Program Director Said Don't Do Anesthesia

[ERRES2288]

Basically he told me to think very hard about it and that the glory days are over..

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[pgg]

Well, that settles it then.

 

[Doctor4Life1769]

Basically he told me to think very hard about it and that the glory days are over..

My former chair said the same thing to all 4th year Med students and proceeded to hire a ton of CRNAs.

 

[Ezekiel2517]

sounds like good advice. I definitely wouldn't recommend you do anesthesia or any other drugs for that matter. First rule: don't get high on your own supply.

 

[deleted171991]

Basically he told me to think very hard about it and that the glory days are over..

Did you thank him profusely? Because he might be one of your greatest benefactors.

 

[soorg]

I wish all program directors in all specialties were this honest.

I wish all med school admission offices were this honest.

I wish all pre-med offices in every college/university were this honest.

 

[Turtlez]

Basically he told me to think very hard about it and that the glory days are over..

which program is this? what did he say exactly? (please PM me if this is sensitive info) thanks!!!

 

[pgg]

I wish all program directors in all specialties were this honest.

I wish all med school admission offices were this honest.

I wish all pre-med offices in every college/university were this honest.

Right, because going to medical school and being a doctor is sooooo much more of an economic gamble than being a teacher/plumber/lawyer/restaurateur/construction worker/i-banker, and the rewards are equally predictable and comparable.

Take a deep breath. The bell curve for medicine (any specialty) is far to the right, with a short tail on the left. If you're reasonably smart, have ass-calluses tough enough to endure med school, medicine is still about the surest attainable thing out there. The major difficulty is in convincing the average med student, resident, or attending with wistful woulda-coulda-shoulda dreams about being an entrepreneur or i-banker that they probably would've failed at those endeavors.

 

[cognitus]

Again, I laugh at folks that are unhappy with their current gig but are not talented/good enough to do anything about it besides being bitter.

 

[Consigliere]

Basically he told me to think very hard about it and that the glory days are over..

Heed his advice if you've got half a brain in your skull.

 

[amLOLdipine]

Basically he told me to think very hard about it and that the glory days are over..

But that's the case for radiology, GI, and a host of other fields...

 

[BLADEMDA]

I'm not agreeing or disagreeing right now, but hopefully he gave you more of a reason or rationale for why you shouldn't do anesthesia than just that the glory days are over? Because the glory days are probably over for many other specialties too.

Pick a specialty where you are higher up in the food chain. If you aren't at the table then you are on the menu.

 

[amLOLdipine]

Pick a specialty where you are higher up in the food chain. If you aren't at the table then you are on the menu.

So, be a hospital administrator instead of going into medicine?

 

[PathoTurnUp1865]

So, be a hospital administrator instead of going into medicine?

Or do both.

 

[pgg]

Or do both.

I've only got one soul to sell and I'm holding out for a better deal than that.

 

[Carbocation1]

Basically he told me to think very hard about it and that the glory days are over..

Are you going to listen? What else are you interested in?

 

[BLADEMDA]

Basically he told me to think very hard about it and that the glory days are over..

http://forums.studentdoctor.net/threads/future-anesthesia-job-market.1062141/page-2#post-15071896

http://forums.studentdoctor.net/thr...hesiology-for-mds.931292/page-6#post-16409632

Most of your questions or concerns are addressed in those threads. Bottom line: Anesthesiology isn't Top tier any longer but you won't starve either earning $275 (academics) up to $450K (majority of true private practices). If you land the best gig in this field expect $650K+.

For most med students I tell them to expect $300-$375K as their salary. If that is enough money for you (besides the actual desire to do the job) then you won't be disappointed.

 

[Noyac]

Agree with Blade's advice above.
Another thing to consider is to look at specialties where midlevels are not infiltrating and are unlikely to in the future. Radiology, pathology and Oncology come to mind. Not sure I could do end of these with the exception of interventional radiology.

 

[deleted171991]

http://forums.studentdoctor.net/threads/future-anesthesia-job-market.1062141/page-2#post-15071896

http://forums.studentdoctor.net/thr...hesiology-for-mds.931292/page-6#post-16409632

Most of your questions or concerns are addressed in those threads. Bottom line: Anesthesiology isn't Top tier any longer but you won't starve either earning $275 (academics) up to $450K (majority of true private practices). If you land the best gig in this field expect $650K+.

For most med students I tell them to expect $300-$375K as their salary. If that is enough money for you (besides the actual desire to do the job) then you won't be disappointed.

