Tell me it’s going to be okay...

[BLADEMDA]

Gastroenterology | 750K+ | 1:9 Call | Endoscopy Ownership | 8 Weeks PTO | IN​

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Southeast Metro Gastroenterology - Partnership Opportunity Large Single Specialty Group - GI Hospitalist Coverage A premier private practice offeri...

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[BLADEMDA]

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...

If by "okay" you mean that there will be employment for you then yes, you will have a job. Can you last 30 years? I would think so as that is what most of us end up doing in this field 30-30+ years. Are things going to get worse? Most likely yes and the field keeps losing prestige by the nurses claiming equivalence. In addition, the advancement of socialized medicine makes private practice and revenue generation much harder. As the country embraces a single payer system over time the consequences to Anesthesiology will be significant in terms of salaries.

The "doom and gloom" is all relative to the past and other specialties doing much better. Looking through the lens of just your career the best thing for you to do is focus on being an outstanding resident and keeping your head down. I would recommend a fellowship to avoid being labeled as a "generalist" as the future for generalists is less Rosy than subspecialists.

 

[abolt18]

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.

Serious? I'd figure a busy interventional cards guy working anywhere but academics would pull 7 figures easy.

 

[dabears505]

arm very tired from long periods of ventilating

Lol there are lots of things I hate about anesthesia, but this has never been an issue for me.

 

[anbuitachi]

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

not allowed to...

 

[anbuitachi]

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.

huh, what are you talking about. with that crappy salary you are no where close to top 1%. Lets not even talk about how we have debt and started 10 years later than the other college grads on wall street, so our wealth is even more lacking compared to those top 1%

New York’s top 1% earn even more: about $2.2 million on average.

Here's how much money you need to make to be in the top 5% in New York

To be a part of the top 5% of earners in an expensive state like New York, where taxes and real-estate costs are among the highest in the country, you'll need to earn at least $250,000 a year.

www.cnbc.com

also i do think the purchasing power is weak. as anesthesiologists, most of US in NYC are W2 workers, meaning we get taxed to the moon, and our benefits are crap compared to other high paying jobs on wall street or tech. been out of residency for years now, still in my studio with partner. want to move to a 2bedroom but its 4-5k rent/month. buying a 2bed room here after 20% down, would be 6-7k/month for 30 years. (not even in manhattan)

 

[anbuitachi]

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.

Interventional cardiologist pulled in 750k in half a yr here in academic

 

[docbsb2015]

Working 30+ years?? Kill me

 

[anbuitachi]

definitely one of the few jobs that has IN HOUSE overnight, weekend, holiday, emergencies that require you to be there immediately, spanning multiple specialties, (stat sections, trauma, stroke, etc), working long hours, (AAMC lists anesthesiology as 3rd most hours, after thoracic and vascular surgery), while making only 380k.

In comparison, surgeons make way more and has way more potential to make more in PP. Calls are mostly home calls
ED makes comparable but doesnt work nearly as much

had a friend just graduate from IM. took a 7 on 7 off job. thinks its great. census of 12-15, first day on the job is tough bc of a new list of patients. from then its just rounding yourself and updating previous notes.. she says finish work in 5-6 hours, rest of the time just chill in lounge/office and be available if any emergencies come up. some of her colleagues bring a switch or ps4 and hook it up to the tv. not bad

 

[BLADEMDA]

Working 30+ years?? Kill me

Oh yes. My plan is 32-33 years then part time. That is pretty typical for my generation with a few outliers doing 40 years.

 

[BLADEMDA]

definitely one of the few jobs that has IN HOUSE overnight, weekend, holiday, emergencies that require you to be there immediately, spanning multiple specialties, (stat sections, trauma, stroke, etc), working long hours, (AAMC lists anesthesiology as 3rd most hours, after thoracic and vascular surgery), while making only 380k.

In comparison, surgeons make way more and has way more potential to make more in PP. Calls are mostly home calls
ED makes comparable but doesnt work nearly as much

had a friend just graduate from IM. took a 7 on 7 off job. thinks its great. census of 12-15, first day on the job is tough bc of a new list of patients. from then its just rounding yourself and updating previous notes.. she says finish work in 5-6 hours, rest of the time just chill in lounge/office and be available if any emergencies come up. some of her colleagues bring a switch or ps4 and hook it up to the tv. not bad

We have one of the few jobs in those surveys where the "average" person has to take a lot of call and work a significant number of hours to earn that pay.
Many of those other specialties are working a lot less than "average" private practice to earn those wages. That's my opinion of course but I know for a fact it is true in my area and by my area, I am talking about 2+ Million people.

