Question for Blade

[Silent Cool]

Blade,

If you were a med student today, what field would you apply to? Would you still do anesthesia?


thanx

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[Spikebd]

Lol, Blade is one of my favorite posters and I think that he has already answered this question recently. I'll do a quick search and link it for you.

Edit - just searched a little bit and couldnt find it. Hopefully blade chimes in with a new perspective. I might be interested in anesthesia... four years from now.

 

[Dwindlin]

I don't know if he means for him personally, but I've seen him recommend surgical sub-specialties recently when this question gets posed.

 

[scudrunner]

Pretty sure he's said either neurosurgery or interventional/EP cardiology in the past.

 

[Silent Cool]

Yeah, I do remember blade saying something along the lines of 1) surg sub-spec or 2) derm.

I just wanted further clarification and to make his thoughts the focus of a particular thread.

Other anesthesia docs who also have nearly famous status on here...you know who you are...feel free to chime in as well.

thanx

 

[D P356]

Blade is one of my favorites as well. He presents a lot of information which we otherwise would not have seen.

I sarcastically jeer at him for his posting style, but he brings a lot to this forum and we're lucky to have him.

But I take what he writes (and everyone else) with grain of salt.

 

[bronx43]

Pretty sure he's said either neurosurgery or interventional/EP cardiology in the past.

You should totally do interventional or EP if you enjoy spending 7-8 years in training and not have a job afterwards. There's actually a joke going around the cardio circle that goes like this. How do you find an interventional cardiologist in California? Yell "waiter!"
And they're still pumping out 200+ interventional guys every year when the cath volume in this country has peaked and on its way down. And new procedures like valve replacements aren't high volume enough to sustain them. Peripherals are a dog fight against vascular surgery and IR, who is now starting to develop their own clinical services.
And let's not forget to mention that given the novelty of the field of interventional cardiology, you won't be having the mythical "exodus" - the Deus Ex Machina, if you will - of practitioners that young graduates of other fields are hoping and waiting for...

 

[BLADEMDA]

You should totally do interventional or EP if you enjoy spending 7-8 years in training and not have a job afterwards. There's actually a joke going around the cardio circle that goes like this. How do you find an interventional cardiologist in California? Yell "waiter!"
And they're still pumping out 200+ interventional guys every year when the cath volume in this country has peaked and on its way down. And new procedures like valve replacements aren't high volume enough to sustain them. Peripherals are a dog fight against vascular surgery and IR, who is now starting to develop their own clinical services.
And let's not forget to mention that given the novelty of the field of interventional cardiology, you won't be having the mythical "exodus" - the Deus Ex Machina, if you will - of practitioners that young graduates of other fields are hoping and waiting for...

An American Graduate from a top 20 EP Fellowship would make at least $1 million per year in my area right now. Yes, they are all Medicare but the volume is staggering not to mention AICDS.

Just like Anesthesia the real money is in small towns, BFE, etc. because there aren't enough qualified Physician providers at those locations.

 

[BLADEMDA]

1. Neurosurgery- because it is brain surgery my friend.
2. Derm
3. Interventional Cards/EP (I like the field- no NPs)
4. Ortho
5. ENT
6. Urology
7. Interventional Rads
8. Retinal Surgery
9. Maxillofacial
10. Hand Surgery

There are my top ten but not necessarily in any order. Pain Medicine would be number 11.

 

[Silent Cool]

1. Neurosurgery- because it is brain surgery my friend.
2. Derm
3. Interventional Cards/EP (I like the field- no NPs)
4. Ortho
5. ENT
6. Urology
7. Interventional Rads
8. Retinal Surgery
9. Maxillofacial
10. Hand Surgery

There are my top ten but not necessarily in any order. Pain Medicine would be number 11.

Blade, are you fellowship-trained? If not would you personally consider a pain fellowship?

 

[Ronin786]

Ill never understand how dermatologists make big bucks. No offense to the dermatologists out there, but I don't think there's a specialty that has less to do with medicine than dermatology.

