Should Allergy replace Anesthesiology in the "ROAD" to success?

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Allergy replace Anesthesiology?

  • Yes

    Votes: 27 22.3%
  • No

    Votes: 94 77.7%

  • Total voters
    121

flatearth22

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Shadowed an Allergy/Immunology specialist and it was such a cush job. Very comparable to the Dermatologist I shadowed but with less procedures of course. Also their income is ~$250k which makes it not much less than Derm. With CRNA's treading on anesthesiologists should Allergy take its place as the "A" in "ROAD"?

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Immunology is a cool field. The A&I fellows I used to work with at Baylor/TCH were really on top of their stuff. I don't know how the private practice environment is, but the academic one was cool as hell.

I don't think it will take the place of the "A", though. I don't really think the whole CRNA/sky-is-falling mentality spouted around these boards has been congruous with my experience in real life. If you're on top of your stuff as an anesthesiologist, you'd be the CRNA's boss not replaced by them.
 
Also, A&I isn't a residency, it's a fellowship.
 
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No, they are very dependent on referrals from PCPs, for things which PCPs can do themselves. It's still a very interesting specialty though. You can usually do a lot for your patients and it is very similar to dermatology. But on a financial level, I don't think it's ROAD caliber.
 
Shadowed an Allergy/Immunology specialist and it was such a cush job. Very comparable to the Dermatologist I shadowed but with less procedures of course. Also their income is ~$250k which makes it not much less than Derm. With CRNA's treading on anesthesiologists should Allergy take its place as the "A" in "ROAD"?

You do know that $250 would be a very low income for Anesthesia right?
 
MGMA 2010 data for the ROAD
.....Mean median 25th% 90th%
Rads 515 468 405 780
Optho 376 338 250 631
Anesthesia 419 426 338 571
Derm 437 385 281 744

Allergy/Imm 312 267 213 516
EM 280 262 225 398

Still want to pull anesthesia out of the "ROAD"? Real EM data open any eyes?
 
MGMA 2010 data for the ROAD
.....Mean median 25th% 90th%
Rads 515 468 405 780
Optho 376 338 250 631
Anesthesia 419 426 338 571
Derm 437 385 281 744

Allergy/Imm 312 267 213 516
EM 280 262 225 398

Still want to pull anesthesia out of the "ROAD"? Real EM data open any eyes?

case closed.
 
Shadowed an Allergy/Immunology specialist and it was such a cush job. Very comparable to the Dermatologist I shadowed but with less procedures of course. Also their income is ~$250k which makes it not much less than Derm. With CRNA's treading on anesthesiologists should Allergy take its place as the "A" in "ROAD"?


What I've seen is what you're feeling. The people who wanted Derm, but couldn't get it, ended up in medicine. They still want nice hours, they still want mostly clinic, and they still want to be paid reasonably well. So, rather than focus on primary care, they focus on Allergy as a subspecialty. Takes 6 years to get there, not the 4 of derm. They pay isn't as great, but the lifestyle is similar.

The same type of people go into allergy as go into derm, just less bubbly, less blonde, and with a slightly lower board score. I see it more as the field people go into because they dont want to work very hard. They've put in their dues, they are 30 years old, maybe a have a young child, and just dont want to be doing 24/7 x 7 days on, then 7 days off to make 250,000 as a private medicine hospitalist.

However, as has been mentioned, the pay just isn't there. Its a fallback, an alternative, an after-the-fact realization that there is more to medicine than just GI and Cards.
i agree, no ROADing. You might as well include Cards (pay), GI (scope scope scope = $ $ $), and Pulm Critical Care (shifts) in ROAD
 
Anesthesia is definitely the least sexy field in ROAD.

Rads has technology.
Optho has delicacy.
Derm has beauty.

Anesthesia and OB GYN -- two fields that can be done by nurses, and are.
 
Anesthesia is definitely the least sexy field in ROAD.

Rads has technology.
Optho has delicacy.
Derm has beauty.

Anesthesia and OB GYN -- two fields that can be done by nurses, and are.

By all means, have your anesthesia and OB needs taken care of by nurses. Make sure to ask for a non-physician provider when you need those services.
 
Anesthesia is definitely the least sexy field in ROAD.

Rads has technology.
Optho has delicacy.
Derm has beauty.

Anesthesia and OB GYN -- two fields that can be done by nurses, and are.

lol u funni.

I wouldn't care if my dermatologist was a nurse, but if I was going to be operated upon, I would make damn sure I had the most qualified person available to keep me alive during surgery. If my wife was going through labor, I would make damn sure that I had the most qualified person available to deliver my baby and deal with any potential complications if they so arise. Nurses can always do bread-and-butter stuff, but when the unexpected arises, only a physician can be counted upon.
 
