Rhode Island Residency/Job Prospects

[RogueBanana]

Hey all,

Sorry if this question has been answered, but I couldn't find any threads on the issue from this decade!

1- Anyone know what the base level of competitiveness is for a Rhode Island/Massachusetts anesthesia residency?

2- On that topic, how is the job market in this area?

3- Are reimbursements in this area generally okay? A Doctor relative of mine suggested I work in Massachusetts because RI has poor Md reimbursement. However I really don't want to commute 1.5 hours to Boston every day.

I am a Rhode Island resident going to NY for Med school. I hope to do my elective rotations at Rhode Island Hospital or a similar hospital and make connections to the area since RI is such a small community.

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[deleted162650]

The Northeast is an AMC wasteland with a few predatory PP groups thrown in. Good luck out there.

 

[AdmiralChz]

I don't have any personal experience with it, but the prevailing opinion on SDN is that the upper NE is not a great market as Salty said. That being said, I am sure there are some good jobs there. If you are from the area, make some connections in your home town and get connected early to learn the lay of the land for anesthesia. There are some AMC employees who are quite happy (and some PP employees who feel overworked and exhausted), so ask around. I did this in my home town (mid-Atlantic) and it eventually landed me a solid job I'm excited about in the area.

The academic jobs, if you are inclined, can be quite prestigious but tough to land without a top-notch residency (likely + fellowship for Harvard hospitals). But not every hospital is MGH, and the level of douche/god complex in the surgeons there is reportedly legendary.

1- Anyone know what the base level of competitiveness is for a Rhode Island/Massachusetts anesthesia residency?

Too broad of a question. The Harvard programs (MGH, BWH, BI) are among the most competitive in the nation, but there are other more-community based programs in the area that are easier to get in to. I'm in the SE and can't speak to specifics beyond those, I am sure others have input though.

Being from the NE will help you though, as there is some degree of regionality in all programs (NE people tend to stay in NE, etc...).

 

[RogueBanana]

I don't have any personal experience with it, but the prevailing opinion on SDN is that the upper NE is not a great market as Salty said. That being said, I am sure there are some good jobs there. If you are from the area, make some connections in your home town and get connected early to learn the lay of the land for anesthesia. There are some AMC employees who are quite happy (and some PP employees who feel overworked and exhausted), so ask around. I did this in my home town (mid-Atlantic) and it eventually landed me a solid job I'm excited about in the area.

The academic jobs, if you are inclined, can be quite prestigious but tough to land without a top-notch residency (likely + fellowship for Harvard hospitals). But not every hospital is MGH, and the level of douche/god complex in the surgeons there is reportedly legendary.



Too broad of a question. The Harvard programs (MGH, BWH, BI) are among the most competitive in the nation, but there are other more-community based programs in the area that are easier to get in to. I'm in the SE and can't speak to specifics beyond those, I am sure others have input though.

Being from the NE will help you though, as there is some degree of regionality in all programs (NE people tend to stay in NE, etc...).

Thanks for the reply!

I'm really not looking for Mass Gen/Harvard, the most prestigious program I can think of in the area is Brown/RI hospital. I'm not going to a top 25 Med school so anything Ivy League in terms of residency is likely out of the question for me.

I don't mind AMC, at least for the start of my career. I know some private pain management places in really good areas of Rhode Island (rich, stuffy soccer moms with back pain galore).

I don't need prestige or power, any job close to the family in RI with decent pay is more than enough for me. I just wanna see patients and live close to home.

 

[RogueBanana]

On another note, is gas still worth going into in your opinion? I've been stalking the forums and many call it a dying specialty...

 

[GravelRider]

There are plenty of jobs in the northeast...including Rhode Island. There are very few good jobs in the northeast...maybe even none. The benefit to Massachusetts and Rhode Island is that they are known not to enforce non-compete clauses. With that said, a good anesthesia job in the northeast will pay 350k with 4-6 weeks vacation. Often you will see starting salaries at 300k or less with 4 weeks vacation.

You're paying a premium to enjoy the wonderful northeastern winters...

 

[noneck_4400]

There's currently no residency program at Brown, but rumor has it one is in the works. If you're MD'21 I'd expect it'll be an option on the table when you apply.