 

[BLADEMDA]

Ill never understand how dermatologists make big bucks. No offense to the dermatologists out there, but I don't think there's a specialty that has less to do with medicine than dermatology.

Book Smart vs Street smart and Derm is a lot of the latter.

 

[BLADEMDA]

Blade, are you fellowship-trained? If not would you personally consider a pain fellowship?

I've posted that info already in the private forum.

 

[bronx43]

An American Graduate from a top 20 EP Fellowship would make at least $1 million per year in my area right now. Yes, they are all Medicare but the volume is staggering not to mention AICDS.

Just like Anesthesia the real money is in small towns, BFE, etc. because there aren't enough qualified Physician providers at those locations.

The attendings at my institution are pulling 1.5-2 mil per year, as well. However, that doesn't mean you can squeeze into those positions as a fresh grad. This is especially true for the medical students, who are going to be 8 years out. The BFE locations do have potential, but a lot lack the proper infrastructure, not to mention CT surgery back-up. As far as cardio, the job market goes heart failure >>> general cards > interventional >>>>>>> EP. And bless the HF guys... they train 4 more years than a hospitalist but make only slightly more money.

 

[PhilDunphy]

1. Neurosurgery- because it is brain surgery my friend.
2. Derm
3. Interventional Cards/EP (I like the field- no NPs)
4. Ortho
5. ENT
6. Urology
7. Interventional Rads
8. Retinal Surgery
9. Maxillofacial
10. Hand Surgery

There are my top ten but not necessarily in any order. Pain Medicine would be number 11.

Thanks for the input! I assume this is based on income potential and perceived stability in the field? Does anesthesia fall from this list because of CRNA-creep into the field? The anesthesia department seems to be a pretty happy place at my institution, so I'm just trying to get a better sense of the doom and gloom that flourishes on here.

Also, there are some pretty significant differences in lifestyle choices in this list. Sure, you can be the 4 day a week neurosurgeon who swims Scrooge McDuck style through his/her pile of cash, but it takes a lot of years of slogging through training/new grad status to get there.

 

[aneftp]

8-9 years for EP training. 3 years internal. Maybe one year chief. 3 years cards. Another 1-2 EP fellowship. U are basically 35-36 when done. Long road

Don't worry. Cuts with hit the EP guys sooner than later.

The trend is to make doctors public servents.

 

[IN2B8R]

Become a guy who sells hair wigs. You will make more money than any of those "top 10" medical specialties.

 

[yesno]

The attendings at my institution are pulling 1.5-2 mil per year, as well. However, that doesn't mean you can squeeze into those positions as a fresh grad. This is especially true for the medical students, who are going to be 8 years out. The BFE locations do have potential, but a lot lack the proper infrastructure, not to mention CT surgery back-up. As far as cardio, the job market goes heart failure >>> general cards > interventional >>>>>>> EP. And bless the HF guys... they train 4 more years than a hospitalist but make only slightly more money.

So what would you recommend for a student who does not feel that he is #1. I am definitely not competitive for most of those specialties that blade listed. And whatever specialty I end up in, I would not want to be one of those unemployed people while somebody else is making millions) It seems that on that list radiology, cardiology, and pain(anesthesia) are a possibility for me. They all require at least 5yrs of residency... So please don't tell me that I am lazy or motivated by money. I am older than a traditional student, so that's why I am concerned about finances. So the question is what is the job outlook for a mediocre graduate of noninterventional cardiology vs general anesthesia vs pain vs interventional radiology? I also want to live in florida or california. And it is not so much the absolute salary that matters to me as job stability and being in demand. I.e. hospitalists are in demand, but I wonder if they will be 10yrs from now considering that IM residency numbers are increasing more than any other specialty.

