Need for anesthesiologists

[Offshore]

Hi Everyone, I've been off the forums for awhile. Busy with internship.

I just wanted to post a couple of things I've noticed this year concerning the need for anesthesiologists. I just finished 3 months of Surgery (Transitional year) and got to know many of the community surgeons, intensivists, and anesthesiologists. After these 3 months, I feel more secure then ever about anesthesiology's future. For example:

1. Just about every surgeon I've met (especially the CT, Vascular, and Neurosurgeons) expressed a strong desire to have an anesthesiologist present for their cases. Most of them had been burned to many times by working with CRNA's. Frankly, they said their patients were for the most part too sick for anyone but another physician to be taking care of them in the OR.

2. The rapidly expanding field of TEE is dramatically changing CT and vascular surgery. This is not just for valve surgery, since many unexpected intraoperative occurences are being detected by TEE. Examples of these are rare things such as ventricular thrombus formation to common things like volume depletion. I don't know any CRNAs who are adept echocardiographers.

3. The true skills of the anethesiologist really show through in the emergent cases, which many people not in the field forget entirely. In my minimal 3 months of general surgery, we took some really sick people to the OR. I'm talking about people who are in DIC, renal failure, septic and hypovolemic shock, with heaps of necrotic bowel and just a day or two out from major anterior wall MI's. The funny thing is, until you actually get into the field (surgery or anesthesia), you don't really notice how often these presentations actually are. Not to mention those with the above problems, plus being 5'0", 250 lbs, and major pulmonary hypertension. The hospitals know this and that's why they want anesthesiologists available 24 hrs a day. The major medical center/trauma center here just made it mandatory that all anesthesiologists with attending priviledges take in house call on a scheduled basis, or lose their priviledges. They already had in house CRNAs.

Anyway, I could go on for awhile but I'll stop now. I guess the impression I've been getting during internship, is that the future of anesthesia is very bright, as long as you don't mind taking care of sick people and working hard.

Bye the way, internship is a blast so far.

---

Members don't see this ad.

 

[ApacheIndian]

I've applied to both Rads and Anesthesia... been leaning heavily towards Rads until just recently... now I'm thinking more and more about Anesthesia... your post is further influencing me. A few questions for you...

1) What do you think about the increasing # of CRNAs and the impact, if any, this will have on the demand/salary/lifestyle of Anesthesiologists in the future?

2) In your opinion, what are the money making potentials and lifestyles of the various Anesthesia fellowships... pain, cardio, etc.?

3) What do you think about the old adage of Anesthesiologists playing "second fiddle" to Surgeons? Is this the impression you get in the OR? I guess what I'm really asking about here is the "prestige" factor.

Thanks in advance for your valuable insight...

 

[Offshore]

Oh Hi Dr. Cuts,

This is just my opinion and it's definitely biased since I'm in anesthesiology...

1. I'm not that worried about CRNAs. I'm sure some will call me stupid or ignorant, but my experience is that they are just not as valuable to the hospital, surgeon, surgicenter, patient, etc... as an anesthesiologist. I'm sure there are lots of reasons for this, but to oversimplify it just looks really bad if a hospital doesn't have anesthesiologists. Most people who will tell you otherwise aren't in surgery or anesthesia (unless they're CRNAs) and don't know about all they crazy things that happen to sick patients who need surgery. As medical care gets increasingly complex, the need for anesthesiologists will only continue to increase.

2. From my experience, aneshtesiologists make a good living. It's definitely a field in where the potential to make a lot of money is there. You just have to be willing to work very hard. The more cases you do, the more money you make. That being said, in my community, there is such a shortage of anesthesiologists, you can literally be as busy as you want to be.

3. Finally, I just want to say that I've never understood why so many people seem to having a hard time choosing between anesthesiology and radiology. They just seem like such totally opposite fields. Anesthesiology is a patient-care oriented specialty. There are few other fields in medicine where you are so intimately involved with the care of the patient (sick patients!). This aspect is what I like about anesthesiology so much. I enjoy caring for people, especially in their greatest time of need, when they are undergoing surgery or are critically ill. One of the cardiac anesthesiologists (also UCSF tranined) at my hospital pointed out that by the time you're finished with your residency, you're practically a PhD in cardiac and and pulmonary physiology. I guess I would just like to point out to those who are thinking radiology vs. anesthesiology, that I don't see many things in common. Rarely in radiology will you be entrusted with the sole responsibilty of caring for a patient who is critically ill and on the verge of multiple organ system collapse. In anesthesiology this situation will be a relatively common occurence. Radiology on the other hand is a much more anatomically and pathologically oriented field. Your knowledge in the radiographic analysis of pathology and anatomy as a consultant is the mainstay of the specialty. Of coure, interventionalists perform many therapeutic procedures, but the overall patient's status and well-being is rarely their sole responsibility. In any case, in either specialty your services will be highly desired. I've had no negative experience with surgeons at my hospitals. If anything they are exceedingly polite. Its had enough for them to get an anesthesiologist to cover their cases.

