Tell me it’s going to be okay...

[otherstuff12321]

I’m applying soon, and I’m applying to anesthesiology. I’ve done all the ECs and gotten all the grades. However, I’m getting cold feet after reading into the doom and gloom.

Is anesthesiology’s future really that bad? I plan to work at least 30 years before retirement. Is it just going to get worse from here on out? I can’t see myself doing anything else in medicine. This is the only thing that’s bearable and actually somewhat enjoyable. Tell me it’s going to be okay friends...

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[Neopolymath]

Every day, better than the next

 

[dabears505]

Ask yourself, do you want a job where a lot of metro jobs involve spending 2 full days in house a month covering OB. That may not seem like much, but its essentially 1/15th of your life wasted in the hospital. It's horrible. Please pick psych.

 

[deleted126335]

I’m applying soon, and I’m applying to anesthesiology. I’ve done all the ECs and gotten all the grades. However, I’m getting cold feet after reading into the doom and gloom.

Is anesthesiology’s future really that bad? I plan to work at least 30 years before retirement. Is it just going to get worse from here on out? I can’t see myself doing anything else in medicine. This is the only thing that’s bearable and actually somewhat enjoyable. Tell me it’s going to be okay friends...

The work is often good.
The job not so much.

 

[ambiturner]

Do you want us to give you advice or do you want us to tell you it's going to be okay?

A lot of the doom is real. In my field (peds), incomes have been stagnant and most hospitals had huge losses during COVID. CRNAs continue to gain inroads in what was formerly a very physician driven subspecialty and more time is spent supervising and giving breaks. Research and admin time is increasingly scarce.

A counterargument to the doom here is that it ignores that bad things are happening in every field of medicine. At least in anesthesia the supervision and loss of respect/autonomy/etc is already baked into the cake. Fields like EM, derm and psych are just beginning to go down this rabbit hole. Other fields that were the most competitive when I was in med school, like rad onc, have come on hard times so things can change fast.

On the flip side there are lots of fields - heme/onc, ortho, neurosurgery, allergy/rheum for example, where things are looking up with no end in sight. What do all of these fields have in common? Heavy involvement with industry/big pharma and favorable reimbursement. Whether those trends hold is anyone's guess, but it'll bankrupt the country if they do, and you didn't mention that you liked any of those fields anyway.

 

[leacott]

Its really not that bad. Stop reading posts on SDN everybody complains about everything here.

 

[PainDrain]

Some days are a grind and some days aren’t. Would I continue to work if I won the lottery, at this juncture in my life I would say no. But, that being said, today I checked up on a patient who is close to 90 that had a pretty significant operation for his age and he was thrilled with his care. His wife was so thankful and he is doing incredibly well. Moments like that make some of the lousy ones a little less memorable.

 

[agolden1]

I’m applying soon, and I’m applying to anesthesiology. I’ve done all the ECs and gotten all the grades. However, I’m getting cold feet after reading into the doom and gloom.

Is anesthesiology’s future really that bad? I plan to work at least 30 years before retirement. Is it just going to get worse from here on out? I can’t see myself doing anything else in medicine. This is the only thing that’s bearable and actually somewhat enjoyable. Tell me it’s going to be okay friends...

There's so much about so many other fields you just can't appreciate as a medical student. As a student, I didn't really like medicine because of the rounding, and the enormous amount of scut work (was at a big inner city hospital) so anesthesia seemed like an escape from all of that. Residency and the work aren't all that bad, but there is an enormous amount of politic-ing thats been in place for a very long time (surgeon vs anesthesia, nurse vs anesthesia, CRNA vs anesthesia) that you are essentially going to be thrown into that you won't be able to change. Also as an intern, you may discover that some of the things you hated as a med student are actually more tolerable with you taking on more responsibility (i.e. rounding).

Many fields in medicine are subject to similar doom and gloom with midlevel encroachment, changing reimbursement, etc. If you have the scores to be able to get into one of these fields with a good business arrangement (ortho vs ophtho) conventional wisdom here will be to tell you to do it. If you are average, below average, or DO, I'd give cardiology a long hard look before signing on the dotted line for anesthesia. Longer training path yes, but much more power/respect/innovation and progress in their field.