 

[Scotty_G]

Yes the Northeast in general is not great for anesthesia due to many AMC's or pp groups with ridiculous long partnership tracks etc. With that being said there are still some good pp groups in the NE. As much as friends/connections is key here, few admit that luck plays a decent role as well. RI def has to be better than NY/NJ and parts of MASS(round boston) Yes Brown does not have a program but you have the CT programs too.

 

[deleted171991]

On another note, is gas still worth going into in your opinion? I've been stalking the forums and many call it a dying specialty...

As years pass, your chances of having a good life in this specialty are decreasing exponentially. I would almost bet that, in 10 years, this will be mostly a nurse supervising (not directing, just supervising) firefighter specialty. It will be a like an employed PCP who sees 40 patients/day for Medicare peanuts.

It's already happening on the East Coast; go visit a private practice. Even if they sign for medical direction on paper, most docs in some practices don't meet all the TEFRA criteria for most cases. The nurses basically do whatever the heck they want; you tell them not to do something, they don't care.

 

[deleted162650]

There's a RI guy on this board. Maybe he'll come out of the woodwork and PM you some details.

 

[Hoya11]

Hey all,

Sorry if this question has been answered, but I couldn't find any threads on the issue from this decade!

1- Anyone know what the base level of competitiveness is for a Rhode Island/Massachusetts anesthesia residency?

2- On that topic, how is the job market in this area?

3- Are reimbursements in this area generally okay? A Doctor relative of mine suggested I work in Massachusetts because RI has poor Md reimbursement. However I really don't want to commute 1.5 hours to Boston every day.

I am a Rhode Island resident going to NY for Med school. I hope to do my elective rotations at Rhode Island Hospital or a similar hospital and make connections to the area since RI is such a small community.

I rotated through RIH/Brown as a resident. I did two months. Very nice. Group seemed good too. Best thoracic surgeon I have ever worked with still to this day. I bet they do well too, though I do not have any specifics.. Despite what you are hearing on this board, this particular area (southeastern MA coast into RI) is very underserved/rural/rough and docs can command a bit higher of a salary than boston/nyc areas. (who wants to live there kind of thing) But for the right person who actually does want to live there, I would apply broadly to all the hospitals in the area and see what options you have. You may be positively surprised with a good private group in SE MA or even RIH itself.

 

[smv1200]

So as someone who just matched into Anesthesiology, what are the best regions for solid job opportunities? Midwest, West coast?

 

[GravelRider]

The anesthesiology group at RIH is now part of Lifespan, as far as I know. Lifespan is a mega hospital system that controls the main hospitals in Providence as well as some outlying hospitals like Newport. I believe all of the anesthesiologists at the Lifespan hospitals are employed by Lifespan.

 

[GravelRider]

As years pass, your chances of having a good life in this specialty are decreasing exponentially. I would almost bet that, in 10 years, this will be mostly a nurse supervising (not directing, just supervising) firefighter specialty. It will be a like an employed PCP who sees 40 patients/day for Medicare peanuts.

It's already happening on the East Coast; go visit a private practice. Even if they sign for medical direction on paper, most docs in some practices don't meet all the TEFRA criteria for most cases. The nurses basically do whatever the heck they want; you tell them not to do something, they don't care.

Actually, in the crowded areas of the east coast you do not find high supervision ratios. It's uncommon to find anything over 1:3. There is actually a fair amount of solo work...at least some of the time...in the crowded east coast markets. The reason is that it's actually cheaper to hire an anesthesiologist who will work for cheap and not have defined hours than it is to hire a CRNA who works "three 10s and an 8" every week. There are plenty of independent CRNAs at endoscopy centers and other offices, but that is everywhere. You might have higher ratios in the more rural and northern areas of the east coast, but that is because no one wants to live there...and the pay is still crummy.

 

[skypilot]

The anesthesiology group at RIH is now part of Lifespan, as far as I know. Lifespan is a mega hospital system that controls the main hospitals in Providence as well as some outlying hospitals like Newport. I believe all of the anesthesiologists at the Lifespan hospitals are employed by Lifespan.

Yes it is called Lifespan Physicians Group and employs many of the Anesthesiologists in Rhode Island. Including those at Rhode Island Hosp. The Miriam hosp , Hasbro Childrens, and Newport.