The question îs what one has to do for those 300k. Being in constant vigilance looking after 3-4-5 CRNAs, who won't even call you for advice before all the dumb things they do, might not be your concept of fun, OP.

The more rooms one will have to supervise for that money, the more chances of winning the malpractice roulette. I can tell you that even at only 3, total supervision is impossible. The only reason I still have an empty malpractice history is because of sheer dumb luck, when I walked in on one of them almost killing a young healthy patient. And s/he was supposedly one of the "good" non-militant ones. S/he just didn't know what s/he didn't know, not even when to call for help.

I am much happier when in the ICU, working solo or supervising just 2 people in the OR, even for less money. But those jobs won't stay for long, because employers are greedy; it's not about your salary, it's about how much money they are not making on your back, safety be damned.

So what you need to find out, OP, is how much whoring can you tolerate before you can't sleep well at night?

 

[deleted171991]

Agree with Blade's advice above.
Another thing to consider is to look at specialties where midlevels are not infiltrating and are unlikely to in the future. Radiology, pathology and Oncology come to mind. Not sure I could do end of these with the exception of interventional radiology.

Radiology and pathology are always open to technological risks. In imaging, the midlevels are the computer and image recognition software. Look at all the image pattern recognition in defense and law enforcement. Do you think none of that will end up being applied in medicine? I wouldn't bet against that, not with my career.

The best bets are complex procedural specialties that cannot be replaced by stents and tech-level jobs. By the way, how long before interventional radiologists or cardiologists or gastroenterologists will face competition from trained nurses, the same way APRNs do central lines and chest tubes and intubations, and generally anything that's pure eye-hand coordination?

And Oncology is probably ripe for the midlevel revolution, too, as most recipe-based specialties. Already they have midlevels checking on their patients, and this is just the beginning.

Go for a surgical specialty, OP.

 

[WholeLottaGame7]

Radiology and pathology are always open to technological risks. In imaging, the midlevels are the computer and image recognition software. Look at all the image pattern recognition in defense and law enforcement. Do you think none of that will end up being applied in medicine? I wouldn't bet against that, not with my career.

The best bets are complex procedural specialties that cannot be replaced by stents and tech-level jobs. By the way, how long before interventional radiologists or cardiologists or gastroenterologists will face competition from trained nurses, the same way APRNs do central lines and chest tubes and intubations, and generally anything that's pure eye-hand coordination?

And Oncology is probably ripe for the midlevel revolution, too, as most recipe-based specialties. Already they have midlevels checking on their patients, and this is just the beginning.

Go for a surgical specialty, OP.

Agree with above. Will add that oncology is very protocol-driven, making it ripe for take-over, and there's a huge number of bread-and-butter line placements (PICCs, broviacs, etc) that surgeons are happy to punt to VIR and are being staffed by PAs, etc.

 

[2018Duke]

Radiology and pathology are always open to technological risks. In imaging, the midlevels are the computer and image recognition software. Look at all the image pattern recognition in defense and law enforcement. Do you think none of that will end up being applied in medicine? I wouldn't bet against that, not with my career.

The best bets are complex procedural specialties that cannot be replaced by stents and tech-level jobs. By the way, how long before interventional radiologists or cardiologists or gastroenterologists will face competition from trained nurses, the same way APRNs do central lines and chest tubes and intubations, and generally anything that's pure eye-hand coordination?

And Oncology is probably ripe for the midlevel revolution, too, as most recipe-based specialties. Already they have midlevels checking on their patients, and this is just the beginning.

Go for a surgical specialty, OP.

So you really think the only option is to do a surgical specialty to be happy or something? I'm genuinely asking. If one can't match into neurosurg/ortho/ENT/urology/ophtho because of the ultra-competitiveness of those fields (step 1 scores are generally >240), all med students should do general surgery before anesthesia, rads, EM, etc.? As a med student that is just ironic. Many surgery residents and even faculty repeatedly tell me to consider anesthesia, EM, and rads because they would give almost anything to switch out of surgery. It seems like everyone is so damn unhappy on this forum.

 

[amLOLdipine]

So you really think the only option is to do a surgical specialty to be happy or something? I'm genuinely asking. If one can't match into neurosurg/ortho/ENT/urology/ophtho because of the ultra-competitiveness of those fields (step 1 scores are generally >240), all med students should do general surgery before anesthesia, rads, EM, etc.? As a med student that is just ironic. Many surgery residents and even faculty repeatedly tell me to consider anesthesia, EM, and rads because they would give almost anything to switch out of surgery. It seems like everyone is so damn unhappy on this forum.

