My mind was fully set to anesthesia before I read this forum..

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jwk said:
You're absolutely right - And I've been hearing it since 1979 (geez, I'm old). :D

If you haven't already been in practice 12-15 years, you've barely seen one cycle of ups and downs in the anesthesia world. I've seen three, affecting both docs and anesthetists at different times. The sky has been falling for someone, somewhere, for every year I've been in this profession since 1979. The only thing you can count on is "things change".
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DAMN...1979!!! I guess you've seen a lot of changes since then. I bet the practice of anesthesia was a lot scarier in the 1970s?
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buccsmf1 said:
So many attendings ripping on the field, if not anesthesia, what else? Per recent match stats, the average anesthesia match had a 226 step 1. This makes the field a barely above average match. So if the students are barely above average, what the hell else do you suppose they do?

FM, IM? If you don't do a fellowship you're stuck doing outpatient or hospitalist. What an absolute nightmare. INR, HTN, lipids and A1C over and over and over and over and over agin till you die

Psych? Peds? OB/GYN? Which of these is going to make substantially more money than anesthesia 15-20 years from now? Which one is so much more interesting on a day to day basis?

Many specialties (plastics, derm, rad onc, optho...) arent possible for most anesthesia applicants.

EM and rads are a couple specialties that are fairly similar in terms of working style and scores needed. But I personally hated EM, I just felt like a glorified triage nurse. And if you ask a radiologist (my dad for example), they'll give you the same spiel about, "terrible job market, jobs are going to be outsourced, this profession won't exist in 30 years."

I'm not claiming to know more than any attending on this planet. But I'm curious to what you suggest we should do?
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Great post. My best friend is a radiologist making big bucks. We talk all the time. I would not recommend his specialty (diagnostic rads) because they can't even find jobs without a fellowship theses days. Interventional radiology is a different story.

As you point out choices are limited with a Step 230 and below score. I realize that fact. So, based upon the reality of the vast majority of Anesthesiology Applicants this specialty makes sense. For example, I hate ER and would not pick that for myself. But, I wouldn't mind becoming an EP specialist or interventional Cardiologist (despite the work hours).

So, again pick the specialty you like best that you can realistically match into.
 
jwk said:
You're absolutely right - And I've been hearing it since 1979 (geez, I'm old). :D

If you haven't already been in practice 12-15 years, you've barely seen one cycle of ups and downs in the anesthesia world. I've seen three, affecting both docs and anesthetists at different times. The sky has been falling for someone, somewhere, for every year I've been in this profession since 1979. The only thing you can count on is "things change".
Click to expand...

JWK, with all due respect things have changed significantly this time. Obamacare is now the law and Medicare is going broke. Anesthesia reimbursements are likely to decrease significantly from CMS over the coming years. In fact, CMS payments are terrible compared to just 15 years ago when cost of living is taken into account.

There won't be any up cycle in this field ever again. There will be small pockets which are able to do well by avoiding Medicare/Medicaid patients and catering to private insurance. That unfortunately won't be available for most of us.

Jet has just such a practice. This is the top 1 percent of all practices in the USA. The reality is that most new graduates won't be getting top 1 percent jobs but rather 25th percentile AMC or hospital employed jobs. And since income will be declining under Obamacare the glory days won't ever be coming back.

There will be jobs for the upcoming PGY-1 class but they will likely pay less money, involve more call and more hours than the jobs of today. On top of that AMCs are trying to bring about the collaborative practice model with CRNAs (and it is becoming more common).
 
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BLADEMDA said:
JWK, with all due respect things have changed significantly this time. Obamacare is now the law and Medicare is going broke. Anesthesia reimbursements are likely to decrease significantly from CMS over the coming years. In fact, CMS payments are terrible compared to just 15 years ago when cost of living is taken into account.

There won't be any up cycle in this field ever again. There will be small pockets which are able to do well by avoiding Medicare/Medicaid patients and catering to private insurance. That unfortunately won't be available for most of us.

Jet has just such a practice. This is the top 1 percent of all practices in the USA. The reality is that most new graduates won't be getting top 1 percent jobs but rather 25th percentile AMC or hospital employed jobs. And since income will be declining under Obamacare the glory days won't ever be coming back.

There will be jobs for the upcoming PGY-1 class but they will likely pay less money, involve more call and more hours than the jobs of today. On top of that AMCs are trying to bring about the collaborative practice model with CRNAs (and it is becoming more common).
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BLADE,

I respect you.

I really do.

I ALSO believe alotta your posts are

MELODRAMATIC.

