's all the corporate bean counters will offer.To paraphrase, why would anyone who can afford a solo anesthesiologist pay for a CRNA?

 

[Nikj]

Resident here who have matched into a top 10 IR fellowship here.

Many bread and butter IR procedures can be taught to a mid level, but the practice of IR requires a lot of "thinking of your feet", and not in a way of put in x med if y happens, but geniune trouble shooting.

High end IR procedures like UAE, prostate embo, or tips/BRTO are solo procedures (dont need assistants) and have a very high skill floor.

More over, most IR departments realized training our replacement is a big mistake and no longer train mid levels or other specialists.

I'll be an osteopathic student, but I really hope I get a shot at IR, it's such an extremely fascinating and exciting field.

For Attending Anesthesiologists, other than CC and pain, are there any new avenues being pursued in anesthesiology that can or are making a niche for the field?

 

[DrfluffyMD]

I'll be an osteopathic student, but I really hope I get a shot at IR, it's such an extremely fascinating and exciting field.

For Attending Anesthesiologists, other than CC and pain, are there any new avenues being pursued in anesthesiology that can or are making a niche for the field?

In the last match, it seems like 95 or so DO plus FMG and IMG (non US grad) applied and 10 DOs matched to IR out of a total of 125 spots or so. So it isn't bad.

 

[bashwell]

I'll be an osteopathic student, but I really hope I get a shot at IR, it's such an extremely fascinating and exciting field.

For Attending Anesthesiologists, other than CC and pain, are there any new avenues being pursued in anesthesiology that can or are making a niche for the field?

I'm not an attending anesthesiologist in the US, but Richard Novak at Stanford is, and he predicts 10 trends for the future of anesthesiology (2016):