 

[bronx43]

So what would you recommend for a student who does not feel that he is #1. I am definitely not competitive for most of those specialties that blade listed. And whatever specialty I end up in, I would not want to be one of those unemployed people while somebody else is making millions) It seems that on that list radiology, cardiology, and pain(anesthesia) are a possibility for me. They all require at least 5yrs of residency... So please don't tell me that I am lazy or motivated by money. I am older than a traditional student, so that's why I am concerned about finances. So the question is what is the job outlook for a mediocre graduate of noninterventional cardiology vs general anesthesia vs pain vs interventional radiology? I also want to live in florida or california. And it is not so much the absolute salary that matters to me as job stability and being in demand. I.e. hospitalists are in demand, but I wonder if they will be 10yrs from now considering that IM residency numbers are increasing more than any other specialty.

I wouldn't go radiology, interventional or otherwise. As far as anesthesia, I would ask these guys around here. Can you get into a good academic program for IM? There are a handful of decent options for IM subspecialties that isn't cardiology. GI, heme onc, pulmonary/CC, allergy are all pretty nice gigs. GI and allergy are probably the most competitive of all IM fellowships. GI guys will bank as long as scoping reimburses well. If you have good business acumen in allergy, you'll BANK. The allergist here in town (medium sized city in the Midwest) pulled $1.5 mil last year. No joke, his cousin is a co-resident.

 

[BLADEMDA]

I wouldn't go radiology, interventional or otherwise. As far as anesthesia, I would ask these guys around here. Can you get into a good academic program for IM? There are a handful of decent options for IM subspecialties that isn't cardiology. GI, heme onc, pulmonary/CC, allergy are all pretty nice gigs. GI and allergy are probably the most competitive of all IM fellowships. GI guys will bank as long as scoping reimburses well. If you have good business acumen in allergy, you'll BANK. The allergist here in town (medium sized city in the Midwest) pulled $1.5 mil last year. No joke, his cousin is a co-resident.

Gi and Heme/Onc are fine choices. As for Pulm/CC or Allergy I would rather do Anesthesia CC or Pain.

 

[BLADEMDA]

So what would you recommend for a student who does not feel that he is #1. I am definitely not competitive for most of those specialties that blade listed. And whatever specialty I end up in, I would not want to be one of those unemployed people while somebody else is making millions) It seems that on that list radiology, cardiology, and pain(anesthesia) are a possibility for me. They all require at least 5yrs of residency... So please don't tell me that I am lazy or motivated by money. I am older than a traditional student, so that's why I am concerned about finances. So the question is what is the job outlook for a mediocre graduate of noninterventional cardiology vs general anesthesia vs pain vs interventional radiology? I also want to live in florida or california. And it is not so much the absolute salary that matters to me as job stability and being in demand. I.e. hospitalists are in demand, but I wonder if they will be 10yrs from now considering that IM residency numbers are increasing more than any other specialty.

1. Pain
2. Interventional Cardiology
3. Gi
4. Heme/Onc
5. Critical Care Medicine- Anesthesia
6. Peds Anesthesia

There are 6 solid choices for you.

 

[bkell101]

1. Pain
2. Interventional Cardiology
3. Gi
4. Heme/Onc
5. Critical Care Medicine- Anesthesia
6. Peds Anesthesia

There are 6 solid choices for you.

Blade,

Why cc anes over pediatric anes? I remember on interview trail seemed like a bunch of people going into peds....

Happy to hear you say cc though because that's what I'd like to do.

 

[yesno]

Thank you all! Did not mean to hijack. I've been reading this forum for a long time, and it is very interesting that radiology was highly recommended just a year ago, but not any more. I wonder if residency match for anesthesia will be more competitive than radiology in a few years?Any thoughts on PMR? They seem to have pain as an option and it's much less competitive? And I am still interested in IM, just not GI or Cancer. But it's something I will learn more about in my rotations.

 

[BLADEMDA]

Blade,

Why cc anes over pediatric anes? I remember on interview trail seemed like a bunch of people going into peds....

Happy to hear you say cc though because that's what I'd like to do.