Recently had a discussion with my attending about the CRNA "crisis." He said not to worry about it and put it pretty simply:

Anesthetists can handle the simple stuff and recognize if X is wrong then Y has to be done, but they do not, and will not, ever have to think out why X is wrong if they don't want to. You, on the other hand, can assess the situation and come up with a differential of what is causing X and treat several ways. You don't have to rely on pattern recognition.
 
Recently had a discussion with my attending about the CRNA "crisis." He said not to worry about it and put it pretty simply:

Anesthetists can handle the simple stuff and recognize if X is wrong then Y has to be done, but they do not, and will not, ever have to think out why X is wrong if they don't want to. You, on the other hand, can assess the situation and come up with a differential of what is causing X and treat several ways. You don't have to rely on pattern recognition.
One of my attendings also says something similar. Midlevels are here to stay, but that they will get the ASA1/2s. The really sick patients will be left to the doctors to care for and that is precisely who they need to treat them. Maybe it is a bit grim to accept that anesthetists are going to be treating patients, likely independent in many places, it does illustrate that there are many patients who require the knowledge, expertise, and experience of physicians.


As to the OP, frankly, who cares? If you love what you do, you won't feel like you are "working" hard in any field, medicine or otherwise.
 
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Anesthesia is definitely the least sexy field in ROAD.

Rads has technology.
Optho has delicacy.
Derm has beauty.

Anesthesia and OB GYN -- two fields that can be done by nurses, and are.

Please...what is beautiful about derm? pemphigus? TEN? acne?
An Optho is basically a dentist for the eyeball...

Don't get me wrong, all the ROAD fields awesome gigs, but I'd take anesthesia any day over those two (as a close second to rads)
 
I was really into Allergy earlier as well because of the amazing lifestyle and I simply loved my immunology class. However, I have recently started hearing the downside of this specialty. I have heard that more recently, primary care physicians have started to treat most patients who would have earlier gone to an allergists. Meaning, that the number of patients for allergists is going down. Also, since allergies are more common in certain areas- it is harder to find a job throughout the US and alot of places with alot of allergies have saturated markets for allergists... I am now reconsidering allergy as a field because of these reasons..any thoughts?

@cowme- I totally agree- in now way shape of form is derm beauty!! haha and yes, the dentist to optho analogy is perfect! lol
 
MGMA 2010 data for the ROAD
.....Mean median 25th% 90th%
Rads 515 468 405 780
Optho 376 338 250 631
Anesthesia 419 426 338 571
Derm 437 385 281 744

Allergy/Imm 312 267 213 516
EM 280 262 225 398

Still want to pull anesthesia out of the "ROAD"? Real EM data open any eyes?

The EM docs that I've worked with make much more than 280k (all while working less than 40 hours a week)... I've heard of residents pulling 350k from moonlighting during their last year of residency.
 
The EM docs that I've worked with make much more than 280k (all while working less than 40 hours a week)... I've heard of residents pulling 350k from moonlighting during their last year of residency.

go on...
 

Albeit in Mississippi, where hospitals are so desperate for EM docs that they will pay whatever is needed to get the ED covered.
 
The EM docs that I've worked with make much more than 280k (all while working less than 40 hours a week)... I've heard of residents pulling 350k from moonlighting during their last year of residency.

390K is the 90th percentile. The people you know are probably 90+ percentile.
 
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Albeit in Mississippi, where hospitals are so desperate for EM docs that they will pay whatever is needed to get the ED covered.

There ya go. See what the anesthesiologists make there, and I bet the number will be proportionately staggering.
 
Has any of you all ever been to Mississippi before?! That place is pretty lackluster at best. and that is coming from a Georgia boy...
 
Has any of you all ever been to Mississippi before?! That place is pretty lackluster at best. and that is coming from a Georgia boy...

Don't hate too hard! MS gets a terrible wrap through the news and other forms of media, but there are some areas that are extremely nice. AKA Oxford, Madison, Tupelo, etc.
 
Don't hate too hard! MS gets a terrible wrap through the news and other forms of media, but there are some areas that are extremely nice. AKA Oxford, Madison, Tupelo, etc.

haha I am just messing around. I used to go down to Biloxi and Tunica every so often to play poker and that is what I am basing my views off of. I guess casinos attract the worst of the worst of an area...

I believe the correct term is, "y'all"

I actually typed out 'y'all' and then put 'you all' in hopes not to get made fun of...obvi i was damned either way...
 
haha I am just messing around. I used to go down to Biloxi and Tunica every so often to play poker and that is what I am basing my views off of. I guess casinos attract the worst of the worst of an area...