I've talked to numerous anesthesiologists (both PP and academic) who were more than happy with their jobs and optimistic about the future of the field.

However, those are not usually the people you find posting on SDN.

It's not limited to just anesthesiology, either. Go take a look at some of the other subforums and you'll see the same kind of doom & gloom talk.

 

[deleted171991]

So you really think the only option is to do a surgical specialty to be happy or something? I'm genuinely asking. If one can't match into neurosurg/ortho/ENT/urology/ophtho because of the ultra-competitiveness of those fields (step 1 scores are generally >240), all med students should do general surgery before anesthesia, rads, EM, etc.? As a med student that is just ironic. Many surgery residents and even faculty repeatedly tell me to consider anesthesia, EM, and rads because they would give almost anything to switch out of surgery. It seems like everyone is so damn unhappy on this forum.

I am not saying you'll be happier in a surgical specialty. That's something you would know best. I myself couldn't be; I am more like an internist with ADD, and I have low tolerance for stupidity.

What a number of us are saying is that surgical specialties have a better future than anesthesia, or even medical specialties. Anything that can be reduced to protocols will end up being taken over by midlevels. Anesthesia is the prime example for that.

Many people are happy because they still have good jobs, or because they equate money with happiness, and they apparently make more than other specialties (when not adjusting for stress). Others are just too dumb to realize what's going on, like the proverbial frog. One way or another, if you want a specialty where you will supervise at least 3 midlevels taking split-second decisions on your license, having only minutes to correct whatever idiocy they have done, you're in the right place. Couple that with a load of attitude and with being treated by surgeons and administrators like just another "body"/nurse/tech, and you're in for a load of happiness.

I am not trying to convince you, or others, of anything. And, by the way, I will never tell a student how I feel, in real life. I did it once, and I got the same idiotic reaction I usually get on SDN. But I do talk to my colleagues, and people are not as happy as they seem to strangers.

 

[BLADEMDA]

I've talked to numerous anesthesiologists (both PP and academic) who were more than happy with their jobs and optimistic about the future of the field.

However, those are not usually the people you find posting on SDN.

It's not limited to just anesthesiology, either. Go take a look at some of the other subforums and you'll see the same kind of doom & gloom talk.

Optimistic? I am not sure what field they are working in or if they have any idea about the drastic changes taking place in Anesthesiology.

 

[BLADEMDA]

 

[amLOLdipine]

I am not saying you'll be happier in a surgical specialty. That's something you would know best. I myself couldn't be; I am more like an internist with ADD, and I have low tolerance for stupidity.

What a number of us are saying is that surgical specialties have a better future than anesthesia, or even medical specialties. Anything that can be reduced to protocols will end up being taken over by midlevels. Anesthesia is the prime example for that.

Many people are happy because they still have good jobs, or because they equate money with happiness, and they apparently make more than other specialties (when not adjusting for stress). Others are just too dumb to realize what's going on, like the proverbial frog. One way or another, if you want a specialty where you will supervise at least 3 midlevels taking split-second decisions on your license, having only minutes to correct whatever idiocy they have done, you're in the right place. Couple that with a load of attitude and with being treated by surgeons and administrators like just another "body"/nurse/tech, and you're in for a load of happiness.

I am not trying to convince you, or others, of anything.

The ability to do a 1-year CC fellowship and work in the ICU is one of the aspects of anesthesiology which often gets overlooked. For someone who has some interest in IM, that seems to be a great exit strategy should the OR not work out well.

 

[deleted171991]

The ability to do a 1-year CC fellowship and work in the ICU one of the aspects of anesthesiology which often gets overlooked. For someone who has some interest in IM, that seems to be a great exit strategy should the OR not work out well.

Anesthesia is indeed a better path to CCM and will probably make you a better intensivist. Do I advise anyone to go into anesthesia for that? No. Critical care is just a touch less ****ed up as the future goes.

Generally, one would want to be in a specialty where patients would follow you to another job as their doctor, or at least where patients get to choose their doctor. Otherwise, to employers, you matter exactly as much as the money you make for them, and the costs and difficulty of replacing you. They will keep you exactly as happy as your importance to them.

Think about it: how difficult is to replace an anesthesiologist nowadays, and how many patients will the business lose if s/he leaves?