1. Lower income (as adjusted for inflation). There will be multiple causes for this: a) An aging population, with the significantly lower pay for attending to Medicare patients, b) Obamacare and other governmental payment cuts, c) Bundled insurance payments to hospitals, requiring anesthesiologists to negotiate for every nickel of that payment due to them, and d) Corporate anesthesia (see #9 below).
2. More care team anesthesia and more Certified Nurse Anesthetists (CRNAs). Hospital systems will have increased incentives to perform anesthetics with cheaper labor. Rather than physician anesthesiologists personally performing anesthesia, expect to see CRNAs supervised by physician anesthesiologists in an anesthesia care team, or in some states, CRNAs working alone.
3. There will be a paucity of new drugs to change the practice of operating room anesthesia. A few years ago I had a conversation with Don Stanski, MD, PhD, former Chairman of Anesthesiology at Stanford and now a leading pharmaceutical company executive, regarding new anesthetic drugs in the pipeline. Dr. Stanski’s reply was something along the line of, “There are almost no new anesthetic drugs in development. The ones we currently have work very well, and the research and development cost in bring an additional idea to market is high. Don’t expect much change in the coming years.” Consider sugammadex, a new drug for the reversal of neuromuscular blockade, recently approved by the Food and Drug Administration. The drug is more effective in reversing a rocuronium or vecuronium block than is neostigmine, but the cost is high. The acquisition cost of the smallest available vial of sugammadex is over $90, far exceeding the cost of neostigmine. In certain instances, faster reversal by sugammadex will be critically important, but for routine cases the cost is prohibitive. This trend of fewer new anesthesia drugs isn’t only a futuristic phenomenon. In my current private practice, I see my colleagues using the same medications that they used 25 years ago: propofol, sevoflurane, rocuronium, fentanyl, and ondansetron.
4. An aging population, an increased volume of surgery, and an increased demand for anesthesia personnel. As the baby boomers age, there will be an increased number of surgeries on older, sicker patients. Anesthesia personnel will be in great demand.
5. Anesthesiology will become more and more a shift-work job. A generation ago an anesthesiologist started a case and finished that case. An on-call anesthesiologist came to work at 7 a.m., took 24-hour call, and finished their last case as the sun came up the next morning. Certain instances of this model may persist, but as more anesthesiologist become corporate employees, expect more anesthesia practitioners working 8-hour or 12-hour shifts, just like employees in other jobs.
6. Increased interest in the specialty of anesthesiology amongst medical students. Although several items on my list may seem discouraging, take heart, because the career of anesthesiology will remain extremely popular. Why? Because the other fields of medicine have problems, too. Bigger problems. Many future doctors will shun the primary care fields of family practice, internal medicine, and pediatrics. The primary care fields offer long days in clinics, dealing with a new patient every 10 – 15 minutes, and they suffer from low pay. Because of the higher reimbursement in procedural specialties, careers in surgery, anesthesia, cardiology, and invasive radiology will always be popular.
7. Expect improved safety statistics regarding anesthesia mortality and morbidity. Anesthesia has never been safer. See “How Safe is Anesthesia in the 21st Century?” Expect further improvements in monitors, protocols, education, and the analysis of Big Data that will make anesthesia safer than ever.
8. There will still be a non-zero incidence of anesthesia-related fatalities. There will still be disasters, particularly airway disasters. Some anesthesia clinical situations will always remain extremely difficult and challenging, and human error will not be eradicated.
9. Large national corporations will continue buying up private anesthesia practices, perhaps eliminating the current model in which groups cover one hospital or one city alone. In the last three months, Sheridan, the physician services division of AmSurg, Corp has purchased the 60-physician, 140-anesthetist Northside Anesthesiology Consultants in Atlanta, and the 240-physician Valley Anesthesiologists & Pain Consultants in Phoenix. In these purchases, senior board members and partners receive seven-digit checks to sell their practice, then all physicians in the practice’s future labor for a discounted wage, perhaps as low as 50% of the prior income. If this trend becomes widespread, this subset of the anesthesia workforce will become low paid practitioners, while the purchasing corporations will make significant profits for their stockholders.
10. Continued fascination with anesthesia practice, a discipline which makes all surgical treatments and cures feasible. Without anesthesia, there can be no major surgical procedures. Medical care without major surgical procedures is unthinkable. Whether as anesthesia providers, as patients requiring surgery, or just as observers of the process, we will all continue to value and marvel at the field of anesthesia.

 

[Carbocation1]

Are the 1 million dollar salary international pain gigs on gaswork legit? I heard regional was more competitive than pain this yr... how can that be with pain salaries this high available with a cush life?

 

[Brahnold Bloodaxe]

I'm not an attending anesthesiologist in the US, but Richard Novak at Stanford is, and he predicts 10 trends for the future of anesthesiology (2016):

1. More care team anesthesia and more Certified Nurse Anesthetists (CRNAs). Hospital systems will have increased incentives to perform anesthetics with cheaper labor. Rather than physician anesthesiologists personally performing anesthesia, expect to see CRNAs supervised by physician anesthesiologists in an anesthesia care team, or in some states, CRNAs working alone.
2. An aging population, an increased volume of surgery, and an increased demand for anesthesia personnel. As the baby boomers age, there will be an increased number of surgeries on older, sicker patients. Anesthesia personnel will be in great demand.

How is this growth in the number of surgeries that will feed the massive hordes of graduating CRNAs going to materialize when the supply of surgeons is not showing any signs of increasing?

 

[deleted126335]

How is this growth in the number of surgeries that will feed the massive hordes of graduating CRNAs going to materialize when the supply of surgeons is not showing any signs of increasing?

most surgeons can operate more. Delegate some of the preop evaluation and preparation and post op management of the surgical patient to midlevels. .

 

[AdmiralChz]

Are the 1 million dollar salary international pain gigs on gaswork legit? I heard regional was more competitive than pain this yr... how can that be with pain salaries this high available with a cush life?

Pain is much, MUCH more competitive than regional. It's a very different skill set. For our program (so n=1 so take it with a grain of salt), we got something like 20-30 applicants for 4 regional spots, compared to 200-300 for 4 chronic pain spots (about 2/3-3/4 were anesthesiology graduates).