Peds anesthesia is more lucrative than CCM by a wide margin. I didn't mean to rank those specialties in any specific order but rather list 6 that an average med student could match into

 

[sandnsurf]

Peds anesthesia is more lucrative than CCM by a wide margin. I didn't mean to rank those specialties in any specific order but rather list 6 that an average med student could match into

Thanks, Blade. This is helpful.

Your 6 choices are focused on IM and anesthesia. But for people who like pediatrics (I like peds) neonatology and PICU could be a good fit too. These are: (1) obtainable as an average med student; (2) as far as I'm aware the current job market is open and looks to remain open for years to come; and (3) judging by MGMA (2010) the salary looks great to me.

 

[BLADEMDA]

Thanks, Blade. This is helpful.

Your 6 choices are focused on IM and anesthesia. But for people who like pediatrics (I like peds) neonatology and PICU could be a good fit too. These are: (1) obtainable as an average med student; (2) as far as I'm aware the current job market is open and looks to remain open for years to come; and (3) judging by MGMA (2010) the salary looks great to me.

1. You need to like your field/job or plan on retiring early.
2. Salary should at least be decent. This means $250K+ (JPP says $400)
3. Job market when you finish looks decent (get out your crystal ball)
4. Midlevels- Do you want a field with minimal midlevel encroachment?
5. ObamaCare- Will you be a valued provider under ObamaCare?

Does Neonatology and PICU pass the test?

 

[Wildstang]

No rad onc?

 

[HollATme]

I'd pick rad onc before anesthesia.

Of course, rad onc is likely a lot more competitive. bulk up on research and have a good score/GPA.

 

[Dwindlin]

I'd pick rad onc before anesthesia.

Of course, rad onc is likely a lot more competitive. bulk up on research and have a good score/GPA.

Understatement considering 35-40% of those who match have Ph.D.'s.

 

[HollATme]

Understatement considering 35-40% of those who match have Ph.D.'s.

True. Poster was listed as "pre-med" so yes, he/she should apply for MD/PhD programs. Free tuition too.

However, if you are strictly an MD at a heavily academic institution, research opportunities are still abundant without spending ~ 3 extra years doing research.

 

[msmith83]

BLADE, I know you haven't posted in this thread for almost a year but since my other thread was semi high-jacked would you mind clarifying your opinion on Pain medicine as a career choice?

I know you tend to warn against anesthesia, but is Pain Management still a decent realm within Anesthesia? Thanks in advance for any advice you can offer, you've offered some great advice already

As you know from the other thread, I'm interested mainly in either IM or Anesthesia.... specifically GI, Cards, Hem/Onc, or Pain Medicine. As far as that goes I'm an average student, so that kind of cuts out GI and Cardio to some extent

 

[Arch Guillotti]

I know you tend to warn against anesthesia, but is Pain Management still a decent realm within Anesthesia? Thanks in advance for any advice you can offer, you've offered some great advice already

Try searching the pain forum. More doom and gloom over there that there is here.

 

[msmith83]

Try searching the pain forum. More doom and gloom over there that there is here.

So that'd be a no?

Just wondering since in another thread he discouraged going into anesthesia at all yet in here he notes Pain as a good area to go into. Not sure if he is referring to going into pain from another specialty

 

[BLADEMDA]

BLADE, I know you haven't posted in this thread for almost a year but since my other thread was semi high-jacked would you mind clarifying your opinion on Pain medicine as a career choice?

I know you tend to warn against anesthesia, but is Pain Management still a decent realm within Anesthesia? Thanks in advance for any advice you can offer, you've offered some great advice already

As you know from the other thread, I'm interested mainly in either IM or Anesthesia.... specifically GI, Cards, Hem/Onc, or Pain Medicine. As far as that goes I'm an average student, so that kind of cuts out GI and Cardio to some extent

Let's review a few things here.

Why does an "average" med student have ZERO chance at Gi or Cards? If you match at a decent IM program and work hard why couldn't you land a fellowship in something? You need to be the kind of Resident who works hard, shows respect, amicable and goes the extra mile. On top of that put in some effort towards research while doing your IM residency.