E-mail me if you're intrested in talking about these topics more.

 

[ApacheIndian]

Great info... thanks Offshore. I can appreciate what you're saying about how Anesthesia and Rads differ, but don't you think that they share many attributes too? I honestly feel that I'd be equally happy (and equally adept at) practicing either of these two specialties. A few more questions if you don't mind...

1) I keep hearing about "Cardiac Anesthesia," but to the best of my knowledge, the only two fellowships available for Anesthesia are Pain and Critical Care right?

2) You seem well informed about Radiology. I've gotten info comparing Rads with Anesthesia before, but it was from a Radilology board. How would you compare the two in regard to lifestyle, average pay, money-making potential, call, and political pull (in hospital)?

3) What about job satisfaction? If we were to ask 100 random Anesthesiologists who've been in practice for 10 years... "Are you happy with having chosen Anesthesia?" and "Is there anything you'd have done differently?" what do you think they'd say?

4) What about your colleagues? Do you find that your fellow Anesthesiologists are cool people/personalities to work with? How would you characterize the "typical" personality type of an Anesthesiologist?

I thought I'd post here rather than e-mail so maybe others could benefit from your insight too. Thanks again...

 

[TulaneKid24]

There are many different fellowships available. You mentioned Pain Medicine and Critical Care medicine.

Other fellowships are Cardiovascular Anesthesiology, Neurosurg Anesthesiology, Pediatric, Obstetrics, and some places even have Transplant Anasthesiology.

There are probably some fellowships that I am missing here, but my main point is that Anasthesiology has many, subspecialities!

Good Luck

 

[gas-x]

Hey dr. cuts,

as i read your posts, i get the feeling that you really don't know which field you're interested. if you're applying to both rads and anesth, which have nothing in common, i think you need to re-evaluate your reasons for applying. as the previous post stated, they are pretty much on opposite spectrums. your posts tell me that you're mainly interested in respect and money; doesn't tell me if you're at all interested in the fields themselves.
make sure you figure it out since i'm assuming you've sent out tons of applications already. life will suck if you pick the wrong field based on those criteria. one field can bore you to death as you sit in a dark room talking through a microphone while reading films. the other one will scare the crap out of you when your patient's vitals bottom out in a matter of seconds.
good luck.

as you can tell, i'm biased towards anesthesia. it's way too cool and exciting. radiology is way too boring for me; and too competitive.

 

[beezar]

In anesthesia, there are only 2 boarded fellowships: pain and critical care.

All the other ones (cardiac, ob, peds, neuro, etc.) are fellowships, but they are not boarded.

 

[gasdoc]

Originally posted by Dr. Cuts
Great info... thanks Offshore. I can appreciate what you're saying about how Anesthesia and Rads differ, but don't you think that they share many attributes too? I honestly feel that I'd be equally happy (and equally adept at) practicing either of these two specialties. A few more questions if you don't mind...

1) I keep hearing about "Cardiac Anesthesia," but to the best of my knowledge, the only two fellowships available for Anesthesia are Pain and Critical Care right?

2) You seem well informed about Radiology. I've gotten info comparing Rads with Anesthesia before, but it was from a Radilology board. How would you compare the two in regard to lifestyle, average pay, money-making potential, call, and political pull (in hospital)?

3) What about job satisfaction? If we were to ask 100 random Anesthesiologists who've been in practice for 10 years... "Are you happy with having chosen Anesthesia?" and "Is there anything you'd have done differently?" what do you think they'd say?

4) What about your colleagues? Do you find that your fellow Anesthesiologists are cool people/personalities to work with? How would you characterize the "typical" personality type of an Anesthesiologist?

I thought I'd post here rather than e-mail so maybe others could benefit from your insight too. Thanks again...