To clear up even more how much they piss on anesthesia: if you filter notes by Physician in Epic, there are places in the country where anesthesia notes are filtered out, because the author belongs to the Anesthesiologist group, not the Physician group. Nobody besides us gives a crap. Most specialties and hospital administrators don't even know what we know and can do as a specialty. To most physicians in the hospital, we matter about as much as a tech or a nurse: they just need one, anyone, to provide a service.

 

[Doctor4Life1769]

Anesthesia is indeed a better path to CCM and will probably make you a better intensivist. Do I advise anyone to go into anesthesia for that? No. Critical care is just a touch less ****ed up as the future goes.

Generally, one would want to be in a specialty where patients would follow you to another job as their doctor, or at least where patients get to choose their doctor. Otherwise, to employers, you matter exactly as much as the money you make for them, and the costs and difficulty of replacing you. They will keep you exactly as happy as your importance to them.

Aren't you relegated to hospital employee role though?

 

[deleted171991]

Aren't you relegated to hospital employee role though?

Absolutely. I am not pleading for CCM either, as a career goal. It's just an escape route for people who are already stuck with something worse.

 

[Doctor4Life1769]

Absolutely. I am not pleading for CCM either, as a career goal. It's just an escape route for people who are already stuck with something worse.

This is true. However, if someone truly wants to escape and doesn't mind the outpatient setting - interventional pain is a decent option too, there you get to be the boss too.

 

[qwerty89]

Generally, one would want to be in a specialty where patients would follow you to another job as their doctor, or at least where patients get to choose their doctor. Otherwise, to employers, you matter exactly as much as the money you make for them, and the costs and difficulty of replacing you. They will keep you exactly as happy as your importance to them.

Think about it: how difficult is to replace an anesthesiologist nowadays, and how many patients will the business lose if s/he leaves?

While this phenomenon is definitely true it will matter less and less with increasing healthcare consolidation. Back in the day the old surgeon could throw a hissy fit and boast that he would "take his business to the other hospital" and get the hospital to comply with his demands.

It becomes harder to do that when more of the hospitals in the area are owned and operated by Dignity Health, Ascension Health, Aurora, Kaiser Permanente, etc.

At that point they are just another cog in the wheel. A more important cog than anesthesia, but still a cog.

 

[gasdoc77]

Anesthesia, like all of medicine, has become a game of leverage. I changed practices several times (AMC, employee in a hierarchical group, partner in an equitable group) to eventually become partner in a large group that covers most of a hospital system. The group is dysfunctional but I think that despite our differences we all agree that we must unite to stand a chance when dealing with these "nonprofit" hospitals. The opportunities to be partner are vanishing quickly and that partnership leverage/market share is necessary to make the cost of replacing (all of) you prohibitive.

 

[2018Duke]

I am not saying you'll be happier in a surgical specialty. That's something you would know best. I myself couldn't be; I am more like an internist with ADD, and I have low tolerance for stupidity.

What a number of us are saying is that surgical specialties have a better future than anesthesia, or even medical specialties. Anything that can be reduced to protocols will end up being taken over by midlevels. Anesthesia is the prime example for that.

Many people are happy because they still have good jobs, or because they equate money with happiness, and they apparently make more than other specialties (when not adjusting for stress). Others are just too dumb to realize what's going on, like the proverbial frog. One way or another, if you want a specialty where you will supervise at least 3 midlevels taking split-second decisions on your license, having only minutes to correct whatever idiocy they have done, you're in the right place. Couple that with a load of attitude and with being treated by surgeons and administrators like just another "body"/nurse/tech, and you're in for a load of happiness.

I am not trying to convince you, or others, of anything. And, by the way, I will never tell a student how I feel, in real life. I did it once, and I got the same idiotic reaction I usually get on SDN. But I do talk to my colleagues, and people are not as happy as they seem to strangers.

Thanks for the explanation. Hopefully my reaction wasn't idiotic. Anyways, I do think about the future of different specialties often. Many medical students solely pick a specialty based on prestige or today's salary or something or other. I'm trying to analytically pick a specialty I enjoy, with a decent enough income, with a bright future ahead. Unfortunately it seems like midlevels are taking over most fields except surgical specialties like you mentioned and I won't be able to have those three things. I don't really want to be a surgeon and many of those fields are tough to get into. I guess I don't know where that leaves me. Do I suck up 5-7+ years of not having a life for a better future/disliking my job or do I do something I enjoy (not necessarily anesthesia) and give up future marketability, prestige, pay? Are there any non-surgical fields with a positive future? Just rants from a med student.