As for Pain Medicine the income is being slashed by 1/3 but the lifestyle is still much better than O.R. anesthesia. The days of $800K Pain jobs may be waning but working hard and earning $500K is ABSOLUTELY on the table. I still recommend Pain as the best combination of money and lifestyle for a one year fellowship after Anesthesiology.

CCM is a solid choice provided you like the field and the sickest patients (ASA4 doesn't do them justice these days). Lifestyle vs Income is much harder for CCM vs PAIN.

Honestly, as long as you are aware of the Positives/Negatives of each of these fields the dissatisfaction will be much less post Residency.

 

[BLADEMDA]

Let's provide a recent example:

A dude recently graduated med school. He was at the bottom 1/3 of the class. He scrambled and landed a General Surgery spot (preliminary). He worked hard and did well on his ITE. He was then offered a Categorical spot as a General Surgery Resident. After the Residency he applied and landed a Hand Fellowship. This individual is now a hand surgeon earning $500K per year.

Second example:

A person was at the bottom of the class. She managed to match only into a Preliminary Medicine year. But, after that year was completed she secured a spot in an Anesthesiology Residency at a Bottom program (think the bottom 5). Following the Residency she got a Pediatric Fellowship. She is now earning $450K doing peds.

I know of many more examples. Med School isn't the end of your career- it is just the beginning. Whether you choose IM, Surgery, Anesthesia, etc. there are ample opportunities to do well in life. Don't give up and work hard to improve your situation.

 

[msmith83]

Let's review a few things here.

Why does an "average" med student have ZERO chance at Gi or Cards? If you match at a decent IM program and work hard why couldn't you land a fellowship in something? You need to be the kind of Resident who works hard, shows respect, amicable and goes the extra mile. On top of that put in some effort towards research while doing your IM residency.

As for Pain Medicine the income is being slashed by 1/3 but the lifestyle is still much better than O.R. anesthesia. The days of $800K Pain jobs may be waning but working hard and earning $500K is ABSOLUTELY on the table. I still recommend Pain as the best combination of money and lifestyle for a one year fellowship after Anesthesiology.

CCM is a solid choice provided you like the field and the sickest patients (ASA4 doesn't do them justice these days). Lifestyle vs Income is much harder for CCM vs PAIN.

Honestly, as long as you are aware of the Positives/Negatives of each of these fields the dissatisfaction will be much less post Residency.

Very good point and thanks again for the incite.

I guess my thinking with GI/Cards is the idea that I know I would not be happy outside of a certain amount of specialties within IM (Hem/Onc as well though I haven't had much exposure) so I feel like I would have to be happy IF the end result ended up being that I had to practice general IM, which I don't think I would be.

In other words, I know I'd be happier doing Anesthesia vs general IM. I do plan on working extremely hard during residency but I also know I probably study more than most of my class, yet still end up with just average scores. I would just like to know that regardless of what I do (because I enjoy several different areas) I want to be able to have the opportunity to be my own boss or partner and not have a fixed set limit of my income.

 

[BLADEMDA]

Very good point and thanks again for the incite.

I guess my thinking with GI/Cards is the idea that I know I would not be happy outside of a certain amount of specialties within IM (Hem/Onc as well though I haven't had much exposure) so I feel like I would have to be happy IF the end result ended up being that I had to practice general IM, which I don't think I would be.

In other words, I know I'd be happier doing Anesthesia vs general IM. I do plan on working extremely hard during residency but I also know I probably study more than most of my class, yet still end up with just average scores. I would just like to know that regardless of what I do (because I enjoy several different areas) I want to be able to have the opportunity to be my own boss or partner and not have a fixed set limit of my income.

I agree with you and that's why I'm so "negative" about Anesthesiology. The loss of control is a major negative in my opinion. Of course, we may all end up as government employees but that could take 20 or 30 years. Hence, why choose to be an employee forever if you don't have to?