Dear Cuts,

I am currently a CA-1 in the East Coast and would like to add a few comments about my thoughts in anesthesia. I don't want to hurt your feelings, but I agree w/ the others that you don't seem to be interested in anesthesia for the right reasons.

True that anesthesia, at its current time, is a great field to go into. Most doctors, even those outside of surgery and anesthesia, would agree. The current anesthesiologist enjoy great pay, great respect (even from surgeons), great demand (most hospitals are short on them; thus the high salaries), and most a very nice lifestyle (unless you want to make something over $300K).

That being said, I don't think anyone should go into this field for these reasons alone. You would be very unhappy otherwise. In my 4 months of anesthesia residency, I can tell you that the "pilot of a plane" analogy holds very true. I still go to work everyday being nervous, and my senior residents tell me that is perfectly normal for a first year resident. I can tell you that I was never nervous or stressed about patient care (i.e. doing the right thing) as a transitional intern last year. Anesthesia is definitely a more stressful specialty than many others. The reality is, a patient can die very fast under your hands...and for any moral person, that will be stressful, even if its not your fault.

Anesthesiology is 97% boredom and 3% shear terror. Perhaps when I become attg, it will be 99% and 1%. To earn the fringe benefits of high pay, respect, demand, etc, you have to work for it! Surgical patients are getting sicker and sicker and so their intraoperative courses become more and more complicated. I am only a CA1, so I usually get the "easier" cases, but even a simple hypertensive can be a nightmare under general anesthesia, which screws up the sympathetic response and other homeostatic mechanisms. It can be a challange to keep up or keep down the patient's blood pressure. Also, in anesthesia, bad things all happen at the same time. Just when the blood pressure starts nose diving, you will hear the O2 sat monitor beeping the wrong way....i.e. patient desating down to the 80s, etc. Usually, you are alone when bad things are happening. The surgeon and scrub tech is busy w/ their thing. The circulator is busy doing her thing. Your attg is outside having coffee or in another room inducing a patient. Also, beside these intraoperative stresses, there is the loneliness factor. As a resident, you are usually in the room by yourself all day. There is a hospitalful of employees, but you hardly ever get to see them. Also, anesthesiology residents do essentially everything themselves, moving the patient, drawing up drugs, administering drugs, etc. Many of the things that other doctors would relegate to the nurses. As an intern, I never drew up drugs, started IVs, etc. The only time you are out of the OR is for preop evals and such.

All this being said, I love the field of anesthesiology. As the original poster said, I also enjoy taking care of patients one on one and literally protecting their lives when they cannot do it themselves. I also enjoy the procedures and fast paced medicine. Its very gratifying to see patients responding to your treatment in minutes, if not seconds. Anesthesiologists are some of the most adapt doctors in using emergency drugs. I know at the end of the day that I have provided a valuable service to the patient, surgeon, and hospital. But, even a good day meant that I did a lot of work.

Well, I hope I gave you and others a small glimpse of what real anesthesiology residency is like for the first year resident. Its a lot of work and stress, but also a lot of fun.

 

[Gator05]

GasDoc,

I never considered the lonliness factor. Does your attd rotate through your room frequently to see how things are going? Also, are you ever too busy recording/keeping the pt alive to be lonely?

Your comments about being a pilot are interesting. I know a few pilots who say they never fly w/ anyone who is just flying to "relieve stress", because the flying takes all your concentration just to make sure things are going right...

Thanks for taking the time to share your thoughts on your specialty!

 

[gasdoc]

Originally posted by Gator05
GasDoc,

I never considered the lonliness factor. Does your attd rotate through your room frequently to see how things are going? Also, are you ever too busy recording/keeping the pt alive to be lonely?

Your comments about being a pilot are interesting. I know a few pilots who say they never fly w/ anyone who is just flying to "relieve stress", because the flying takes all your concentration just to make sure things are going right...

Thanks for taking the time to share your thoughts on your specialty!

Hi Gator,

Yes, your pilot friends are right. Even the simple patients should theoretically take up your undivided attention. When it is a stable patient and the case is long, say more than a hour, there is usually plenty of time to chart and get bored, assuming its a simple case w/ just standard monitors. The attg is there for induction and 99% of the time for emergence. But, in between, it varies, esp. if they trust you. Some of them come in every 20 or 30 minutes, some like every hour. They also take into account how sick the patient is. Some just call you on the phone. But most come in at least q30 min, since they knowits a CA 1 in there. Oh yeah, emergence is far more tricky than induction. Anyone can give a lot of drug and knock out someone, but bringing back the patient smoothly w/ minimal pain, bucking on the tube, spontaneously breathing, and waking up alert and not in distress is a total art form that I have not mastered.