 

[RogueBanana]

Actually, in the crowded areas of the east coast you do not find high supervision ratios. It's uncommon to find anything over 1:3. There is actually a fair amount of solo work...at least some of the time...in the crowded east coast markets. The reason is that it's actually cheaper to hire an anesthesiologist who will work for cheap and not have defined hours than it is to hire a CRNA who works "three 10s and an 8" every week. There are plenty of independent CRNAs at endoscopy centers and other offices, but that is everywhere. You might have higher ratios in the more rural and northern areas of the east coast, but that is because no one wants to live there...and the pay is still crummy.

I wouldn't call upwards of 300k crummy! Maybe that's just cause I don't come from money haha

 

[RogueBanana]

Yes it is called Lifespan Physicians Group and employs many of the Anesthesiologists in Rhode Island. Including those at Rhode Island Hosp. The Miriam hosp , Hasbro Childrens, and Newport.

They don't have their tentacles at roger Williams medical yet, I think RW also has an anesthesia residency

 

[deleted171991]

I wouldn't call upwards of 300k crummy! Maybe that's just cause I don't come from money haha

It is crummy when you run around for 8-10 hours/day and do 2 calls/week, while your employer pockets 40-50% of what they collect.

 

[deleted171991]

Actually, in the crowded areas of the east coast you do not find high supervision ratios. It's uncommon to find anything over 1:3. There is actually a fair amount of solo work...at least some of the time...in the crowded east coast markets. The reason is that it's actually cheaper to hire an anesthesiologist who will work for cheap and not have defined hours than it is to hire a CRNA who works "three 10s and an 8" every week. There are plenty of independent CRNAs at endoscopy centers and other offices, but that is everywhere. You might have higher ratios in the more rural and northern areas of the east coast, but that is because no one wants to live there...and the pay is still crummy.

What I meant is that, already, although they sign for medical direction on paper, a lot of docs basically just supervise and nurses do whatever the heck they want to do. The ASA president was recently complaining that this phenomenon was showing up in academia, too. I have heard of (AMC) practices where CRNAs interview the physician candidates for jobs and have veto power on their hiring.

There are few medical students I have less respect for than those who plan to become anesthesiologists.

 

[RogueBanana]

It is crummy when you run around for 8-10 hours/day and do 2 calls/week, while your employer pockets 40-50% of what they collect.

That's pretty messed up. Didn't know that.

 

[RogueBanana]

What I meant is that, already, although they sign for medical direction on paper, a lot of docs basically just supervise and nurses do whatever the heck they want to do. The ASA president was recently complaining that this phenomenon was showing up in academia, too. I have heard of (AMC) practices where CRNAs interview the physician candidates for jobs and have veto power on their hiring.

There are few medical students I have less respect for than those who plan to become anesthesiologists.

Then what do you suggest medical students interested in this type of work go into?

 

[deleted171991]

Then what do you suggest medical students interested in this type of work go into?

Students who are interested in this type of work should have gone to CRNA school, and saved a lot of money and headaches in the process.

 

[RogueBanana]

Students who are interested in this type of work should have gone to CRNA school, and saved a lot of money and headaches in the process.

 

[Man o War]

@FFP I'm almost positive I've seen you say on here that you won't have anesthesia with an independent CRNA because of their lack of training and their mismanagement of cases that you've witnessed, so why would you not respect students who actually want to keep patients safe from that?
It literally terrifies me to think of showing up at a hospital emergently and not having access to an anesthesiologist.
I hope the strong students continue to choose anesthesia so that scenario won't come to fruition for me.

 

[GravelRider]

@FFP I'm almost positive I've seen you say on here that you won't have anesthesia with an independent CRNA because of their lack of training and their mismanagement of cases that you've witnessed, so why would you not respect students who actually want to keep patients safe from that?
It literally terrifies me to think of showing up at a hospital emergently and not having access to an anesthesiologist.
I hope the strong students continue to choose anesthesia so that scenario won't come to fruition for me.