I actually typed out 'y'all' and then put 'you all' in hopes not to get made fun of...obvi i was damned either way...

haha Biloxi is awful. Never again, I'll just drive a little bit further to NO
 
Yeah its basically just a congregation of the worst/fattest/laziest/trashiest people in the US

That geographic area magnetically attracts those types.

From northern FL over to eastern TX the civil war never ended, gun-racks are fashion statements, and obesity is the rule, not the exception.
 
MGMA 2010 data for the ROAD
.....Mean median 25th% 90th%
Rads 515 468 405 780
Optho 376 338 250 631
Anesthesia 419 426 338 571
Derm 437 385 281 744

Allergy/Imm 312 267 213 516
EM 280 262 225 398

Still want to pull anesthesia out of the "ROAD"? Real EM data open any eyes?
are these right? I didn't think rads got paid that well, unless you're including interventional and such.
 
are these right? I didn't think rads got paid that well, unless you're including interventional and such.

Those are private practice numbers, but yep, I've seen 2 sources now saying that the median rads in PP is 500K. Will be way closer to 400K in next year's MGMA with the most recent set of cuts, and I would guess 300K by the end of the decade.
 
fine with me. I don't keep up with salaries in general but I assumed if I went rads I'd be seeing more like 250-300. good enough for me
 
Those are private practice numbers, but yep, I've seen 2 sources now saying that the median rads in PP is 500K. Will be way closer to 400K in next year's MGMA with the most recent set of cuts, and I would guess 300K by the end of the decade.

What have you seen the median for interventional?
 
haha I am just messing around. I used to go down to Biloxi and Tunica every so often to play poker and that is what I am basing my views off of. I guess casinos attract the worst of the worst of an area...

...

I recently moved from Jackson MS to Memphis TN. Play poker in Tunica (mainly Harrah's) several x per week. The worst of the worst are attracted to the slot machines, not the poker room
 
I recently moved from Jackson MS to Memphis TN. Play poker in Tunica (mainly Harrah's) several x per week. The worst of the worst are attracted to the slot machines, not the poker room

HAHA you are 100% correct. Isn't it amazing how 500lb+ people with O2 will just sit at those slot machines for hours on end using every cent of their welfare checks? Whats even worse is that there isnt just a few, there are literally hundreds of degenerates. It's quite amazing to watch
 
Shadowed an Allergy/Immunology specialist and it was such a cush job. Very comparable to the Dermatologist I shadowed but with less procedures of course. Also their income is ~$250k which makes it not much less than Derm. With CRNA's treading on anesthesiologists should Allergy take its place as the "A" in "ROAD"?

I'm always confused why people think that the CRNAs are making the Anesthesiologists much less of a cush job when it really is making it more. Now you can cover 3-4 (or more if the cases are light) rooms per doctor with the CRNA doing all the work. You still go for pre-ops, then stand there while they go under, then you can wander off and do what you want until they extubate or if any problems come up. When I was on Anesthesiology, the attendings were always getting coffee, reading the paper/internet, hanging out, etc. during the surgeries since the CRNA did everything for them. Add in that it's shift work so you know when you have off and are on. Sounds like it's just gotten better.
 
I'm always confused why people think that the CRNAs are making the Anesthesiologists much less of a cush job when it really is making it more. Now you can cover 3-4 (or more if the cases are light) rooms per doctor with the CRNA doing all the work. You still go for pre-ops, then stand there while they go under, then you can wander off and do what you want until they extubate or if any problems come up. When I was on Anesthesiology, the attendings were always getting coffee, reading the paper/internet, hanging out, etc. during the surgeries since the CRNA did everything for them. Add in that it's shift work so you know when you have off and are on. Sounds like it's just gotten better.

That's what I was thinking! From what I've been reading it sounds like CRNAs will benefit anesthesiologists more than hurt them, at least in the bigger metro areas...it's only in the rural areas where there is a lack of doctors that CRNAs can work without supervision. So in most cases, MDAs should be able to utilize CRNAs to their benefit. Right?
 
I'm always confused why people think that the CRNAs are making the Anesthesiologists much less of a cush job when it really is making it more. Now you can cover 3-4 (or more if the cases are light) rooms per doctor with the CRNA doing all the work. You still go for pre-ops, then stand there while they go under, then you can wander off and do what you want until they extubate or if any problems come up. When I was on Anesthesiology, the attendings were always getting coffee, reading the paper/internet, hanging out, etc. during the surgeries since the CRNA did everything for them. Add in that it's shift work so you know when you have off and are on. Sounds like it's just gotten better.