 

[BLADEMDA]

not allowed to...

This year CRNAs working overtime at one practice are making the same hourly wage I was paid last last year (2020) when filling in. The irony is that I would be willing to work again for that current CRNA overtime rate if I could get the same responsibility as the CRNA. Currently, I am not allowed to do that role (CRNA) in that practice.

 

[BLADEMDA]

Serious? I'd figure a busy interventional cards guy working anywhere but academics would pull 7 figures easy.

My interventional cards colleagues are pulling in the low 7 figures but they work hard and I didn't want to use anecdotes to make my point. The IR guys are also pulling in around $900K in my area.

 

[pgg]

Working 30+ years?? Kill me

Well there's working full time with in-house call at age 65 because you have a boat, alimony, and $6M mortgage payment to make, and there's working part time at 65 with no call because you enjoy keeping busy and maybe you want to help fund a grandkid's 529. Both qualify as "working 30+ years" but one is sad and one is not.

 

[pgg]

huh, what are you talking about. with that crappy salary you are no where close to top 1%. Lets not even talk about how we have debt and started 10 years later than the other college grads on wall street, so our wealth is even more lacking compared to those top 1%

New York’s top 1% earn even more: about $2.2 million on average.

Here's how much money you need to make to be in the top 5% in New York

To be a part of the top 5% of earners in an expensive state like New York, where taxes and real-estate costs are among the highest in the country, you'll need to earn at least $250,000 a year.

www.cnbc.com

also i do think the purchasing power is weak. as anesthesiologists, most of US in NYC are W2 workers, meaning we get taxed to the moon, and our benefits are crap compared to other high paying jobs on wall street or tech. been out of residency for years now, still in my studio with partner. want to move to a 2bedroom but its 4-5k rent/month. buying a 2bed room here after 20% down, would be 6-7k/month for 30 years. (not even in manhattan)

Man you must really like NYC.

 

[POW16]

huh, what are you talking about. with that crappy salary you are no where close to top 1%. Lets not even talk about how we have debt and started 10 years later than the other college grads on wall street, so our wealth is even more lacking compared to those top 1%

New York’s top 1% earn even more: about $2.2 million on average.

Here's how much money you need to make to be in the top 5% in New York

To be a part of the top 5% of earners in an expensive state like New York, where taxes and real-estate costs are among the highest in the country, you'll need to earn at least $250,000 a year.

www.cnbc.com

also i do think the purchasing power is weak. as anesthesiologists, most of US in NYC are W2 workers, meaning we get taxed to the moon, and our benefits are crap compared to other high paying jobs on wall street or tech. been out of residency for years now, still in my studio with partner. want to move to a 2bedroom but its 4-5k rent/month. buying a 2bed room here after 20% down, would be 6-7k/month for 30 years. (not even in manhattan)

Way to miss the forest for the trees. Ok maybe you are relegated to the lowly 5% as an attending anesthesiologist in NYC. I trained there and was living in a 1 BR in Manhattan with a combined income of about 130K. At the end of the day it's a personal choice. Life is all about perspectives. If you only look at other specialties making over 1 mil, you will be sad/grumpy. If you look at the rest of America including most of your fellow docs, you will be happy.

 

[anbuitachi]

on a different note, anyone know where to find a hourly rate that i can use to negotiate? mgma is only salary i believe

 

[BLADEMDA]

Way to miss the forest for the trees. Ok maybe you are relegated to the lowly 5% as an attending anesthesiologist in NYC. I trained there and was living in a 1 BR in Manhattan with a combined income of about 130K. At the end of the day it's a personal choice. Life is all about perspectives. If you only look at other specialties making over 1 mil, you will be sad/grumpy. If you look at the rest of America including most of your fellow docs, you will be happy.

Happiness is a complicated word. I am not sure income alone will solve the issue of happiness. What I can tell you are the facts regarding Anesthesiology vs other specialties so you can make an informed decision. In the end, if one chooses Anesthesiology then that is your decision. I respect it but there is no reason not to discuss/display the good, bad and the ugly along with the income.

