MS4: Is anesthesia for me?

[HAL9001]

Hello everyone,

I know there's been previous similar threads but considering recent changes in anesthesia, I was hoping for some more 'recent' advice. Apologies for this being long:

I am an MS4 who's been involved with the anesthesia dept. since a wee lad. I ran the interest group, done research, know many of the attendings personally, and just generally made a good name for myself in the department… and they have already told me they will save me residency spot next year should I choose to stay at my current institution (which is public but a solid training program with a good reputation) - so the stress of matching is off my shoulders. I was always 100% confident that anesthesia was for me until now… I just completed my official rotation, and while I enjoyed it, have some reservations that I'm hoping someone can clear up for me.

a) I missed talking to patients and developing relationships. (Maybe pain is for me?) I really loved psych and FM bc I really got to know my patients and build relationships with them - I'm a people person. However, I know that primary care/psych is inundated with red tape, bureaucracy, and low pay which is why I avoided it. I know that a lot 'needle pain docs' are mostly procedural and barely touch opioids which def entices me to go that route.

b) I enjoy procedures and pharm/phys (standard response I know) but I seemed to get bored in the OR. from time to time… is this because I wasn't actually RUNNING the case, and instead watching as a spectator? My attendings let me intubate and put in lines which was enjoyable, but when things calmed down, as much as I tried to stay engaged and ask questions etc, it used to get to the point where I was like "great… now I just have to sit around until the case is over?" I tried to put myself in the resident's shoes but it felt like a factory line after a while. Is this how it becomes once you're an attending, or does being responsible for the patient's life and knowing that sh** can hit the fan any second prevent you from getting bored and having cases feel mundane? And maybe you're wondering if I didn't experience hard enough cases - I felt like I saw a decent amount of peds and hearts and a lot of basic stuff (ENT/lap choles etc). Not much regional though.

c) The elephant in the room… compensation. I know bringing it up grinds people's gears but what is a realistic salary in private practice nowadays, assuming you are working ~50-60 hours/week in a medium saturated city? Medscape claims the average for last year was ~$360. Is this accurate? Will compensation really drop THAT much from the current levels? I've heard absurd numbers of $450-500+ if you're willing to relocate to a smaller city. Is this true, or are there other strings attached? With a huge student loan and parents to support (I'm an immigrant whose parents moved here at a late age with no nest egg) along with the eventual wife/kids, I wish I could say money isn't an issue but it is and who doesn't want to be able to buy nice things once in a while?

Also, people say that pain isn't lucrative anymore - is this entirely true? Or just relative that they were making filthy $$$ before but now just less? Is pain still the most lucrative anesthesia subspecialty and what is a reasonable pain salary nowadays?

d) Will doing a fellowship really prevent me from having to compete with CRNA's down the line? Are CRNA's something I should really even be THAT concerned about should I choose to do general anesthesia? I really loved I.M. - it stimulated me - but it also doesn't pay very well unless I do a fellowship… But do I want to slave 80 hour work weeks in cards or scope butts all day in GI? Which leaves me to think critical care might be a good option for me. What is an average CC salary through anesthesia and is burn out something I should be worried about?

e) Are you happy? I initially was attracted to the field bc attendings just seemed happier than most other fields and less burned out. I was looking at the medscape stats and 5+ years ago, ~75% of anesthesiologists said they would choose anesthesia again if they could. Now in 2016, less than half would. Is the major issue reimbursement and CRNA's? Or are people in medicine, generally just less happier across the board?

I am sorry for sounding like a brat, if I did. However, these are my thoughts/concerns and I would be grateful for any advice on this matter.

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[deleted171991]

a) Yes, your middle name is Pain. On the other hand, if you stay in anesthesia, chatty OR/PACU people and patients will love you.

b) Anything done enough times will become routine after a while. So, even as an attending, you will have to actively fight boredom and maintain vigilance. You will have to find your own way to achieve that. One is to work with residents/CRNAs, so that you can go do something elseduring the boring parts.

c) I won't comment beyond don't count on anything above 360.

d) Depends on the fellowship and the skills you gain. Will a fellowship training prevent loss of job to an independent midlevel skilled in the same stuff? It depends on what you can do, that the employer needs and a CRNA couldn't. That's the ball to keep your eye on.

e) There is no way in hell anesthesiologists are as happy now as 5 years ago, and even less true for 5 years from now. One could argue it applies to the entire medical field. Maybe. The main issue is lack of ownership (of patients and practice); that's the root of most unhappiness in anesthesiology (and the reason we are abused), and it's not likely to go away. Loss of income, especially when compared to other specialties, is just the cherry.

P.S. You should have had the guts to post with your main user, especially if you want meaningful answers.

 

[HAL9001]

a) Yes, your middle name is Pain. On the other hand, if you stay in anesthesia, chatty OR/PACU people and patients will love you.

b) Anything done enough times will become routine after a while. So, even as an attending, you will have to actively fight boredom and maintain vigilance. You will have to find your own way to achieve that. One is to work with residents/CRNAs, so that you can go do something elseduring the boring parts.

c) I won't comment beyond don't count on anything above 360.

d) Depends on the fellowship and the skills you gain. Will a fellowship training prevent loss of job to an independent midlevel skilled in the same stuff? It depends on what you can do, that the employer needs and a CRNA couldn't. That's the ball to keep your eye on.

e) There is no way in hell anesthesiologists are as happy now as 5 years ago, and even less true for 5 years from now. One could argue it applies to the entire medical field. Maybe. The main issue is lack of ownership (of patients and practice); that's the root of most unhappiness in anesthesiology (and the reason we are abused), and it's not likely to go away. Loss of income, especially when compared to other specialties, is just the cherry.

P.S. You should have had the guts to post with your main user, especially if you want meaningful answers.

Thank you!!! And believe it or not, this is my first post. I trolled SDN for years all throughout pre-med and med school but never needed to post until now. Kinda funny right?