It's nice to see someone more jaded than me. The problem with your premise is that the decision on how to staff hospitals is increasingly being made by someone who cares more about the bottom line and profit more than actual patient care. Silly things like expertise and training levels don't mean a lot when there is a profit to be made (or cost to be cut). As the market becomes more and more diluted by CRNAs (and midlevels in other fields) and they continue to advance their political agenda, the smart and talented student will self select themselves out of pursuing a medical degree. It just doesn't make economic sense.

My local hamburger joint makes a much better burger, but that doesn't mean they'll be able to survive the McDonald's up the road from them.

 

[drmwvr]

Students who are interested in this type of work should have gone to CRNA school, and saved a lot of money and headaches in the process.

If that is what you really believe (forgive me if I'm doubtful) it sounds like, judging from other things you've said here, anesthesiologists better become much more serious and involved in training nurses. In the interests of safety and all of that.

 

[Stank811]

As years pass, your chances of having a good life in this specialty are decreasing exponentially. I would almost bet that, in 10 years, this will be mostly a nurse supervising (not directing, just supervising) firefighter specialty. It will be a like an employed PCP who sees 40 patients/day for Medicare peanuts.

It's already happening on the East Coast; go visit a private practice. Even if they sign for medical direction on paper, most docs in some practices don't meet all the TEFRA criteria for most cases. The nurses basically do whatever the heck they want; you tell them not to do something, they don't care.

The only reason it is happening in the east coast is bc the AMCs are forcing the issue to make more money for their VC partners. The underlying fundamentals on the east coast are strong. If a group could take the contract from an AMC I bet they would do very well.

 

[GravelRider]

The only reason it is happening in the east coast is bc the AMCs are forcing the issue to make more money for their VC partners. The underlying fundamentals on the east coast are strong. If a group could take the contract from an AMC I bet they would do very well.

Yes, and hospitals are getting fed up with AMCs as evidenced by the falling out NAPA is having with the hospital that incubated its formation and EmCare losing some ground. However, the end result is not an opportunity for private practices to thrive again, but rather for mega hospital systems to take the control and employ the anesthesiologists (and all physicians)...like the aforementioned Lifespan.

 

[deleted126335]

Yes, and hospitals are getting fed up with AMCs as evidenced by the falling out NAPA is having with the hospital that incubated its formation and EmCare losing some ground. However, the end result is not an opportunity for private practices to thrive again, but rather for mega hospital systems to take the control and employ the anesthesiologists (and all physicians)...like the aforementioned Lifespan.

Hospital boards all debate the same circle of life over and over for anesthesia groups. Option three is flying south for the winter or permanently because of excess numbers of anesthesia personnel.

1. We can do this. Employ the docs and CRNAs, do the billing (board member who has medical billing company), manage internally. Our surgeons and nurse managers are here every day and know how the OR/OB/ICU runs.

2. Outside AMC. This is what they do. Only anesthesiologists can optimally manage (exploit) other anesthesiologists. Their interests are our interests.

3. Private group. We have had clinical/malpractice disasters and crap service. Let's get this liability off our plate and incentivize a private group properly so they have the hustle to work hard and run lean and make more and give them carrot of ownership.

After one of the above turns to **** or they decide that they are paying more than they want they go to one of the other options.

 

[GravelRider]

Hospital boards all debate the same circle of life over and over for anesthesia groups. Option three is flying south for the winter or permanently because of excess numbers of anesthesia personnel.

1. We can do this. Employ the docs and CRNAs, do the billing (board member who has medical billing company), manage internally. Our surgeons and nurse managers are here every day and know how the OR/OB/ICU runs.

2. Outside AMC. This is what they do. Only anesthesiologists can optimally manage (exploit) other anesthesiologists. Their interests are our interests.

3. Private group. We have had clinical/malpractice disasters and crap service. Let's get this liability off our plate and incentivize a private group properly so they have the hustle to work hard and run lean and make more and give them carrot of ownership.

After one of the above turns to **** or they decide that they are paying more than they want they go to one of the other options.

Maybe. The difference now is we are seeing hospitals form these gargantuan systems and even providing their own insurance health plans. These hospitals are not going to go backwards and ask a small private practice to provide services. Instead they will hire the anesthesiologists as employees and incentivize them to run the department lean and mean.

 

[deleted126335]

That's why I said option 3 is flying south. Won't come back short of a major drop in graduating residents.