 

[BLADEMDA]

on a different note, anyone know where to find a hourly rate that i can use to negotiate? mgma is only salary i believe

Sure. Have you used Gaswork? The average hourly rate was $225 per hour plus travel costs for a locums. Typically, many are getting $250 per hour for non cardiac. If you want a "side gig" local to your home then I would say $200-$225 is the norm per hour. Cardiac locums is $275-$300 per hour.

 

[Southpaw]

if I had it to do again I’d maybe choose a different field but I only say that because of the mid level issues. Anesthesiology has been very good to me. My parents aren’t wealthy, not even close. In 5-10 years as an attending (I don’t want to list the exact number) I’ve paid off all loans and have over $1 mill saved up. I don’t love my job but I also don’t hate it. It’s a job. I’d likely feel the same if I were in another field.

when I look at fields like interventional cards or GI I see the physicians as procedure monkeys. The PA or NP sees all the patients before and after the procedure. That’s not exactly what I’d want if I were doing what they are, but if I were to guess their practices are no different than mine. Structured to be as financially successful as possible.

I wouldn’t trust a single poster here about the realities of anesthesia. Because it very much depends on the person and the job.

 

[Southpaw]

@anbuitachi dude, just freaking leave NYC. Anesthesia is subject to supply and demand. Everyone on this board has told you by now how much your job sucks. If you have to stay in the city for whatever reason, then do so knowing your job sucks. It isn’t the entire specialty that sucks, but perhaps just being an anesthesiologist in nyc that sucks.

For everyone else, the day CRNAs universally start making more than anesthesiologists is the day I start applying for jobs as a crna. Or the day I just freaking retire.

 

[BLADEMDA]

if I had it to do again I’d maybe choose a different field but I only say that because of the mid level issues. Anesthesiology has been very good to me. My parents aren’t wealthy, not even close. In 5-10 years as an attending (I don’t want to list the exact number) I’ve paid off all loans and have over $1 mill saved up. I don’t love my job but I also don’t hate it. It’s a job. I’d likely feel the same if I were in another field.

when I look at fields like interventional cards or GI I see the physicians as procedure monkeys. The PA or NP sees all the patients before and after the procedure. That’s not exactly what I’d want if I were doing what they are, but if I were to guess their practices are no different than mine. Structured to be as financially successful as possible.

I wouldn’t trust a single poster here about the realities of anesthesia. Because it very much depends on the person and the job.

Of course the "reality" of Anesthesiology differs greatly from job to job; location, salary, work-load, supervision, etc all play a huge role in job satisfaction.
Some attendings do indeed have great jobs, but how do you define great? Does that mean 90th percentile MGMA income supervision 1:4? Or, does it mean 70th percentile MGMA doing solo cases? Or, 25th percentile working 35 hours per week at an outpatient center? In my younger days I wanted income but now I want the easiest job possible.

I totally agree that this specialty cuts a wide swath through so many different types of practices. All we can do is post the pluses and minuses or the good, bad and the ugly.

I find it ironic that you view GI or cards as "procedure monkeys" when they view us as exactly the same with many of us "supervising" CRNAs while at least they actually perform the procedure. In the end, if you do it long enough, it is just a job which started out as a career.

 

[anbuitachi]

@anbuitachi dude, just freaking leave NYC. Anesthesia is subject to supply and demand. Everyone on this board has told you by now how much your job sucks. If you have to stay in the city for whatever reason, then do so knowing your job sucks. It isn’t the entire specialty that sucks, but perhaps just being an anesthesiologist in nyc that sucks.

For everyone else, the day CRNAs universally start making more than anesthesiologists is the day I start applying for jobs as a crna. Or the day I just freaking retire.

yea, i meant im just answering the OPs questions =)

how do you apply for jobs as CRNA when you dont have the CRNA license. sometimes when a CRNA calls out, we have a MD fill the role but it doesnt feel the same. The MD after your name just gives you all the liability, even if you have a supervising MD (as attendings)

 

[<(^_^)>]

I don’t know anyone that was seriously considering anesthesiologist vs interventional cardiologist vs gastroenterologist vs IR. They’re very different fields and I doubt someone would be happy in all of them, and indeed OP says they only find anesthesiology to be tolerable.