I'm happy to have matched pain, and that remains an option for some, but I also had several co residents who wanted it bad and didn't match. it certainly isn't sunshine and roses, but some people have made it work. Will see where the chips fall.

 

[caligas]

Ask yourself, do you want a job where a lot of metro jobs involve spending 2 full days in house a month covering OB. That may not seem like much, but its essentially 1/15th of your life wasted in the hospital. It's horrible. Please pick psych.

That might be a relatively GOOD schedule with some locations

 

[PlayToWin]

Rank the fields you like .
Look at the work life balance
Look at the compensation.
Figure out what makes sense for you.

 

[GassYous]

That might be a relatively GOOD schedule with some locations

Eh even the good places are getting bought up. I heard the cedars sinai folks got bought out.

 

[coffeebythelake]

I really enjoy the physiology, pharmacology and procedures of Anesthesiology. There is a lot of BS as well but that's true for most every field in one way or another

 

[Guillemot]

Things will only get worse, but it will probably happen slowly.
Edit: To elaborate: eg pay not increasing with inflation. Workload increasing without pay increasing. Various ways to extract more work per dollar paid.

 

[linkin06]

I also genuinely like learning the physiology. I love understanding concepts and applying it, and to be honest the concepts are not that crazy abstract. I felt like in medicine we learn so many word and symptoms association. UWorld and step groom you to just read a prompt, and you need to recall and memorize what the answer is.

that being said, the future feels always like an impending doom lol. I think there will be outstripped demand for anesthesia though because all the boomers need surgery, and it will continue exponentially. I feel secure there will be a job always, but it may not be the job I want. That’s why I’m aggressively saving and investing. I hope to FIRE early so I can pick the schedule I want (hopefully with no call)

 

[coffeebythelake]

I also genuinely like learning the physiology. I love understanding concepts and applying it, and to be honest the concepts are not that crazy abstract. I felt like in medicine we learn so many word and symptoms association. UWorld and step groom you to just read a prompt, and you need to recall and memorize what the answer is.

that being said, the future feels always like an impending doom lol. I think there will be outstripped demand for anesthesia though because all the boomers need surgery, and it will continue exponentially. I feel secure there will be a job always, but it may not be the job I want. That’s why I’m aggressively saving and investing. I hope to FIRE early so I can pick the schedule I want (hopefully with no call)

this is unforutnately all of medicine.
hospital systems see $$$
and hiring midlevels mean even more of it

 

[GravelRider]

You already made your bad decision by going to medical school. Anesthesiology is not necessarily worse than other fields. If you don’t think you’ll like to spend at least 1/7th of your working life sleeping (hopefully) on a call room bed or working through the night then consider another specialty. Anesthesia is ok 7a-3p. The call is a form of torture.

 

[Realgassy]

Medicine isn’t all sunshine and rainbows as you have figured out. No one can predict the future for any field. Currently various groups are aggressively hiring as the older cohort continues to retire.

I’m a year out of anesthesia residency. Overall I’m very happy with my group, location, and quality of life. I chose the employed route with a private practice to maintain a protected shift schedule and know when I’m going home. I’m 95% md only. Trade off is I make less, but it is more than enough to keep me happy in a beautiful setting. Good luck

 

[ERRES2288]

You already made your bad decision by going to medical school. Anesthesiology is not necessarily worse than other fields. If you don’t think you’ll like to spend at least 1/7th of your working life sleeping (hopefully) on a call room bed or working through the night then consider another specialty. Anesthesia is ok 7a-3p. The call is a form of torture.

Then take a day only job

 

[pro-propofol]

If your doing it for the money? Don’t!

 

[nimbus]

Ask yourself, do you want a job where a lot of metro jobs involve spending 2 full days in house a month covering OB. That may not seem like much, but its essentially 1/15th of your life wasted in the hospital. It's horrible. Please pick psych.

I have a metro job doing my own cases. Call is 1-2 nights/month with pre and postcall days off. I’m in my 50s and still look forward to taking call. I just consider it part of my life and don’t find it painful at all. But yes, psych, allergy, ID, PMR, derm, Ortho, ent, ophtho, nephrology, FM, primary care IM, rad onc etc all have “better” lifestyles. I also have partners in anesthesia who have transitioned to no call positions for less money.