 

[Stank811]

That's why I said option 3 is flying south. Won't come back short of a major drop in graduating residents.

Option three is doing well in certain areas of the country largely thanks to hospitals being exploited by AMC in other areas first.

 

[GravelRider]

Option three is doing well in certain areas of the country largely thanks to hospitals being exploited by AMC in other areas first.

I'm not so sure other areas are immune to hospital consolidation. Why is a hospital going to let their surgeons or cardiologists provide services at a competitor hospital system across town when they can just employ them and make them keep everything in-house or in-system? As these hospitals consolidate they want to control every aspect of the healthcare transaction.

 

[Stank811]

I'm not so sure other areas are immune to hospital consolidation. Why is a hospital going to let their surgeons or cardiologists provide services at a competitor hospital system across town when they can just employ them and make them keep everything in-house or in-system? As these hospitals consolidate they want to control every aspect of the healthcare transaction.

I am referring to the business of anesthesiology specifically. Cardiology and orthopedics is a completely different animal.

 

[GravelRider]

I am referring to the business of anesthesiology specifically. Cardiology and orthopedics is a completely different animal.

Oh but once they get the taste of control, it becomes addicting. It starts with surgeons and cardiologists and spreads from there. You think they want their great anesthesia group helping the OR in the hospital across town run more efficiently? Maybe even telling those surgeons how great they can have it over there (assuming they didn't sign a non-compete clause)?

 

[Stank811]

Oh but once they get the taste of control, it becomes addicting. It starts with surgeons and cardiologists and spreads from there. You think they want their great anesthesia group helping the OR in the hospital across town run more efficiently? Maybe even telling those surgeons how great they can have it over there (assuming they didn't sign a non-compete clause)?

My initial point was that the underlying business of anesthesiology is solid even if it is being masked in certain geographical regions currently run by an AMC.

The above axenario is regional. My guess is if a hospital didn't want their contracts anesthesia providers to cover local competitors it wouldn't matter if it was an AMC or PP group.

 

[deleted171991]

@FFP I'm almost positive I've seen you say on here that you won't have anesthesia with an independent CRNA because of their lack of training and their mismanagement of cases that you've witnessed, so why would you not respect students who actually want to keep patients safe from that?
It literally terrifies me to think of showing up at a hospital emergently and not having access to an anesthesiologist.
I hope the strong students continue to choose anesthesia so that scenario won't come to fruition for me.

Your memory serves you well. Just yesterday I was repeatedly contradicted by a CRNA in a situation that was bordering my subspecialty expertise. She didn't know what she didn't know. In the end, the patient did exactly as I had predicted (bad). I felt like dealing with a resident with senioritis. Had we done things as she wanted to, the patient may have done much worse. This happens on a weekly basis, at least.

I still believe that anesthesiology as an OR medical specialty is dead. There is an overproduction of graduates (both physicians and CRNAs) working in the OR, and the bean counters and surgeons don't really see the difference between various providers for most cases (otherwise we wouldn't have AMCs replacing competent groups). So if one wants to be about as appreciated as a PCP (meaning as appreciated as a FNP), one should go for it. It takes a special type of masochism. Students shouldn't fool themselves that it will never happen in their neck of woods; if it's happening anywhere in the country and it's expanding, it will happen to them, too, sooner of later.

The real value of anesthesia training is in associate fields, such as CCM, where anesthesia-related skills really shine. Unfortunately, our lazy "ancestors" not only did lose the anesthesiology field to CRNAs, they also managed to lose CCM to internists. In most countries, neither of these has happened. So, yes, I do think that the field is doomed in the US, long-term, at least as long as there is an overproduction of anesthesia "providers".

 

[Chip N Sawbones]

There are few medical students I have less respect for than those who plan to become anesthesiologists.

In that case, who do you want to be putting you to sleep when you need an operation? A CRNA who had the chops to do med school and an anesthesiology residency but chose the CRNA route instead? An anesthesiologist who did not plan on becoming an anesthesiologist during medical school but scrambled into the specialty after failing to match into something else? Or the anesthesiologist who could have gone into any specialty but planned on anesthesiology throughout medical school, who you say you have no respect for?