 

[pgg]

Pain is much, MUCH more competitive than regional. It's a very different skill set. For our program (so n=1 so take it with a grain of salt), we got something like 20-30 applicants for 4 regional spots, compared to 200-300 for 4 chronic pain spots (about 2/3-3/4 were anesthesiology graduates).

I don't know if those numbers really mean anything WRT competitiveness.

Everyone who applies, does so to multiple locations. Pain is far more popular than regional and there are far more pain positions nationwide. Until recently regional wasn't even ACGME accredited. Apples and oranges.

A few years ago when anesthesia was transiently more competitive, programs got many more applicants ... but that was just a reflection of the same number of people applying to more programs.

Per charting outcomes, the match rate for pain is around 75-80% and has been for at least the last few years, with more programs unfilled and more spots unfilled in 2017 than in previous years. That's a much different picture than "200-300 applicants for 4 spots" ...

That said, it seems anybody who wants a regional spot gets one, so my quibbling aside, your point stands that pain is more competitive than regional.

 

[AdmiralChz]

Per charting outcomes, the match rate for pain is around 75-80% and has been for at least the last few years, with more programs unfilled and more spots unfilled in 2017 than in previous years. That's a much different picture than "200-300 applicants for 4 spots" ...

That said, it seems anybody who wants a regional spot gets one, so my quibbling aside, your point stands that pain is more competitive than regional.

Yeah, who knows? Like I said, N=1. Number of applicants is the only objective way I really know how to compare "competitiveness." I can't speak to the quality of those 200ish applicants, I am sure some are better than others.

 

[Twiggidy]

How is this growth in the number of surgeries that will feed the massive hordes of graduating CRNAs going to materialize when the supply of surgeons is not showing any signs of increasing?

surgeons love to operate. that's why they're surgeons. anesthesiologists love time off. thats why we're anesthesiologists

 

[JPSmyth]

It seems that on gaswork there are a lot of jobs in many states that pay 300k+ with 10 weeks vacation, reasonable hours and minimal call.

When people talk about the field paying worse in the future, do you envision a world where attendings make less than 280k for a full time position?

 

[Consigliere]

It seems that on gaswork there are a lot of jobs in many states that pay 300k+ with 10 weeks vacation, reasonable hours and minimal call.

When people talk about the field paying worse in the future, do you envision a world where attendings make less than 280k for a full time position?

Definitely. And careful inspection of those ads reveals the vast majority of them to suck the big one. Please realize too that there may be multiple ads for a single position. People think "wow! 1100 jobs! Anesthesia is still going strong." Then you look closer and that job in Bumbleville is being posted by 6 agencies.

 

[JPSmyth]

Definitely. And careful inspection of those ads reveals the vast majority of them to suck the big one. Please realize too that there may be multiple ads for a single position. People think "wow! 1100 jobs! Anesthesia is still going strong." Then you look closer and that job in Bumbleville is being posted by 6 agencies.

I wasn't looking at the sheer number of jobs. I just browsed through states and areas that I could potentially see myself living in. But still, unless the ASA does something to turn the field of anesthesia around within the next ten years I'll pass on it

 

[TeslaCoil]

These questions are ridiculous. Anesthesia isnt going anywhere. Anesthesiologists arent just gonna start getting laid off. For one we're the most valuable specialty in the hospital if you go by objective measures. There are many things that MD's do that CRNA's cant (no offense to them). Economically speaking the supply has not met demand in the field, ever. If you need proof of that just go to gaswork.com and see for yourself. Plenty of jobs out there. Sure the days of 600-700k/year are gone. But starting out at 250-300 immediately out of residency is not bad. When put in context of doctoring, as compared to other specialties like surgery and IM, anesthesia is friggin awesome in just about ALL aspects. People have been dooming and glooming about anesthesia practice for decades.


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