I was very impressed by the thought that went into this discussion concerning future anesthesiologists so I thought I put in my 2 cents.
I am currently in a California transitional program and have several fellow interns going into anesthesia (me included) and several into radiology.
What I can see currently is that it will probably be a lot harder for med students to match into transitional spots this year and the forseeable future b/c of the influx of new radiology/anesthesia/rad/onc and PMR people.
Secondly, as for anesthesiology's future, I like to make a few points b/c I have obviously thought about the matter b/f going in.
1. anesthesiologists are not the only ones w/ midlevel providers (i.e. CRNAs). Virtually every single specialty of medicine has a competiting midlevel provider: family practice/general medicine/pediatrics/Emergency medicine have the PAs and NPs, OB/Gyn has the midwife, ophthalmologists have the optometrists, orthopods have the podiatrists (minor threat), subspecialty medicine docs like cardiologists and GI are using more and more PAs and NPs. I know this for a fact b/c my hospital not only uses these people, but TRAINS new ones!
So, my point is that to use the traditional idea of anesthesiology as THE THREATENED specialty w/ CRNAs are the verge of taking over is just OUTDATED. Every single specialty, and especially the primary care ones, are in danger of having more and more of their duties performed by the NPs and PAs, who are by the way DOING MORE AND WANTING MORE AUTONOMY.
If anything, for those interested in anesthesiology, we anesthesiologists are acustomed to having a competitor (ie. CRNA) and know how to FIGHT back. FPs and internists never had this threat until the last decade or so and in my opinion are more VULNERABLE simply b/c they are not used to dealing w/ it. The American Society of Anesthesiology I know for a fact is very much into fighting for the anesthesiologists and is VERY capable at it. The least we can do is pay our annual dues so they can continue lobbying.
2. It is extremely important that good american medical grads (me included) go into the field b/c that's how you keep the specialty from becoming a second rate specialty as it was and is in danger of becoming b/c of the current shortage of anesthesiologists. We need more bright young anesthesiologists to go into academic anesthesia and do research and ADVANCE the field of anesthesia. We were in danger of loosing this vital RESEARCH component of the field in the last few years b/c of the shortage and quality of the people going in.
3. From my research and own opinion, I believe the field will continue to be short on anesthesiolgists for some time (say a decade?) b/c of the effects of a few years ago (i.e. it takes longer to compensate for each year that few residents went into the field) as well as the fact that many of the early generation ofanesthesiologists are in their 60s and retiring. CRNAs will always continue to play a role in anesthesia but also remember that anesthesiologists are always needed to do INCREASINGLY MORE COMPLICATED SURGERIES ON SICKER PTS as well as MORE OUTPATIENT SURGERIES (surgeons don't want the onus of just having a CRNA provide anesthesia outpt and take the blame...).
My conclusion is that I see a bright future for anesthesiologists. There are just as many uncertainties w/ oversupply and competition in other specialties. Anesthesiologists will always be needed. Market forces will always control the "numbers" of anesthesiologists. Try to go to a good academic program. Go into it only if you truely enjoy it. You don't need to LOOOVVE pharmacology and physiology (there's actually not that many drugs utilized and you are concerned w/ only certain vital organs). If you really LOOOVE p and p, you would go into critical care medicine (which anesthesiologist can do). If you like what you do, you will be happy. But, as someone going into the field, I see a bright future. As others have said, it will not be as good (in job finding) and lucrative as it is now, but it will continue to be highly paid.
Anesthesiology will not get as competitive as radiology (which like everyone else noticed was also quite easy to get into a few years back and now anesthesiology is following its tail in becoming more competitive) b/c there are more programs and more spots (b/c it has always been a BIGGER SPECIALTY), but the good programs will get harder and harder. Just remember that in the 80s and early 90s, ANESTHESIOLOGY WAS ONE OF THE MOST COMPETITIVE OF SPECIALTIES AND ONLY THE BEST AND BRIGHTEST WENT IN. It just became an undervalued specialty that is gaining back its former value (like a good stock
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