I decided on anesthesiology when I was about halfway through medical school. I suppose I could have dropped out then and there, gone to nursing school and then CRNA school. That would have been cheaper than two more years of my insanely expensive school, and I would have been a fully licensed CRNA sooner than I'll be an attending. There's no way I would do that, though. I'm going to be working in rural areas where I'll be doing a doctor's job no matter if I'm a CRNA or an MD, and it wouldn't be fair to my patients for me to take the shortcut and not really be qualified for the work I'll be doing. Anesthesiology is still a pretty cool specialty no matter how many problems it has with midlevel encroachment.

 

[Mad Jack]

That's why I said option 3 is flying south. Won't come back short of a major drop in graduating residents.

And that'll never happen because residency programs aren't going to close, they're free labor. And they'll keep filling with lower-tier US grads or FMGs.

 

[deleted171991]

In that case, who do you want to be putting you to sleep when you need an operation? A CRNA who had the chops to do med school and an anesthesiology residency but chose the CRNA route instead? An anesthesiologist who did not plan on becoming an anesthesiologist during medical school but scrambled into the specialty after failing to match into something else? Or the anesthesiologist who could have gone into any specialty but planned on anesthesiology throughout medical school, who you say you have no respect for?

I decided on anesthesiology when I was about halfway through medical school. I suppose I could have dropped out then and there, gone to nursing school and then CRNA school. That would have been cheaper than two more years of my insanely expensive school, and I would have been a fully licensed CRNA sooner than I'll be an attending. There's no way I would do that, though. I'm going to be working in rural areas where I'll be doing a doctor's job no matter if I'm a CRNA or an MD, and it wouldn't be fair to my patients for me to take the shortcut and not really be qualified for the work I'll be doing. Anesthesiology is still a pretty cool specialty no matter how many problems it has with midlevel encroachment.

I hope your family will feel the same way 10 years from now, when you'll be as frustrated as some of us here. Please let me know where to go and visit the statue all those patients will erect in honor of your sacrifices. I just can't count the number of monuments erected in honor of all those highly-educated hard-working primary care physicians. Oh, wait, they have a Doctors' Day! Btw, happy Nurses' Week to us all!

Nobody denies anesthesiology is a cool specialty. Heck, anything is cool when one is passionate about it. But cool will wear off pretty fast when the training ends and reality hits. When I do stuff outside of the OR, in the hospital, the nurses tell me that no other CRNA takes care of patients the way I do (I am wearing an MD tag, by the way). Prepare to become just another faceless anesthesia provider cog, about as appreciated as the ten people standing in line to replace you.

The same way one doesn't invest in currencies with high inflation rate, one should invest one's career in a specialty with a foreseeable neverending inflation of providers.

 

[Chip N Sawbones]

I hope your family will feel the same way 10 years from now, when you'll be as frustrated as some of us here. Please let me know where to go and visit the statue all those patients will erect in honor of your sacrifices. I just can't count the number of monuments erected in honor of all those highly-educated hard-working primary care physicians. Oh, wait, they have a Doctors' Day! Btw, happy Nurses' Week to us all!

Nobody denies anesthesiology is a cool specialty. Heck, anything is cool when one is passionate about it. But cool will wear off pretty fast when the training ends and reality hits. When I do stuff outside of the OR, in the hospital, the nurses tell me that no other CRNA takes care of patients the way I do (I am wearing an MD tag, by the way). Prepare to become just another faceless anesthesia provider cog, about as appreciated as the ten people standing in line to replace you.

The same way one doesn't invest in currencies with high inflation rate, one should invest one's career in a specialty with a foreseeable neverending inflation of providers.

Yes, I am preparing to become just another faceless anesthesia provider cog. If nobody notices the anesthesiologist it means they didn't screw anything up. If I needed the world to constantly tell me how great I am I'd be a surgeon. And you didn't answer my question - who do you want to be putting you to sleep when you need an operation ten years down the road? Today's CRNA student, the med student who matched into anesthesiology because they couldn't get into their dream specialty, or the med student who actually wants to do anesthesiology? I'll take B or C on that list.