Picture yourself talking to my girlfriend's brother who is a teacher by craft. Actually he's the Athletic Director at the school so bring the conversation up a notch. He works....

NO DUDE...SERIOUSLY...LISTEN TO ME... THIS DUDE

WORKS.

INCESSANTLY.

He coaches certain teams. Teams he doesn't coach, he's probably driving the School Bus that transports the School Athletes to their Out Of Town Destination.

SO ESSENTIALLY HE IS A TEACHER. AND ON HIS "OFF" TIME HE'S THE "ATHLETIC COORDINATOR." DRIVING GIRLS AROUND, SINCE HE TEACHES AT AN ALL-GIRLS-SCHOOL, IN A SCHOOL BUS TO THEIR NEXT COMPETITIVE DESTINATION.

Volleyball. Basketball. Softball.

WHATEVER THE SPORT, THIS DUDE IS

THERE

staying late, driving a school bus with them in the back,

WHATEVER.

I LOOK AT MY GIRLFRIEND'S BROTHER'S M.O.

didga follow that? Need a pen and paper?

THE TEACHER.

THE ATHLETIC DIRECTOR, WORKING 70 HOURS A WEEK AND DRIVING SCHOOL BUSES AND S H I T....

And here we are as anesthesiologists,

BALKING at making

THREE HUNDRED LARGE.

(which WE, me included, consider to be a PAULTRY SALARY.)

And my future Brother In Law The Teacher is sacrificing himself and being with his family so he can be

The Compliant Catholic School Teacher

COMPENSATION?

We've never talked about it.

I'll put it on the high end as an educator:

70 LARGE.

I think my number is in reality TOO BIG.

I don't think he makes that. Probably FIFTY RANGE.

WHICH SHOULD MAKE YOU ASK YOURSELF, AS WE TALK ABOUT 300 LARGE BEING A PAUPER'S SALARY IN OUR BIZ....

I'm as guilty as YOU.

DOESN'T CHANGE, HOWEVER, RECEIVING WHAT THE MARKET GIVES YOU.

Right now if SOMEONE wants to hire an anesthesiologist, regardless of where they trained or what their background is, you're looking at

THREE HUNDRED LARGE.

MINIMUM.

THAT'S THE GAME CURRENT DAY, MAN.

I'm in the game.

This is what I do for a living.

I'm not feeling the

TOTAL NEGATIVE VIBE

sent by other posters.

Do we as anesthesiologists Need Some Concern?

YES.

Is The Sky Falling referring to Other Posters?

NO.

The sky is not falling on our specialty.

We are experiencing changes...like most specialties.

I can post that

I'M STILL HERE MAN. AND...NOW....I'M THE MAN....I'VE GOT MY OWN GROUP...I WRITE THE PAYCHECKS....

And it's still all good man.

CHALLENGES?

Absolutely.

I'm still waking up a few minutes before my alarm goes off at that ridiculously early time.

There's only ONE RESPONSE to what I just said, and only a few of you will understand my response, but that's OK:

WORD.
 
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I keep on saying this, but I'll say it again:

There are GREAT jobs out there. Still... ripe... for the taking!

(Maybe not in Florida where some of our sdn colleagues practice... but we are a big country with big opportunities IF you are willing to look for it and be reasonable with expectations).

300 large is a minimum.
Move to BFE and you can double that and then some.

If you are worried, move to BFE for 5 years. Then move to your preferred location and get on the gravy train thereafter sipping Cognac and Martini's by the pool.

This plan works (@ least in the current environment).

Trust me.
 
Silent Cool said:
Consig,

you are a perennial downer re: anesthesia. could you tell us why? how many years have you been out? what would you have done instead?

thanx
:cool:
Click to expand...

I am a perennial downer because I have seen a speciality that I love (and still do) go down the toilet. Huge gains made by CRNAs toward independent practice, AMCs absorbing every group on the planet, competition with CRNAs for jobs, an EXTREMELY TIGHT job market....basically, you will be working harder for less pay. I have been "out" 13 years and have seen the unfortunate decline in this speciality. I wouldn't and couldn't do anything else once I started down the road to become a physician since I had accrued such a huge debt. Realize that people like myself and jetproppilot represent both ends of the happiness spectrum in anesthesiology.

Go ahead and spend the time and effort becoming an anesthesiologist; just don't complain when you are working for $135k a year IF you can find a job.
 
sevoflurane said:
I keep on saying this, but I'll say it again:

There are GREAT jobs out there. Still... ripe... for the taking!