Exactly. There's another anesthesiologist that I know who does just that too. His practice contracts out to the hospital and hired a few CRNAs to work for them. Now instead of sitting in one OR at a time he can cover multiple ones with CRNAs and hang out during the operations...or if he's feeling really ambitious actually cover one of the operations himself :laugh:. They still charge the same amount and the CRNAs get paid 1/2-1/3 of what he gets paid. I think he's making more money now.

People who get concerned about CRNAs replacing doctors have to remember that somebody has to be liable for everything in the end...and the nurses don't necessarily want it to be them. I think people also get concerned about CRNAs decreasing the amount of anesthesiologists because each one can cover multiple cases now. I don't know if that's such a problem. There is such a thing as a replacement rate. Old doctors retire every year so you have to have a certain amount coming in just to replace them. Plus there's not really going to ever be a shortage of operations in the near future.
 
I'm always confused why people think that the CRNAs are making the Anesthesiologists much less of a cush job when it really is making it more. Now you can cover 3-4 (or more if the cases are light) rooms per doctor with the CRNA doing all the work. You still go for pre-ops, then stand there while they go under, then you can wander off and do what you want until they extubate or if any problems come up. When I was on Anesthesiology, the attendings were always getting coffee, reading the paper/internet, hanging out, etc. during the surgeries since the CRNA did everything for them. Add in that it's shift work so you know when you have off and are on. Sounds like it's just gotten better.

That's what I was thinking! From what I've been reading it sounds like CRNAs will benefit anesthesiologists more than hurt them, at least in the bigger metro areas...it's only in the rural areas where there is a lack of doctors that CRNAs can work without supervision. So in most cases, MDAs should be able to utilize CRNAs to their benefit. Right?

Exactly. There's another anesthesiologist that I know who does just that too. His practice contracts out to the hospital and hired a few CRNAs to work for them. Now instead of sitting in one OR at a time he can cover multiple ones with CRNAs and hang out during the operations...or if he's feeling really ambitious actually cover one of the operations himself :laugh:. They still charge the same amount and the CRNAs get paid 1/2-1/3 of what he gets paid. I think he's making more money now.

People who get concerned about CRNAs replacing doctors have to remember that somebody has to be liable for everything in the end...and the nurses don't necessarily want it to be them. I think people also get concerned about CRNAs decreasing the amount of anesthesiologists because each one can cover multiple cases now. I don't know if that's such a problem. There is such a thing as a replacement rate. Old doctors retire every year so you have to have a certain amount coming in just to replace them. Plus there's not really going to ever be a shortage of operations in the near future.

That's not the complaint. The complaint is that it used to be one MD per room. Now its one MD per 4 operating rooms. The need has decreased x 3 MDs. Not to mention some states allow CRNA to practice without supervision. They aren't cutting residency slots so the same amount of new graduating residents each year.

So its a great gig if you can land a job, but the future of the job market is where the uncertainty lies.
 
are these right? I didn't think rads got paid that well, unless you're including interventional and such.

Medscape published a decent salary survey of specialties this year, and likely provides less biased salary figures than some of the headhunter numbers people like to point to. Radiology and Ortho topped the list with median salaries of $350k each. Meaning half of all radiologists and orthopods earn more than this. Peds brought up the tail with a median income of $148k. Meaning half of all pediatricians earn less than this. So those are your extremes in this current year. All other specialties are somewhere in between this number. Anyone you know earning crazy money in another field is an outlier far away from a relatively modest median for the specialty. I don't know how interventional radiologists do as compared to diagnostic, but would suggest that a diagnostic radiologist can read an awful lot of studies in the time it takes an interventional radiologist to do a procedure and turn over an OR. So it depends on how meaty the per procedure reimbursement is. It's probably a wash.
 
Medscape published a decent salary survey of specialties this year, and likely provides less biased salary figures than some of the headhunter numbers people like to point to. Radiology and Ortho topped the list with median salaries of $350k each. Meaning half of all radiologists and orthopods earn more than this. Peds brought up the tail with a median income of $148k. Meaning half of all pediatricians earn less than this. So those are your extremes in this current year. All other specialties are somewhere in between this number. Anyone you know earning crazy money in another field is an outlier far away from a relatively modest median for the specialty. I don't know how interventional radiologists do as compared to diagnostic, but would suggest that a diagnostic radiologist can read an awful lot of studies in the time it takes an interventional radiologist to do a procedure and turn over an OR. So it depends on how meaty the per procedure reimbursement is. It's probably a wash.