To answer the OP, yes things will be more than okay, especially if you really like anesthesia.

 

[BLADEMDA]

I have a metro job doing my own cases. Call is 1-2 nights/month with pre and postcall days off. I’m in my 50s and still look forward to taking call. I just consider it part of my life and don’t find it painful at all. But yes, psych, allergy, ID, PMR, derm, Ortho, ent, ophtho, nephrology, FM, primary care IM, rad onc etc all have “better” lifestyles. I also have partners in anesthesia who have transitioned to no call positions for less money.

To answer the OP, yes things will be more than okay, especially if you really like anesthesia.

2 days per month? Are you serious? That’s an academic type schedule which most of us could do well into our late 60s. Many jobs out there involve trauma call or busy OB at least once per week with no guarantee of pre call off. That is much more common than 2 days per month. All you need to do is look at the jobs posted on gaswork in metro areas to see the real call frequency.

 

[D P356]

Pre-call off? @nimbus
Solid work. Unless call is a beating and that arrangement is needed.

 

[nimbus]

2 days per month? Are you serious? That’s an academic type schedule which most of us could do well into our late 60s. Many jobs out there involve trauma call or busy OB at least once per week with no guarantee of pre call off. That is much more common than 2 days per month. All you need to do is look at the jobs posted on gaswork in metro areas to see the real call frequency.

Pre-call off? @nimbus
Solid work. Unless call is a beating and that arrangement is needed.

Totally serious. We are a level 1 trauma center so nights can be busy. But we are MD only so we have a lot of people to spread the call around. We have 20+ full time call takers so it works out to about 18calls/year. Call night starts at 5pm and finishes 7am. Usually we work 5-midnight or so. Rarely we work all night. OB is covered by a separate subgroup. I don’t like OB so I don’t do any. Some people in my subgroup do OB to keep their skills up and/or for extra money. And as long as my health holds up, I plan to keep doing this into my 60s. I think it actually helps to keep me young.

 

[chocomorsel]

If your doing it for the money? Don’t!

You’re!! You’re!!! Please try it.
You are killing me here.

 

[D P356]

You’re!! You’re!!! Please try it.
You are killing me here.

Going hard in the paint on that one!!!

 

[GassYous]

2 days per month? Are you serious? That’s an academic type schedule which most of us could do well into our late 60s. Many jobs out there involve trauma call or busy OB at least once per week with no guarantee of pre call off. That is much more common than 2 days per month. All you need to do is look at the jobs posted on gaswork in metro areas to see the real call frequency.

We have one weekday call a month and one weekend every two months (one day first, other backup). No trauma or ob. Home call. Sometimes get called back after leaving the hospital sometimes not. Usually done around 9 pm, it is not common to work all night. A lot of our people don't do any call.

 

[pgg]

It'll be OK. Probably.

Unless you're one of those people who HAS to live within 27 feet of some desirable urban coastal location. Think the urban equivalent of Samwise Gamgee, who was nervous about leaving the Shire. Plenty of great places to work if you're willing to go there.

But some people act like a daily whiff of New York or Los Angeles bus exhaust is required to maintain a tolerable life.

YMMV

Decide what you want in life, take it, and pay for it. Be Frodo.

 

[chocomorsel]

Going hard in the paint on that one!!!

It’s on every one of his or her posts when trying to use you’re.
It’s killing me!!

 

[pro-propofol]

😀

 

[GassYous]

It’s on every one of his or her posts when trying to use you’re.
It’s killing me!!

Your very neurotic

 

[pro-propofol]

F’ are totally normal !!

 

[deleted126335]

It'll be OK. Probably.

Unless you're one of those people who HAS to live within 27 feet of some desirable urban coastal location. Think the urban equivalent of Samwise Gamgee, who was nervous about leaving the Shire. Plenty of great places to work if you're willing to go there.

But some people act like a daily whiff of New York or Los Angeles bus exhaust is required to maintain a tolerable life.

YMMV

Decide what you want in life, take it, and pay for it. Be Frodo.