All I know is that there is a big difference being an "anesthesia medical student" vs. an "anesthesia resident". The main difference is the resident has all the responsibility and if something goes wrong, the attg will BLAME me, not the student, not the surgeon, not the circulator.

For those who are not familiar w/ monitors and such, I will give a list of what the resident continually checks and replenishes: pulse ox, HR, BP, EKG, ETco2, FIO2, inhalational agent % vol, MAC, temperature, BIS monitor (some institutions), twitch monitor, Ventilator Vt, RR, PIP, foley, IV fluid bag, etc. Sicker patients may get an art line and CVP monitor. There's also ABG's to draw if needed. Blood transfusions are not uncommon. Sometimes there's drips (NTG, nipride, phenylephrine, etc) for BP control, mannitol drips for renal/CNS cases, etc. I am just giving you some of the CA-1 beginning level cases. I don't even know all that goes on w/ CA-2 and above, like cardiac bypass pump and transplant livers, etc.

So, as you can see, the only reason medical students (me included) think anesthesia is cool and easy is b/c the dept usually assigns the CA 3s and 2s as well as the best teaching attendings to medical students. Most of the stuff I talked about is second nature to them. They could literally do it in their sleep. But, as a first year resident, everything is new. I have to practically learn everything, especially the manual stuff. Nobody in medical school or internship taught me how to mix drugs or administer them. I had to learn that there is a correct way to place ekg leads, ogt, etc. Intubation is not nearly the most important skill of an anesthesiologist...only people outside of anesthesia think so.

Well, I may be exaggerating a bit on the above stuff, but its all true and as I see it as a CA 1.

 

[Gator05]

Gasdoc,

I'm a bit confused; if anesthesia is fun, and there's all the charting to do and drips to manage, how does the boredom fit into the picture? Can I (hopefully!) assume the boredom is, in the grand scheme of things, of minimal concern and not a major detractor to the specialty?

 

[gasdoc]

Originally posted by Gator05
Gasdoc,

I'm a bit confused; if anesthesia is fun, and there's all the charting to do and drips to manage, how does the boredom fit into the picture? Can I (hopefully!) assume the boredom is, in the grand scheme of things, of minimal concern and not a major detractor to the specialty?

Gator,

I don't know if I am getting your questions right. But in terms of boredom...it is very much a part of anesthesia if you are going to be in the room, mostly a concern for residents and CRNAs, but also for those attgs who choose to practice individually instead of the common practice of supervising CRNAs. Although some of anesthesia is shear terror or excitement, which ever you choose, as I said, much of it is still routine and can be considered "crusing along" (as I see it) or "boredom", if you don't like having idle hands. A good anesthesiologist is one who can anticipate and prevent disasters before they happen. Thus, theoretically, the better you are, the more time you have just "crusing along" or be plain "bored". I love the downtime in anesthesia. That's one of the main reasons I chose it. While the surgeons are standing there hour after hour dissecting and sometimes sweating away, I am sitting there happily charting my vital signs and getting my morning break, lunch break, and afternoon break. I have the computer/internet explorer right next to me. In my program, we get the post call day off and call days are only from the afternoon until the next morning. I get most weekends off. So, as you can see, there is some truth to the "recreational lifestyle" people claim anesthesiologists have. It starts in residency. usually, good residency hours translate into good attending hours later on. My hours pale in comparison to surgeons and medicine people.

 

[Gator05]

Gasdoc,

Cruising right along sounds much more fun than boredom! Just curious if you've done any cardiac/major vascular cases? The few I've been involved with were...exciting, for better or for worse! And I like the schedule idea; have to remind myself sometimes that there's no reason to feel guilty for working hard rather than obscene hours...

Thanks for all your input!
Gator

 

[gas-x]

hey gasdoc,

where do you train?

 

[Sandpaper]

Hey offshore fella, good to hear you're doing okay and that they didn't kill ya during the three months of surgery out on the island.
Hawaii is beautiful. Damn shame they don't have an anesthesia program.