 

[repititionition]

Anesthesia is indeed a better path to CCM and will probably make you a better intensivist. Do I advise anyone to go into anesthesia for that? No. Critical care is just a touch less ****ed up as the future goes..

Would you say more about this, FFP?

 

[EtherBunny]

Wow! I can't believe a program director told you that!

There's no question that anesthesiology is facing significant challenges on the horizon. Midlevel encroachment, loss of hospital subsidies, the risk of a major reduction in compensation if Medicare rates become the norm, the rise of "mega-groups" regionally and nationally with no partnership tracks. But, in the grand scheme of things, it's still a great career.

As an anesthesiologist...
1. You're essentially guaranteed to be in the top 2% of annual income nationally. Depending on where you decide to work, you could easily push yourself into the top 0.2%.
2. You will have at least 8 weeks of vacation every year. Some groups offer 12 (or MORE) weeks of vacation. That's an INSANE amount of vacation, especially compared to the average American (or average physician, for that matter).
3. Your overhead is low. Anesthesia supplies are cheap compared to other fields of medicine. In an era of declining reimbursement, low overhead is a blessing.
4. You have tremendous career flexibility in terms of location, regardless of how many years you've been in practice. 10 years in and you want to pack your bags and move to California? No problem. You don't have to worry about closing a practice and building up one elsewhere.
5. You don't have to worry about building a referral base.
6. You get to see immediate results from the things you do intra-operatively.
7. You're truly a master of practical physiology/pharmacology and the airway. Situations that would make other physicians s$%t their pants, you perceive as a piece of cake.
8. You don't have any clinic. Ever.
9. You're insulated from the perils of patient's follow-up. Every day is effectively a brand new day. If you had a problem with a patient yesterday, guess what? It's ancient history. Surgeons and other physicians don't have this luxury. If a surgeon operates on a patient and has a complication, the surgeon gets to deal with the aftermath for a LONG time. It can be a source of tremendous stress and anxiety.
10. You get to wear the equivalent of pajamas at work, every single day.

The doom and gloom on the anesthesia forum is a bit overstated, in my opinion. The field is facing a variety of challenges. I readily acknowledge that, and every medical student considering anesthesiology should be well informed about these issues. But it's still a great career choice if you focus on the big picture.

 

[deleted171991]

Would you say more about this, FFP?

There is midlevel encroachment coming to CCM, too. Also there is the threat of eICU, which is almost worse than covering CRNAs: basically you are covering more patients than you normally would, remotely, through proxies. And the incomes are lower than in anesthesia. Plus you are much more dependent on the quality of the rest of the team, including nurses. You are a money loser to the hospital; you are making money only indirectly, by allowing them to offer a certain level of care which includes ICU if needed. In many surgical ICUs, the surgeon still thinks he's the king and treats you accordingly, as if you were his scut worker who should feel honored to be allowed to touch his patient. And then there is the lifestyle, and the social and death issues, so you can burn out if not careful.

But there are more good jobs, fewer midlevels, less production pressure, good future prospects because of the huge numbers of baby boomers who want everything to be done, and generally you are a doctor and everybody treats you as such.

 

[GA8314]

Right, because going to medical school and being a doctor is sooooo much more of an economic gamble than being a teacher/plumber/lawyer/restaurateur/construction worker/i-banker, and the rewards are equally predictable and comparable.

Take a deep breath. The bell curve for medicine (any specialty) is far to the right, with a short tail on the left. If you're reasonably smart, have ass-calluses tough enough to endure med school, medicine is still about the surest attainable thing out there. The major difficulty is in convincing the average med student, resident, or attending with wistful woulda-coulda-shoulda dreams about being an entrepreneur or i-banker that they probably would've failed at those endeavors.

What PGG said......

As for anesthesia. Are the glory days over? Let me tell you, and listen well. The glory days are over for EVERY specialty. This isn't the 60's. Yes, some specialties are still able to do very very well. We all know what those are.

Be sensible with student loans and make a very high priority out of paying them back. Know that your work environment is likely to change over your career. Be good at what you do and bring a positive attitude to your workplace, and you will have a comfortable living AND the ability to save aggressively for retirement.

The biggest guarantee for disappointment is if you think you will be a really wealthy individual going into medicine these days. Again, you will live a very comfortable life if you work hard and manage your finances wisely. You can also develop, over time, wealth. But, you need to have discipline and do the right things.