Frodo got stabbed and lost a finger. Also didn’t wind up happy. I think Sam would have been just fine never leaving the Shire. Just sayin.

 

[GassYous]

Frodo got stabbed and lost a finger. Also didn’t wind up happy. I think Sam would have been just fine never leaving the Shire. Just sayin.

He brought it upon himself for putting the ring on. Also for not using the eagles to simply fly to Mount Doom.

 

[pgg]

Frodo got stabbed and lost a finger. Also didn’t wind up happy. I think Sam would have been just fine never leaving the Shire. Just sayin.

Stop ruining my analogy

Also, Sam would've been Forever-Alone-Hobbit if he'd stayed in the Shire. Killing goblins for his old gaffer gave him the confidence to bag Rosie.

 

[chocomorsel]

Your very neurotic

Yes I am. Tell me something I don’t already know. And your not helping the neurosis. Lol

 

[Ho0v-man]

Everything sucks and will get worse. So just do what you want.

 

[Neopolymath]

He brought it upon himself for putting the ring on. Also for not using the eagles to simply fly to Mount Doom.

LOTR is a great example of an annoying flaw in the story (frodo being a little bitch, basically) being both irritating and yet simultaneously the only reason the story exists in the first place. Very frustrating but interesting to notice in a lot of good books and television.

 

[Neopolymath]

Stop ruining my analogy

Also, Sam would've been Forever-Alone-Hobbit if he'd stayed in the Shire. Killing goblins for his old gaffer gave him the confidence to bag Rosie.

In the alternate universe Sam is red-pilled and a weird men's rights activist. I don't want to see this alternate film now.

 

[pgg]

In the alternate universe Sam is red-pilled and a weird men's rights activist. I don't want to see this alternate film now.

Incel Sam is one of the saddest and most disturbing parallel universe alternate histories I've ever heard. Maybe not worse than The Man In The High Castle but probably runner up.

 

[D P356]

 

[Drwine]

A senior anesthesiologist who lived through the doom and gloom surrounding the advent of Medicare in 1965 told me 40 years ago that he can't predict specific details but that if you become an anesthesiologist you will make a good living. As I near retirement, it was sage advice. Doom and gloom in medicine has been a constant for at least 50 years in the USA but in spite of it all we have prospered.

 

[anbuitachi]

yea its real. just be prepared if you enter the specialty.
include the very real possibility that you will need to do fellowship or fellowships to have a chance of landing something decent as a new today, so instead of a 4 yr residency, can be looking at 5-6 yrs of training

crna issue is real. one hospital, the crna hourly rate is higher than attendings. another here is the same rate, but of course your license is mainly on the line since you supervise.. honestly they almost seem 'unfireable' bc their need is so high, and its so hard to hire them because the demand for crnas these days is just insane. much higher than for attendings here. CRNAs literally can go almost anywhere

hours are tough. lots of call, long/unpredictable hours/nights/weekends/holidays

work can be very demanding. get a lot of steps in. arm very tired from long periods of ventilating. watch out for your back when you transfer patients to and from OR table.

the pay in terms of purchasing power is weak

 

[BLADEMDA]

A senior anesthesiologist who lived through the doom and gloom surrounding the advent of Medicare in 1965 told me 40 years ago that he can't predict specific details but that if you become an anesthesiologist you will make a good living. As I near retirement, it was sage advice. Doom and gloom in medicine has been a constant for at least 50 years in the USA but in spite of it all we have prospered.

40 years ago you could pick this specialty and make a bundle. Today, if you enter Anesthesiology the odds are against you making more than a mediocre salary due to AMCs, hospital employment, CRNAs, very low Medicare reimbursement, etc. I would say this is almost a perfect storm environment for even lower pay once the community programs start pumping out new generalists.

This is in contrast to the Best specialties of today where there are no midlevels and Medicare pays about 80% of the typical reimbursement. I would encourage any med student with a Step 1 over 250 and/or a Step 2 over 260 to seek a much better financial future than Anesthesiology where good paying jobs are scarce and you need a lot of luck to land a primo private practice gig (if they survive Medicare for all).

I would advise picking a specialty where reimbursement from Medicare is sufficient to earn you a good living. I can assure you that specialty is not Anesthesiology. These days matching into any specialty is difficult and for many of you with Step scores below 240 the options are indeed limited. I truly hope you can make lemonade from the lemons.