I'm well aware of the problems with anesthesiology that I'm buying into, but even if I wanted to do something else, there aren't many good alternatives for the 50% of med students who, like me, are in the bottom half of their class. Let's look at the choices I have with my Step I score:
IM: Endless rounding, clinic.
IM subspecialty: Clinic, clinic, and more clinic.
Family medicine: Runny noses, low pay, and midlevel problems of their own.
General surgery: Horrible lifestyle, butt pus, high chance of developing malignant personality 2/2 horrible lifestyle.
Pathology: Employment prospects are far worse than anesthesiology.
Radiology: Employment prospects are far worse than anesthesiology and will get even worse when the day comes (and it will) when computers can read films better than humans.
Psychiatry: You work with crazy people all day. The patients are nuts too.
OB/GYN: See general surgery only with worse bodily fluids.

Anesthesiology has it's problems, but it's still better than the alternatives.

 

[Man o War]

Your memory serves you well. Just yesterday I was repeatedly contradicted by a CRNA in a situation that was bordering my subspecialty expertise. She didn't know what she didn't know. In the end, the patient did exactly as I had predicted (bad). I felt like dealing with a resident with senioritis. Had we done things as she wanted to, the patient may have done much worse. This happens on a weekly basis, at least.

I still believe that anesthesiology as an OR medical specialty is dead. There is an overproduction of graduates (both physicians and CRNAs) working in the OR, and the bean counters and surgeons don't really see the difference between various providers for most cases (otherwise we wouldn't have AMCs replacing competent groups). So if one wants to be about as appreciated as a PCP (meaning as appreciated as a FNP), one should go for it. It takes a special type of masochism. Students shouldn't fool themselves that it will never happen in their neck of woods; if it's happening anywhere in the country and it's expanding, it will happen to them, too, sooner of later.

The real value of anesthesia training is in associate fields, such as CCM, where anesthesia-related skills really shine. Unfortunately, our lazy "ancestors" not only did lose the anesthesiology field to CRNAs, they also managed to lose CCM to internists. In most countries, neither of these has happened. So, yes, I do think that the field is doomed in the US, long-term, at least as long as there is an overproduction of anesthesia "providers".

@FFP I hope you will consider switching jobs. You seem like you did really love this field before you entered this life sucking job. That place sounds awful. There are so many good places to work out here where you are treated with respect.
Give that craphole two middle fingers.

 

[deleted171991]

@FFP I hope you will consider switching jobs. You seem like you did really love this field before you entered this life sucking job. That place sounds awful. There are so many good places to work out here where you are treated with respect.
Give that craphole two middle fingers.

I like most of the people I work with, from my colleagues to the OR staff and surgeons. What I dislike is the lifestyle, the lack of patient-doctor relationship, the rat race, the bleak future, the CRNA militancy (even when not in your face, just passive-aggressive), the more and more work every year for the same or less money, the liability, the declining job market, the lack of intellectual challenge, the various forms of (more or less obvious) disrespect etc. The list is long. I was more of a doctor as a CCM fellow, especially in the MICU. That would be my ideal job, every third week, in a good community hospital. There are just none in my geographically-restricted neck of woods.

I am not sure I have ever loved the field since I started residency and got to really know it from the inside. I love the skills it has given me, I love the science behind it (second only to critical care) and it has taught me how to take great hands-on care of my patients, but I don't enjoy the practice of anesthesia anymore and I would make a much bigger difference as an intensivist. I don't enjoy being in the OR (there is a reason CRNAs can do most of that without killing patients) and, for the first time in my life, I am contemplating giving it up for CCM-only. I still have to meet a good intensivist who loves anesthesia more after having tasted CCM. Not that CCM has much better lifestyle and perspectives, it's just way more satisfying, especially in the MICU. Either that, or a mommy-track job with 12 weeks of vacation/year. Right now, with the typical community hospital call burden, I feel like a highly-paid overworked anesthesia resident.

 

[Man o War]

I like most of the people I work with, from my colleagues to the OR staff and surgeons. What I dislike is the lifestyle, the lack of patient-doctor relationship, the rat race, the bleak future, the CRNA militancy (even when not in your face, just passive-aggressive), the more and more work every year for the same or less money, the liability, the declining job market, the lack of intellectual challenge, the various forms of (more or less obvious) disrespect etc. The list is long. I was more of a doctor as a CCM fellow, especially in the MICU. That would be my ideal job, every third week, in a good community hospital. There are just none in my geographically-restricted neck of woods.