 

[deleted126335]

The high level of gloom and doom of many in Anesthesia is only partially related to Income. On a per hour basis anesthesia is still well compensated financially even among medical specialties, let alone what 95% of anesthesiologists could earn outside of medicine.

Many, but certainly not all anesthesia practices are emotionally very unsatisfying:
1. Encroachment and disrespect from CRNAs who frequently don't answer to us.
2. Disrespect form surgeons and administrators who view us as less than the surgeon or any physician who does not bring business to the hospital.
3. It is reasonable at some point in the practice to expect comparable pay for comparable work in the same setting and a generally fair splitting of the pie. Employment arrangements and organizational structure within many, but not all, anesthesia groups makes this often impossible. Be they private practice, hospital employee, or AMC.

The emotional reasons are responsible for lots of the gloom and doom, IMO

 

[GA8314]

http://forums.studentdoctor.net/threads/future-anesthesia-job-market.1062141/page-2#post-15071896

http://forums.studentdoctor.net/thr...hesiology-for-mds.931292/page-6#post-16409632

Most of your questions or concerns are addressed in those threads. Bottom line: Anesthesiology isn't Top tier any longer but you won't starve either earning $275 (academics) up to $450K (majority of true private practices). If you land the best gig in this field expect $650K+.

For most med students I tell them to expect $300-$375K as their salary. If that is enough money for you (besides the actual desire to do the job) then you won't be disappointed.

I would say this is realistic. Only that the 650K jobs are very very very hard to crack and are becoming very scarce.

It's true. There is a LARGE opportunity cost to medicine. That's why you need to enjoy what you do. I enjoy anesthesia. Last week I did a very smooth awake FOI. Yesterday I bailed out ER with a glidescope (was already in the patient's mouth) to successfully intubate (it actually wasn't easy) an angioedema patient.

It's NOT, however, about "glory". It's about smoothly, professionally, and efficiently facilitating the surgical flow. If you view yourself as an important cog in that money machine, then you will be well served. But, it's an important role. Yes, you will make less. So will most specialties. But, do the right things (think 5 years POST residency NOT escalating your lifestyle too substantially), then you will be comfortable, have a nice meaningful job, and able to save aggressively.

***Live like a mid-level engineering manager and save like someone earning $350k/year. Take advantage of every tax break that you can over time. You will have peace of mind of not living an overextended life. Peace of mind that you have joined a fun, interesting profession, albeit with hard work and stress for sure, and the peace of mind that you can have some nice things while at the SAME TIME pay for college education, family vacations, and set yourself up for a nice retirement. But, you need to do the right things.

It is what it is. This world isn't going to give you anything. The WORLD is getting more competitive. If you can earn what most docs earn (or are even projected to earn), then there is NO reason you can't build substantial wealth. But, your lifestyle also needs to reflect that and for sure you need some discipline.

Read The White Coat Investor by Dr. James M. Dahle, MD
Very good book. Puts it all in perspective and gives you a plan. Some may not like the plan, but it will work if you are smart. Even his expected future interest rates are realistic (4-6% versus the 12% always quoted by many other advisors such as Dave Ramsey etc.)

 

[Planktonmd]

You are very lucky to have found a program director who is willing to tell you the truth!
All those who are still trying to highlight the positives of this sinking ship are mainly either still in training or new grads. They simply don't know what they don't know and they need to assure themselves that they did not make a terrible choice going to this dead specialty.

 

[deleted171991]

The high level of gloom and doom of many in Anesthesia is only partially related to Income. On a per hour basis anesthesia is still well compensated financially even among medical specialties, let alone what 95% of anesthesiologists could earn outside of medicine.

Many, but certainly not all anesthesia practices are emotionally very unsatisfying:
1. Encroachment and disrespect from CRNAs who frequently don't answer to us.
2. Disrespect form surgeons and administrators who view us as less than the surgeon or any physician who does not bring business to the hospital.
3. It is reasonable at some point in the practice to expect comparable pay for comparable work in the same setting and a generally fair splitting of the pie. Employment arrangements and organizational structure within many, but not all, anesthesia groups makes this often impossible. Be they private practice, hospital employee, or AMC.

The emotional reasons are responsible for lots of the gloom and doom, IMO

My personal bias is that I come from a country where there were no midlevels, and there was more respect for physicians in the healthcare system. I still can't stomach how low the American physician has sunk and continues to do so. It's not all about money. I did not train so hard for so long to be an underling, a grunt, especially not one controlled by people who know less, think less and generally are less. It can be very frustrating, especially in big places. Students should look at the whole package.