 

[GassYous]

yea its real. just be prepared if you enter the specialty.
include the very real possibility that you will need to do fellowship or fellowships to have a chance of landing something decent as a new today, so instead of a 4 yr residency, can be looking at 5-6 yrs of training

crna issue is real. one hospital, the crna hourly rate is higher than attendings. another here is the same rate, but of course your license is mainly on the line since you supervise.. honestly they almost seem 'unfireable' bc their need is so high, and its so hard to hire them because the demand for crnas these days is just insane. much higher than for attendings here. CRNAs literally can go almost anywhere

hours are tough. lots of call, long/unpredictable hours/nights/weekends/holidays

work can be very demanding. get a lot of steps in. arm very tired from long periods of ventilating. watch out for your back when you transfer patients to and from OR table.

the pay in terms of purchasing power is weak

Why wouldn't the doctors just work as crnas then? I would be ashamed to make less than my nurses.

 

[<(^_^)>]

40 years ago you could pick this specialty and make a bundle. Today, if you enter Anesthesiology the odds are against you making more than a mediocre salary due to AMCs, hospital employment, CRNAs, very low Medicare reimbursement, etc. I would say this is almost a perfect storm environment for even lower pay once the community programs start pumping out new generalists.

This is in contrast to the Best specialties of today where there are no midlevels and Medicare pays about 80% of the typical reimbursement. I would encourage any med student with a Step 1 over 250 and/or a Step 2 over 260 to seek a much better financial future than Anesthesiology where good paying jobs are scarce and you need a lot of luck to land a primo private practice gig (if they survive Medicare for all).

I would advise picking a specialty where reimbursement from Medicare is sufficient to earn you a good living. I can assure you that specialty is not Anesthesiology. These days matching into any specialty is difficult and for many of you with Step scores below 240 the options are indeed limited. I truly hope you can make lemonade from the lemons.

Just to clarify the mediocre salary you refer to puts you in the top 1% and exceeds the median for doctors as well.

 

[POW16]

Yea people need to get a grip. I'm 2 years out and have never made below 375-400K in desirable cities. Even in NYC I would not call that purchasing power weak. Enjoy your 1% income, save some for retirement and stop worrying about things you can't control.

 

[BLADEMDA]

Just to clarify the mediocre salary you refer to puts you in the top 1% and exceeds the median for doctors as well.

The salary is mediocre relative to the other high paying specialties which involve a lot of call, nights and weekends. But, if you take a job working family practice hours the pay is much closer to family practice. The 800 pound gorilla in the room is CMS. Anesthesiology is highly exposed to much lower reimbursement vs other specialties if/when the Bernie Sanders or AOCs take control of the government. The more "socialized" medicine becomes the lower the salary for Anesthesiology, significantly more so than than other specialties.

You can spin it however you want the fact remains Anesthesiology is a shell of what it once was in the USA. The notion that you earn the top 1% is also fed by the left to make you feel better. Most business people hide their income via S corp or LLCs so they pay less taxes but live far better than a W-2 Anesthesiologist. When I was "earning" $250K my actual income was much higher due to the tax code.

By no means will you go hungry working as an Anesthesiologist but when the pay raises over the past 3-5 years are compared to our CRNA colleagues they win easily. Their income is going way up every year due to competition for their services.

I hope you keep making the lemonade and drinking the Kool-Aid.

 

[BLADEMDA]

 

[BLADEMDA]

MGMA, AMGA, and McGladrey Pullen Weighted Mean Salaries FY2020 ($)

Non-interventional Radiology	489,126
Interventional Radiology	566,115
Neurointerventional Radiology	573,499
Nuclear Medicine/Radiology	461,715

 

[BLADEMDA]

According to MedAxiom, interventional cardiology is one of the top-earning cardiology medical specialties, second only to electrophysiology. This survey claims that their national average salary is $674,910 per year.

• All regions of the country reported increases in median total cardiology compensation with the South remaining in the lead.

Comparably claims the median base salary for an interventional cardiologist is $425,000 but has the top 80% earning up to $750,000.