(Maybe not in Florida where some of our sdn colleagues practice... but we are a big country with big opportunities IF you are willing to look for it and be reasonable with expectations).

300 large is a minimum.
Move to BFE and you can double that and then some.

If you are worried, move to BFE for 5 years. Then move to your preferred location and get on the gravy train thereafter sipping Cognac and Martini's by the pool.

This plan works (@ least in the current environment).


Trust me.
Click to expand...

You are right, there are still jobs... much less jobs but they are still out there for now.
But, We are producing thousands of residents, people are not retiring, Medicare is killing us, We are being taken over by hospitals and AMC's (both in the city and in BFE), and CRNA's are abundant and becoming more independent especially in BFE!
We are not talking about what's out there today we are talking about what will be out there in 4-5 years when a med student finishes his/her residency.
It's not an invitation to abandon the specialty but it is just a call for being informed.
Optimism is good, but too much optimism is destructive.
 
The job market can turn on a dime. Radiology jobs were plentiful until 2009 and then literally overnight they dried up. So just because there seems to be lots of gas jobs right now, it could easily change in 2-3 years. You have to look at the underlying structural changes to get an idea of where things are heading and it doesn't look good.
 
jetproppilot said:
BLADE,



I'll put it on the high end as an educator:

70 LARGE.

I think my number is in reality TOO BIG.

I don't think he makes that. Probably FIFTY RANGE.

That's fine. That's what someone who went to college for 4 years SHOULD make. I did that plus 8 additional years of training. I'm not even going to factor in the stress of the job, sacrifices, etc. Bottom line - we DESERVE what we make.
Click to expand...
 
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Planktonmd said:
It's really funny when people try to convince themselves that the world fits their personal uneducated choices.
Click to expand...

It seems that your main prerogative is to crush any smidgen of optimism and have everyone join your pity party. You have clearly stated your belief that this field as a whole is doomed. You may be right or you may be wrong but there's no need for continuous underhanded remarks against those who don't share your particular view.
 
AnesThrow said:
It seems that your main prerogative is to crush any smidgen of optimism and have everyone join your pity party. You have clearly stated your belief that this field as a whole is doomed. You may be right or you may be wrong but there's no need for continuous underhanded remarks against those who don't share your particular view.
Click to expand...

:)
I am sorry... I really have no interest in this whole argument.
I am just a private practice anesthesiologist who has been in practice for 15 years.
You seem to know and see things more clearly than I do so good for you
 
jetproppilot said:
BLADE,

I respect you.

I really do.

I ALSO believe alotta your posts are

MELODRAMATIC.
Click to expand...

fe_white.jpg

Couldn't resist this little nugget of irony.
 
Planktonmd said:
:)
I am sorry... I really have no interest in this whole argument.
I am just a private practice anesthesiologist who has been in practice for 15 years.
You seem to know and see things more clearly than I do so good for you
Click to expand...

I know that you have a lot more experience in this field than I do and your opinion is valued but those credentials don't make you the oracle. There are other people whom I know personally that have been in this field for as long or longer than you have who don't share your views. There are people posting in this thread who have double your experience (jwk stated he's been practicing since 1979) who also don't share your views. But I guess they are all just "uneducated" and "convincing themselves".
 
AnesThrow said:
I know that you have a lot more experience in this field than I do and your opinion is valued but those credentials don't make you the oracle. There are other people whom I know personally that have been in this field for as long or longer than you have who don't share your views. There are people posting in this thread who have double your experience (jwk stated he's been practicing since 1979) who also don't share your views. But I guess they are all just "uneducated" and "convincing themselves".
Click to expand...

My friend... I never said you are obligated to listen to me...
If you feel that you need to do something because it's best for you then PLEASE just do it!
 
AnesThrow said:
I know that you have a lot more experience in this field than I do and your opinion is valued but those credentials don't make you the oracle. There are other people whom I know personally that have been in this field for as long or longer than you have who don't share your views. There are people posting in this thread who have double your experience (jwk stated he's been practicing since 1979) who also don't share your views. But I guess they are all just "uneducated" and "convincing themselves".
Click to expand...

For clarification, jwk has stated many times that he is an AA. The future may affect him differently than an anesthesiologist.
 
Gern Blansten said:
For clarification, jwk has stated many times that he is an AA. The future may affect him differently than an anesthesiologist.
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Oh OK, I didn't know that, not that it really discredits my point as he's not the only one with a positive outlook.
 
Gern Blansten said:
For clarification, jwk has stated many times that he is an AA. The future may affect him differently than an anesthesiologist.
Click to expand...