An anesthesiologist who makes 300k per year, after 9-10 years of postgraduate sacrifices (and many before) works about 2200 hours for that, being paid at around $125 plus benefits per hour. My talented stylist makes that money before business expenses, but he also has employees that make him extra money, and generally gets to work as much or as little as he wants. There are car mechanics who make that hourly money. Your plumber will bill you much more, especially outside of business hours. Etc. And money is worth about 40% less than 10 years ago, so these numbers are much less impressive than you'd think. Just to put it into perspective. Again, that does not include the stress level, and the risk of losing everything you have worked for in just one mistake, especially one made by a team member you have little control over.

Money is a perk. Don't choose your specialty based on the money you think you'll make. Personally, as an immigrant, I feel extremely lucky regardless of my whining, but you should know what you're facing.

Before you choose anesthesia, think about the lifetime role you'd like in Downton Abbey. If it's downstairs, go for it.

 

[Carbocation1]

Is this a list of specialties that have been taken over by midlevels enough to avoid or are there more

• ACNP: Acute Care Nurse Practitioner
• AGACNP: Adult-Gerontology Acute Care Nurse Practitioner
• ANP: Adult Nurse Practitioner
• APHN: Advanced Public Health Nurse
• APRN: Advanced Practice Registered Nurse (Same as Advanced Practice Nurse)
• APN: Advanced Practice Nurse (Refers to the four recognized general areas of advanced professional specialization: CRNA, NP, CNM, and CNS)
• ARNP: Advanced Registered Nurse Practitioner (Refers to Nurse Practitioners in some US States)
• C or BC following a title: Certified or Board Certified (i.e., APRN-BC, WHNP-BC, PNP-BC, FNP-C, GNP-C, ANP-BC)
• CMCN: Certified Managed Care Nurse
• CNM: Certified Nurse Midwife
• CNS: Clinical Nurse Specialist
• CRNP: Certified Registered Nurse Practitioner
• CS: Clinical Specialist
• CRNA: Certified Registered Nurse Anesthetist
• DNP: Doctor of Nursing Practice (the terminal professional degree for APNs)
• FNP: Family Nurse Practitioner
• GNP: Gerontological Nurse Practitioner
• NNP: Neonatal Nurse Practitioner
• NP: Nurse Practitioner
• ONP: Oncology Nurse Practitioner
• PMHCNS: Psychiatric & Mental Health Clinical Nurse Specialist
• PMHNP: Psychiatric & Mental Health Nurse Practitioner
• PNP: Pediatric Nurse Practitioner
• PsyNP: Psychiatric Nurse Practitioner
• WHNP: Women's Health Nurse Practitioner

https://en.wikipedia.org/wiki/Advanced_practice_registered_nurse

 

[Man o War]

Thanks for the explanation. Hopefully my reaction wasn't idiotic. Anyways, I do think about the future of different specialties often. Many medical students solely pick a specialty based on prestige or today's salary or something or other. I'm trying to analytically pick a specialty I enjoy, with a decent enough income, with a bright future ahead. Unfortunately it seems like midlevels are taking over most fields except surgical specialties like you mentioned and I won't be able to have those three things. I don't really want to be a surgeon and many of those fields are tough to get into. I guess I don't know where that leaves me. Do I suck up 5-7+ years of not having a life for a better future/disliking my job or do I do something I enjoy (not necessarily anesthesia) and give up future marketability, prestige, pay? Are there any non-surgical fields with a positive future? Just rants from a med student.

DO NOT go into surgery if you don't like it. You will be a miserable human being for the next 30 plus years if you do. We can all look around at our jobs and find these surgeons. I would take a pay cut before I'd want to trade places with any of them. I was seriously between ortho and anesthesia when somebody gave me this advice and I'm so glad for it. I would've been miserable in surgery. Plus, the future is not guaranteed for any of us. All it takes is a few election cycles, and you could be a miserable surgeon who is employed by a hospital and making the kind of money that is being thrown around on this thread anyway.