IIRC most of the studies I've seen IR and DR are pretty close. It's not like people are doing IR for the money.
 
Medscape published a decent salary survey of specialties this year, and likely provides less biased salary figures than some of the headhunter numbers people like to point to. Radiology and Ortho topped the list with median salaries of $350k each. Meaning half of all radiologists and orthopods earn more than this. Peds brought up the tail with a median income of $148k. Meaning half of all pediatricians earn less than this. So those are your extremes in this current year. All other specialties are somewhere in between this number. Anyone you know earning crazy money in another field is an outlier far away from a relatively modest median for the specialty. I don't know how interventional radiologists do as compared to diagnostic, but would suggest that a diagnostic radiologist can read an awful lot of studies in the time it takes an interventional radiologist to do a procedure and turn over an OR. So it depends on how meaty the per procedure reimbursement is. It's probably a wash.

"Likely provides less biased salary figures." Based on what?

Medscape's survey includes academia, and doesn't include bonus (which is usually at least 80K for rads), hence the lower salaries than a survey that includes bonus and takes academic salary out of the equation. So I would imagine peds is not nearly that low either out in PP world. Over on the general rads boards, MGMA figures sound spot on for 90% of the community.

Regarding IR guys, they make a little more, but work a LOT more. However, the procedures they do are less likely to face reimbursement cuts than reading CT, MR, US will.
 
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A & I is a good field, it should not replace it, just add to it. There's also pathology which is a very good field, almost no on-call and good salary (>$250k). Hence the new acronym-->RAPIDO (rads, gas, path, immuno, derm, ophtho)
 
A & I is a good field, it should not replace it, just add to it. There's also pathology which is a very good field, almost no on-call and good salary (>$250k). Hence the new acronym-->RAPIDO (rads, gas, path, immuno, derm, ophtho)

:thumbup:

Yeah I've never understood why Path isn't always included in conversations about lifestyle specialties that also pay fairly well. It's not for everyone, but the same can be said about any of the other "ROADs". I worked 3 years in 2 different private hospital pathology labs and saw how good and predictable the hours were (mainly 8-5). "Call" does exist technically, but in 3 years, I only know of the pathologists being called back to the hospital twice! One was for abnormal lab results that turned out to be a busted machine, and the other was an acute GI obstruction patient being operated on at 10pm that turned out to have undiagnosed colon cancer. 99% of the time call is taken from home, and even then it just doesn't happen too often. There are many subspecialties (including cytopath and dermpath which actually do allow you to see patients regularly if you desire) and there is also some business aspects (generally this work is contracted out to management companies). Also, you're technically in charge of the hospital clinical lab, but day to day operations and even most major decisions are taken care of by medical lab technicians and supervisors. The only thing I can't speak to is how different academic path is from PP path. But aside from the ongoing debate about the job market for path, it's not a bad specialty to consider if you can handle not having to interact with patients and do H and P's forever more (for some of you, I'm sure that wouldn't be an issue).
 
:thumbup:

Yeah I've never understood why Path isn't always included in conversations about lifestyle specialties that also pay fairly well. It's not for everyone, but the same can be said about any of the other "ROADs". I worked 3 years in 2 different private hospital pathology labs and saw how good and predictable the hours were (mainly 8-5). "Call" does exist technically, but in 3 years, I only know of the pathologists being called back to the hospital twice! One was for abnormal lab results that turned out to be a busted machine, and the other was an acute GI obstruction patient being operated on at 10pm that turned out to have undiagnosed colon cancer. 99% of the time call is taken from home, and even then it just doesn't happen too often. There are many subspecialties (including cytopath and dermpath which actually do allow you to see patients regularly if you desire) and there is also some business aspects (generally this work is contracted out to management companies). Also, you're technically in charge of the hospital clinical lab, but day to day operations and even most major decisions are taken care of by medical lab technicians and supervisors. The only thing I can't speak to is how different academic path is from PP path. But aside from the ongoing debate about the job market for path, it's not a bad specialty to consider if you can handle not having to interact with patients and do H and P's forever more (for some of you, I'm sure that wouldn't be an issue).

wouldn't the job market make it a terrible reason to consider it? It probably has the worst job prospects of any specialty in medicine
 
wouldn't the job market make it a terrible reason to consider it? It probably has the worst job prospects of any specialty in medicine

An equal number of people will tell you there is nothing to be concerned about with the path job market, check the path forums and other message boards. If the possible job market 4-6 years from now (when a current 4th year med student would need to worry about it) is a major reason in deciding what specialty you want to go into, you might want to talk to some advisers... For a premed, it might be a decade before you have to worry about the job market, so it's a little premature to be concerned now.
 
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