Everyone should understand that when I post something on this forum it is simply my personal opinion and it could be wrong.
I am a private practice anesthesiologist... i am not in academia and I don't deal with the artificial optimism the ASA has been injecting in the minds of youngsters.
 
Planktonmd said:
Everyone should understand that when I post something on this forum it is simply my personal opinion and it could be wrong.
I am a private practice anesthesiologist... i am not in academia and I don't deal with the artificial optimism the ASA has been injecting in the minds of youngsters.
Click to expand...

Sharing an opinion does not have to involve insulting those who don't share your opinion, but I digress.
 
Planktonmd said:
I Insulted you???
If i did I apologize but seriously....
Click to expand...

"It's really funny when people try to convince themselves that the world fits their personal uneducated choices. "

You didn't insult me in particular as I don't think that particular comment was directed at me but I failed to see how it contributed to this thread as anything other than a degradation of someone else.
 
AnesThrow said:
Sharing an opinion does not have to involve insulting those who don't share your opinion, but I digress.
Click to expand...

Hopefully anesthesia will be a good medical specialty for decades to come. I think that in even the best case scenario it will not be nearly as good as it was. Every change taking place at this time makes things worse. That doesn't mean it won't be a fine career, but it very well might not be. Whether it's a risk you are willing to take, only you can decide, of course. Just keep in mind that the risk of this field going to **** is real, and not all that unlikely.
 
GypsySongman said:
Hopefully anesthesia will be a good medical specialty for decades to come. I think that in even the best case scenario it will not be nearly as good as it was. Every change taking place at this time makes things worse. That doesn't mean it won't be a fine career, but it very well might not be. Whether it's a risk you are willing to take, only you can decide, of course. Just keep in mind that the risk of this field going to **** is real, and not all that unlikely.
Click to expand...

The risk of all of medicine going to ***** is real, and not all that unlikely.
 
AnesThrow said:
"It's really funny when people try to convince themselves that the world fits their personal uneducated choices. "

You didn't insult me in particular as I don't think that particular comment was directed at me but I failed to see how it contributed to this thread as anything other than a degradation of someone else.
Click to expand...

:D
Good luck my friend
 
GypsySongman said:
Hopefully anesthesia will be a good medical specialty for decades to come. I think that in even the best case scenario it will not be nearly as good as it was. Every change taking place at this time makes things worse. That doesn't mean it won't be a fine career, but it very well might not be. Whether it's a risk you are willing to take, only you can decide, of course. Just keep in mind that the risk of this field going to **** is real, and not all that unlikely.
Click to expand...

I don't live in a bubble or stick my fingers in my ears when I hear something that I don't like. I understand that all of these risks are real and that PlanktonMD could be 100% correct in his views. I only take issue when people find it necessary to beat a dead horse to the extent of quasi-sadism.

For a real world analogy, I know of a Caribbean IMG who told me that he is going to be applying for Dermatology. Should I be giving him a PRN reminder that his chances of matching are probably less than 1% every time he brings that topic up?
 
AnesThrow said:
Should I be giving him a PRN reminder that his chances of matching are probably less than 1% every time he brings that topic up?
Click to expand...

I understand the point you are making, but this is a bad analogy. Somebody should absolutely tell this person. It could save their future.
 
Gern Blansten said:
I understand the point you are making, but this is a bad analogy. Somebody should absolutely tell this person. It could save their future.
Click to expand...

He's applying with FP as a backup (trying to go the "derm" route that way if a derm residency doesn't work out).
 
Planktonmd said:
So.. you future plan is being a *****?? :naughty:
Click to expand...

A fate well-accepted upon signing the medical school contract years ago.

To be honest, I prefer the term 'Sexual healer'. It's got sort of a clinical ring to it and I believe I am certified since I've had an OB-GYN rotation in the past.
 
AnesThrow said:
A fate well-accepted upon signing the medical school contract years ago.

To be honest, I prefer the term 'Sexual healer'. It's got sort of a clinical ring to it and I believe I am certified since I've had an OB-GYN rotation in the past.
Click to expand...

Hey... nothing wrong with this approach...
when you finish your residency call me I might have a job for you :p
 
Stellar Clouds said:
I dunno...anesthesia might not exist when he finishes his residency
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I believe he was going to hire me for my unique ability to lull women to deep sleep with just a hint of my sexual prowess, an attribute I greatly elucidated on in my personal statement. I am an asset, stellar clouds, an asset. Propofol shortage, what propofol shortage?
 