 

[Planktonmd]

Is this a list of specialties that have been taken over by midlevels enough to avoid or are there more

• ACNP: Acute Care Nurse Practitioner
• AGACNP: Adult-Gerontology Acute Care Nurse Practitioner
• ANP: Adult Nurse Practitioner
• APHN: Advanced Public Health Nurse
• APRN: Advanced Practice Registered Nurse (Same as Advanced Practice Nurse)
• APN: Advanced Practice Nurse (Refers to the four recognized general areas of advanced professional specialization: CRNA, NP, CNM, and CNS)
• ARNP: Advanced Registered Nurse Practitioner (Refers to Nurse Practitioners in some US States)
• C or BC following a title: Certified or Board Certified (i.e., APRN-BC, WHNP-BC, PNP-BC, FNP-C, GNP-C, ANP-BC)
• CMCN: Certified Managed Care Nurse
• CNM: Certified Nurse Midwife
• CNS: Clinical Nurse Specialist
• CRNP: Certified Registered Nurse Practitioner
• CS: Clinical Specialist
• CRNA: Certified Registered Nurse Anesthetist
• DNP: Doctor of Nursing Practice (the terminal professional degree for APNs)
• FNP: Family Nurse Practitioner
• GNP: Gerontological Nurse Practitioner
• NNP: Neonatal Nurse Practitioner
• NP: Nurse Practitioner
• ONP: Oncology Nurse Practitioner
• PMHCNS: Psychiatric & Mental Health Clinical Nurse Specialist
• PMHNP: Psychiatric & Mental Health Nurse Practitioner
• PNP: Pediatric Nurse Practitioner
• PsyNP: Psychiatric Nurse Practitioner
• WHNP: Women's Health Nurse Practitioner

https://en.wikipedia.org/wiki/Advanced_practice_registered_nurse

You need to spend a few days in the OR to understand the CRNA issue.
The AANA, the ASA, the government, and all the insurance carriers are all actively pushing to transform anesthesiology into a nursing domain.
I know you think that your list is cute but anesthesiology is in a uniquely crappy position and anyone who is unable to see that is either naive or blind.

 

[Carbocation1]

You need to spend a few days in the OR to understand the CRNA issue.
The AANA, the ASA, the government, and all the insurance carriers are all actively pushing to transform anesthesiology into a nursing domain.
I know you think that your list is cute but anesthesiology is in a uniquely crappy position and anyone who is unable to see that is either naive or blind.

I have spent many days in the OR... and I didn't like how crnas were doing basically everything from start to finish while my mentor was the pre-op monkey and liability sponge. Other times they were close to killing the patient when we happened to walk in just in time.

 

[criticalelement]

My personal bias is that I come from a country where there were no midlevels, and there was more respect for physicians in the healthcare system. I still can't stomach how low the American physician has sunk and continues to do so. It's not all about money. I did not train so hard for so long to be an underling, a grunt, especially not one controlled by people who know less, think less and generally are less. It can be very frustrating, especially in big places. Students should look at the whole package.

An anesthesiologist who makes 300k per year, after 9-10 years of postgraduate sacrifices (and many before) works about 2200 hours for that, being paid at around $125 plus benefits per hour. My talented stylist makes that money before business expenses, but he also has employees that make him extra money, and generally gets to work as much or as little as he wants. There are car mechanics who make that hourly money. Your plumber will bill you much more, especially outside of business hours. Etc. And money is worth about 40% less than 10 years ago, so these numbers are much less impressive than you'd think. Just to put it into perspective. Again, that does not include the stress level, and the risk of losing everything you have worked for in just one mistake, especially one made by a team member you have little control over.

Money is a perk. Don't choose your specialty based on the money you think you'll make. Personally, as an immigrant, I feel extremely lucky regardless of my whining, but you should know what you're facing.

Before you choose anesthesia, think about the lifetime role you'd like in Downton Abbey. If it's downstairs, go for it.

Finally someone who knows what the F*** he is talking about. Dude youre a hero.. The only people who get aroused for 300k are the one's who are not doing what we do day in and day out.

 

[criticalelement]

You need to spend a few days in the OR to understand the CRNA issue.
The AANA, the ASA, the government, and all the insurance carriers are all actively pushing to transform anesthesiology into a nursing domain.
I know you think that your list is cute but anesthesiology is in a uniquely crappy position and anyone who is unable to see that is either naive or blind.

Very true.

The only reason we are not a completely nursing domain is because horrific events still happen in the peri-operative period. Albeit rare but they do happen. And they happen to people that are healthy. The administrators cannot guess which ones so here we still are. But once they have a better handle on the morbidity/mortality we will be cut out.

 

[gasp]

Basically he told me to think very hard about it and that the glory days are over..

 

[Random Anesthesiologist]

This is true. However, if someone truly wants to escape and doesn't mind the outpatient setting - interventional pain is a decent option too, there you get to be the boss too.

Crnas are encroaching there too. Slower, but it's happening.