In regards to the poster with mental status changes in regards to his career paths, I find his post particularly slimy in the same way I find use car salesman slimy. The homeboy boil his decisions down to money, prestige and lifestyle. Not that that stuff ain't important, but what the fudge? Radiology and anesthesia are not even remotely similar. As many here have pointed out, one involves little patient care with pure anatomy and pathology while the other is all about physiology, pharmacology, and direct patient care. What's the confusion? If ya can't tell the difference then we don't need your shallow patronage. Don't be pissin' and moanin' when you can't match into radiology and have to "settle" for anesthesia. Jeezus. Where do ya find these people.

 

[ApacheIndian]

Originally posted by Sandpaper

In regards to the poster with mental status changes in regards to his career paths, I find his post particularly slimy in the same way I find use car salesman slimy

lol I suppose I can understand where all of you are coming from, and although y'all might not believe me, I honestly feel that although Radiology and Anesthesiology ARE indeed somewhat different, I really am very interested in the prospect of practicing either or both of these fields... too bad they're aren't any combined 8 year Rads-Gas programs, b/c I'd jump at the chance. As a matter of fact, there are other fields in medicine that I find very appealling... Neurology, EM, Pathology, Cardiology, Nephrology, Pulmonology, Endocrinology, even straight-IM! I for one find almost all fields of medicine fascinating, and I believe I'd be very happy and very adept at practicing any one of them should I so choose (and earn a spot in of course). So yes, my subjective feelings about these "disparate" specialties place them so close together in desirability for me, that I am indeed required to use more objective criteria to "break the tie" so to speak.

For those of you who are lucky enough to have discovered your "calling" early on, and are indeed 110% sure about your specialty choice... kudos... I hope that whatever I ultimately decide on will yield me a similar sense of unwavering devotion.

 

[ApacheIndian]

On a side note, the threads in the SDN archives on these very topics are numerous...

"Is it possible to be sincerely intersted in two very different specialties? Or is this just an indication of uncertainty and/or confusion (i.e. mental status changes ) about oneself?"

I obviously attest to the former.

and

"If one takes issues such as lifestyle and salary into consideration when choosing his career choice or for deciding b/w two fields, is he necessarily a slime-ball who's unfit to practice medicine?"

IMHO, no.

 

[gas-x]

Sure, i'm also interested in almost every specialty out there in medicine, but time is running out. most people use their clinical years as a "weed out" period to decide on their specialty. if by now you haven't decided, i would suggest that you do a transitional internship to take another year to figure things out. do some more electives, take a year off, or whatever. based on your interests in neuro, med, path, cardio, endo, pulm, etc... why don't you just go after FP. you see all this stuff. you can live and breathe the entire spectrum of medicine. and if you're especially interested in anesthesia, you can even do some conscious sedation during your FP practice while doing some kind of procedure. but something tells me you won't do it simply because of money and prestige.

it bugs the hell out of me when people start applying to multiple specialties just to have a back-up. leave anesth to people who truly want it. same for rads. you had a prior post about applying to crap loads of rads programs. looks like you already made a decision. just accept it and move on, dude.

 

[bigfrank]

Nice post, Gas-X. It seems that at least 25% of current medical students would have made MUCH better CEOs at companies like Enron, etc.

---------Frank

 

[Offshore]

Well actually I'm happy my post has had a healthy response. Go easy on Dr. Cuts, he's just trying to make up his mind about things. Having finally crossed that chasm of being a med student vs. a resident, I would like to say that how much of a student superstar one is or how great of a specialy or residency one's mactched into doesn't really mean much on the second day of residency. As anyone who's actually strated residency becomes quickly aware, once you begin it's no longer about I matched here or there in this or that, but instead "Can you take care of sick people or can you not?" In a way residency is a great equalizer. After 4+ years of playing competitive games with your classmates as an undergraduate, and then 4 more years of trying to see how easy you can cruise by in med school while still getting AOA and a high board score, finally in residency it will all come to an end. It's actually quite simple. Either you'll know what to do with sick patients or you won't. And those folks that can't will quickly become apparent. The patient's condition doesn't lie. It's actually amazing how many people who've matched to the most competitive residencies don't know an endotracheal tube from a foley catheter at the beginning of residency. Maybe they were too busy going home early to study for their shelf exam; to get a head start on their classmates that is...

 

[drusso]

Originally posted by Offshore
the most competitive residencies don't know an endotracheal tube from a foley catheter at the beginning of residency. Maybe they were too busy going home early to study for their shelf exam; to get a head start on their classmates that is...