Stellar Clouds said:
I dunno...anesthesia might not exist when he finishes his residency
Click to expand...

Anesthesia will exist. And you all will likely find jobs. But, will they be good jobs? Again, you get determine what the definition of good means.

Jet and Sevo are making boat loads of money right now. Top 1 percent income. This doesn't reflect on the average new grad getting an AMC job.

Longer term out (5-7 years) anesthesia could be facing the perfect storm. I hope it doesn't happen but it seems quite possible if not probable.

1. Major cut in reimbursement by Medicare/Medicaid
2. More Collaborative practice or independent practice by CRNAs
3. Fewer jobs available due to cheap and abundant midevel labor
4. More AMCs and hospitals downsizing Anesthesiologists and using cheaper CRNA labor
5. More Medicaid patients
6. Fewer jobs due to Anesthesiologists working longer and increased supply
7. More practices selling out to AMCs
8. Hospitals cutting subsidies (take it or leave it attitude by CEO)
9. The doctor CRNA (CRNA DNAP) circa 2015
10. More Surgicenters using solo CRNAs and more opt out states
 
AnesThrow said:
I believe he was going to hire me for my unique ability to lull women to deep sleep with just a hint of my sexual prowess, an attribute I greatly elucidated on in my personal statement. I am an asset, stellar clouds, an asset. Propofol shortage, what propofol shortage?
Click to expand...

I will have to say that talking about your sexual prowess in your personal statement is truly unique! Please tell them you will demonstrate when they inquire about that on interviews next year :laugh:
 
Stellar Clouds said:
I will have to say that talking about your sexual prowess in your personal statement is truly unique! Please tell them you will demonstrate when they inquire about that on interviews next year :laugh:
Click to expand...

Next year?! I already matched :p And as it turns out, my PD is male. Unfortunately, all the female PDs fell asleep during my interviews.
 
BLADEMDA said:
Anesthesia will exist. And you all will likely find jobs. But, will they be good jobs? Again, you get determine what the definition of good means.

Jet and Sevo are making boat loads of money right now. Top 1 percent income. This doesn't reflect on the average new grad getting an AMC job.

Longer term out (5-7 years) anesthesia could be facing the perfect storm. I hope it doesn't happen but it seems quite possible if not probable.

1. Major cut in reimbursement by Medicare/Medicaid
2. More Collaborative practice or independent practice by CRNAs
3. Fewer jobs available due to cheap and abundant midevel labor
4. More AMCs and hospitals downsizing Anesthesiologists and using cheaper CRNA labor
5. More Medicaid patients
6. Fewer jobs due to Anesthesiologists working longer and increased supply
7. More practices selling out to AMCs
8. Hospitals cutting subsidies (take it or leave it attitude by CEO)
9. The doctor CRNA (CRNA DNAP) circa 2015
10. More Surgicenters using solo CRNAs and more opt out states
Click to expand...

I have no doubt that anesthesia will exist when I finish residency (and certainly well beyond). It does concern me that so many groups are selling out, but I hope to be protected in the world of academia (NOT the reason why I want to stay in academics). I didn't pick anesthesia to make a million a year. I could have gone into any specialty, but instead I picked anesthesia because I love it. There has been no time in medical school that I was genuinely excited to go to the hospital on a daily basis, except when I was on my anesthesia rotations. Hell, just like jet, I'd wake up before my alarm went off. I know I've picked the right specialty, and no amount of doom and gloom on SDN will ever change that for me.
 
AnesThrow said:
Next year?! I already matched :p And as it turns out, my PD is male. Unfortunately, all the female PDs fell asleep during my interviews.
Click to expand...

My mistake, I thought I read in one of your posts that you were only about to start fourth year.

Edit: I took one of your quotes out of context!
 
Stellar Clouds said:
I have no doubt that anesthesia will exist when I finish residency (and certainly well beyond). It does concern me that so many groups are selling out, but I hope to be protected in the world of academia (NOT the reason why I want to stay in academics). I didn't pick anesthesia to make a million a year. I could have gone into any specialty, but instead I picked anesthesia because I love it. There has been no time in medical school that I was genuinely excited to go to the hospital on a daily basis, except when I was on my anesthesia rotations. Hell, just like jet, I'd wake up before my alarm went off. I know I've picked the right specialty, and no amount of doom and gloom on SDN will ever change that for me.
Click to expand...

Just be aware that a big storm may be up ahead even if the sky looks clear right now.
A Fellowship will provide additional protection against damage but you will still get wet.

It's good that you like your chosen field now. I just hope you still like it after the perfect storm has hit.
 
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