I am not sure I have ever loved the field since I started residency and got to really know it from the inside. I love the skills it has given me, I love the science behind it (second only to critical care) and it has taught me how to take great hands-on care of my patients, but I don't enjoy the practice of anesthesia anymore and I would make a much bigger difference as an intensivist. I don't enjoy being in the OR (there is a reason CRNAs can do most of that without killing patients) and, for the first time in my life, I am contemplating giving it up for CCM-only. I still have to meet a good intensivist who loves anesthesia more after having tasted CCM. Not that CCM has much better lifestyle and perspectives, it's just way more satisfying, especially in the MICU. Either that, or a mommy-track job with 12 weeks of vacation/year. Right now, with the typical community hospital call burden, I feel like a highly-paid overworked anesthesia resident.

I should've clarified, I meant it's apparent you like CCM.
I don't know, I'm looking at your list and most of those are job dependent IMO. I left a crap situation not too long ago and it's amazing how much better I feel. The culture is totally opposite of what you're describing here. The biggest one is no CRNAs. 180 in my attitude. The program where I did my fellowship neutered them, they were pretty much there to support resident and fellow education. It was how it should be. The doctors were in charge, and the midlevels didn't challenge that.

 

[deleted171991]

I should've clarified, I meant it's apparent you like CCM.
I don't know, I'm looking at your list and most of those are job dependent IMO. I left a crap situation not too long ago and it's amazing how much better I feel. The culture is totally opposite of what you're describing here. The biggest one is no CRNAs. 180 in my attitude.

I have worked both as solo attending and directing CRNAs. I can tell you that, after critical care, I find my solo days highly-boring and labor-intensive (we don't have a computerized anesthesia record, and OR nurses don't help in getting patients to the OR, putting on monitors, setting up fluids etc.). I get less burnt out running 2-3 rooms than working in a room. I now completely understand those of us who prefer not being in a room; I have become one of them.

 

[nimbus]

I have worked both as solo attending and directing CRNAs. I can tell you that, after critical care, I find my solo days highly-boring and labor-intensive (we don't have a computerized anesthesia record, and OR nurses don't help in getting patients to the OR, putting on monitors, setting up fluids etc.). I get less burnt out running 2-3 rooms than working in a room. I now completely understand those of us who prefer not being in a room; I have become one of them.

Sorry to hear anesthesia wasn't the right choice for you. I actually love being in a room doing my own cases. Nobody confuses me with a CRNA because we don't have any. The only reason I steer medical students to better options is because I don't know with certainty if my job will still be here when they complete training. And it does sound like you work at a less than collegial place. Some places we help each other because we actually like each other. It's the longstanding culture of the operating room where I work. It's not the same everywhere.

 

[GravelRider]

I don't think the soul-suckingness of working in the American healthcare system is anesthesia specific. There are plenty of docs in other fields that look at anesthesia with envy while they are staring at EHRs and clicking boxes all day...I was one of them. The difference with anesthesia and any hospital based specialty is that you are reliant on the corporate entities that are making our lives miserable. The internist who is staring at the boxes on the EHR can take a risk of going at it solo with a direct pay or concierge style practice and somewhat shed himself of his corporate overlords. The misery that people talk about in anesthesia is less about the money and more about the loss of autonomy.

 

[Scotty_G]

CHIP as much as you think you know..... it's not until you are finished/in the real world where you begin to see what medicine or in this case anesthesia really is. FFP is on one spectrum, and others on this board in the opposite spectrum. With that being said it is becoming harder to land a good/great gig. This is independent of where you did your training.

 

[Chip N Sawbones]

CHIP as much as you think you know..... it's not until you are finished/in the real world where you begin to see what medicine or in this case anesthesia really is. FFP is on one spectrum, and others on this board in the opposite spectrum. With that being said it is becoming harder to land a good/great gig. This is independent of where you did your training.

I know. If things get really bad I can always go back to rebuilding houses.

 

[partydoc]

I know. If things get really bad I can always go back to rebuilding houses.

Sure, but it's a little bit tougher with $250k in debt