 

[BuzzPhreed]

There is potential for anti-trust litigation with the current trend of anesthesia management and consolidation of groups. In the meantime I think graduating residents should not just take what is handed to them but instead strongly considering a less than desirable geographic move to get what they want.

http://www.thehealthlawpartners.com/files/size_matters.pdf

 

[msmith83]

I agree with you and that's why I'm so "negative" about Anesthesiology. The loss of control is a major negative in my opinion. Of course, we may all end up as government employees but that could take 20 or 30 years. Hence, why choose to be an employee forever if you don't have to?

Sorry to sound like a broken record but do feel like private practice jobs in PM Anesthesia will be a viable option for the future? At least as long as other areas I mean.

 

[BLADEMDA]

Sorry to sound like a broken record but do feel like private practice jobs in PM Anesthesia will be a viable option for the future? At least as long as other areas I mean.

Yes. Private practice for Pain Medicine will exist as long as the other specialties. You don't need to work for an AMC or hospital but I know a few pain docs working 40 hours per week (or less) for a HMO at $375K. No call. No weekends. No holidays.

 

[sloh]

Hey Blade, not sure if you have answered this elsewhere but what are your thoughts on pursuing pain medicine with PM&R instead of Anesthesia?

 

[HollATme]

Hey Blade, not sure if you have answered this elsewhere but what are your thoughts on pursuing pain medicine with PM&R instead of Anesthesia?

I say go PM&R if you enjoy it. It'll be easier (relatively) with the anesthesia route; however, there are pain programs that cater to PM&R grads and the competition is not nearly as stiff as it would be if one were coming from psychiatry, medicine, etc.

 

[Spinach Dip]

I also want to live in florida or california.

There's your problem.

Why not Topeka? Or Boise? Or Nashville? I hear people in those places need doctors too.



(EDIT: sorry for responding to a year-old post, but this one line irked me.)

 

[HollATme]

There's your problem.

Why not Topeka? Or Boise? Or Nashville? I hear people in those places need doctors too.



(EDIT: sorry for responding to a year-old post, but this one line irked me.)

Why does that bother you?

 

[LeverArm]

Yes. Private practice for Pain Medicine will exist as long as the other specialties. You don't need to work for an AMC or hospital but I know a few pain docs working 40 hours per week (or less) for a HMO at $375K. No call. No weekends. No holidays.

How realistic is it to do 50:50 gas and pain? I heard pain gas pays a lot higher than pmr/neuro pain if your willing to do pain by day and gas call by night. Its one of the reasons pain fellowships at one place I rotated at said they try to keep it as much anesthesia trained as possible so that fellows can do acute pain and call during training.

 

[Telekinesis]

1. Neurosurgery- because it is brain surgery my friend.
2. Derm
3. Interventional Cards/EP (I like the field- no NPs)
4. Ortho
5. ENT
6. Urology
7. Interventional Rads
8. Retinal Surgery
9. Maxillofacial
10. Hand Surgery

There are my top ten but not necessarily in any order. Pain Medicine would be number 11.

Isn't it relatively difficult for the average student to match optha to become a retinal surgeon?

 

[GABAergic]

Isn't it relatively difficult for the average student to match optha to become a retinal surgeon?

Of the others on the list, neurosurgery, derm, urology, ortho, and ENT are probably more difficult/at least as difficult to match into as compared to ophtho. Rads too. And most hand surgery fellows come from ortho or plastics. So yeah, ophtho isn't the least competitive field, but it's not the most difficult match either.

 

[Telekinesis]

Of the others on the list, neurosurgery, derm, urology, ortho, and ENT are probably more difficult/at least as difficult to match into as compared to ophtho. Rads too. And most hand surgery fellows come from ortho or plastics. So yeah, ophtho isn't the least competitive field, but it's not the most difficult match either.

Interesting. So you're saying an average student from an average school with an average Step can match optha?