Just as an aside...


There's a lot of truth to what you say, but you can't dismiss the "country club"mentality prevalent in medicine. Brand-names and pedigrees do matter to a large extent. Training at competitive programs and prestigious institutions helps land highly sought after positions and lucrative partnership opportunities down the line. Training at these sort of places also helps one absorb a certain kind of worldview and attitude that top programs prize. So, yes, it's important to know a foley catheter from a endotracheal tube, but it also important to have personal connections and affiliations with prominent institutions. It really is an extension of social class.

The corollary to this argument is that you're also only as good as your last achievement. If you went to a so-so undergraduate college, but got into a good medical school, the latter will be emphasized more in the decision-making process by interview committees than if you attended a great college, then a so-so medical school. But, if you attended a mediocre medical school and then landed a great residency; you will likely be forgiven for your medical school. As in the rest of life, you will be amazed to discover how much of medicine comes down to "who you know" and not "what you know."

While a certain degree of scholastic prowess and a good work ethic is the minimum for most programs, practically all applicants meet this minimum threshold. Then, for most programs, it comes down to a whole host of "intangibles." If a student asked me if it were more important to earn five extra points of the USMLE or secure an audition rotation at a leading residency program in one's anticipated field, I would emphasize the latter. I would also say that in the great scheme of things it is less important for a student to leave early and go study for the shelf exam than it is to leave early and go play golf with the department chairman. Moreover, students forget that top programs (which are keenly aware of what doors their name and training will open down the lline) also consider heavily what a given applicant brings to the table in terms of life-long career potential (so they can say to future applicants, "Dr. So-and-so trained here"), research potential (again as a means to advance the program's reputation), and social capital (Does this applicant fit in with our cultural norms and expectations?). The process is less of a meritocracy and more a quid-pro-quo.

Thus, learning the culture of academic medicine is very much part of the "hidden curriculum" at top institutions. You are trained not only in medical science, but also how to behave and conduct oneself as a certain kind of physician. I think that most premeds and medical students underestimate the impact of this kind of social learning until it has started working against them.

 

[ApacheIndian]

Excellent post Drusso... you very eloquently verbalized what I suspect a lot of us--subcounsiously anyway--know, but for some reason never really act on or use to our advantage. I'm gonna be thinking about this... thanks.

 

[gasdoc]

I also have a few points to make.

As a anesthesia resident, I agree that it does and it doesn't matter what your past is. I know from first hand experience that one of the first questions asked of you by anyone is "where are you from" and more specifically, "what medical school?" I am pretty certain that your answer starts a chain of judgement in people's head. This question is asked by your attgs, your patients, and your fellow residents. People want to know about your "past" in order to estimate your abilities and intelligence, as well as conversation piece. Thus, it does matter what your past achievements are. ON the other hand, I also agree that when it comes to patient care, past achievements can mean little. Some of the best residents come from lousy medical schools. But, lousy medical schools sometimes have the best "clinical" training while prestigeous medical schools "baby" their medical students.

As far as people using "anesthesia as a backup", often for radiology, I am glad that this process is getting harder, mainly because anesthesia is become a more and more competitive speciality in its own right. I agree that a future radiologist will be just as adept at being a future gas passer. But, at the same time, I see as as "cheating" and wrong for people to pick two different specialties and make it harder for the ones who truly want to pass gas. Its also interesting to note that not only anesthesia, but radiology was considered the "pits" just five or six years ago. No one wanted to go into these 2 specialties in favor of primary care. Now, everyone wants radiology and anesthesia, like I said, is fast following in popularity. The bad news for these "opportunists" is that if anesthesia or radiology for that matter, ever loses its luster, mainly high pay, they will be sorely sorry that they were so eager to go into it. Whatever people do, I just hope they go into a field b/c of a gut feeling that they truly enjoy it and not just for the material benefits. Otherwise, they will make lousy collegues and do a dis-service to the specialty in terms of disinterest in the field (and thus, in its advancement and prestige, which the ASA is always trying to work hard it doing), indifferent patient care, unhappy collegues, etc.

So bottom line, its okay to want to go into anesthesia for the money and good lifestyle, as many of us in it do. But, its also important to have a gut feeling (ie. genuine interest) in the field itself. Anything else and you are selling yourself and your future collegues short.