With regard to potential storm clouds on the horizon that’s true…for anesthesiology and every field in medicine.

Procedures are very much “on the menu”. In the UK nurse endoscopists do colonoscopies all the time. PAs increasingly do IR procedures and now want to be known as “physician associates”.

The argument that you “own your patients” is going out the window now that clinic increasingly is staffed by NPs/PAs.

Tax rates both federal and state continue to be more progressive (proposed increase to 53% federal over 400-500k, and Hawaii and Arizona just passed 16% and 8% top brackets. You make 300k more than someone making 400k, but take home just 111k more post taxes etc.

HCA residencies are learning that they can simply flood the market with physicians (emergency medicine) to drive down wages. It’s not like you’d have a shortage of qualified ortho applicants even if you trained 50% more residents trained a year.

Private practices are being bought up in all fields.

Insurance networks are consolidating as are hospital systems leaving no room for a small independent practice to get their fair shake.

AI is threatening some fields (derm, radiology, pathology).

New technology may reduce demand for procedures (DNA stool testing vs screening colonoscopies, minimally invasive valve replacement vs surgical).

Fundamentally there are clouds on the horizon for many fields, some more than others but the majority of them overlap.

So what is an anxious person in training (like OP) to do? First, live (relatively) modestly. Realize a budget of 150k is 3x what the average American family spends. Second, be thankful for what you have. It sounds silly but plenty of research shows taking a couple of minutes a day to actively appreciate what you have will improve your outlook and your health. Third, become financially independent as soon as possible and start giving up call to the young docs. There are people here that despite disliking their job continue to work with 5M liquid. You’ll see plenty of surgeons like this too. That’s a recipe of how to be miserable regardless of what comes to pass with the future of medicine.

 

[BLADEMDA]

I don’t know anyone that was seriously considering anesthesiologist vs interventional cardiologist vs gastroenterologist vs IR. They’re very different fields and I doubt someone would be happy in all of them, and indeed OP says they only find anesthesiology to be tolerable.

With regard to potential storm clouds on the horizon that’s true…for anesthesiology and every field in medicine.

Procedures are very much “on the menu”. In the UK nurse endoscopists do colonoscopies all the time. PAs increasingly do IR procedures and now want to be known as “physician associates”.

The argument that you “own your patients” is going out the window now that clinic increasingly is staffed by NPs/PAs.

Tax rates both federal and state continue to be more progressive (proposed increase to 53% federal over 400-500k, and Hawaii and Arizona just passed 16% and 8% top brackets. You make 300k more than someone making 400k, but take home just 111k more post taxes etc.

HCA residencies are learning that they can simply flood the market with physicians (emergency medicine) to drive down wages. It’s not like you’d have a shortage of qualified ortho applicants even if you trained 50% more residents trained a year.

Private practices are being bought up in all fields.

Insurance networks are consolidating as are hospital systems leaving no room for a small independent practice to get their fair shake.

AI is threatening some fields (derm, radiology, pathology).

New technology may reduce demand for procedures (DNA stool testing vs screening colonoscopies, minimally invasive valve replacement vs surgical).

Fundamentally there are clouds on the horizon for many fields, some more than others but the majority of them overlap.

So what is an anxious person in training (like OP) to do? First, live (relatively) modestly. Realize a budget of 150k is 3x what the average American family spends. Second, be thankful for what you have. It sounds silly but plenty of research shows taking a couple of minutes a day to actively appreciate what you have will improve your outlook and your health. Third, become financially independent as soon as possible and start giving up call to the young docs. There are people here that despite disliking their job continue to work with 5M liquid. You’ll see plenty of surgeons like this too. That’s a recipe of how to be miserable regardless of what comes to pass with the future of medicine.

I think your last few sentences are good advice. I really do. But, in the USA, not the UK, which specialty is in the very front lines of medicine facing the brunt of the issues you mentioned? Ortho? IR? Cards? No. It is Anesthesiology with serious issues regarding reimbursement from CMS and over 54,000 nurse providers of anesthesia ready and willing to work for Medicare rates. Who will replace all the Cards and Ortho docs? NPs? There are maybe 100 NPs who could fill those shoes vs 54,000 CRNAs ready to go right now.

ACGME has not approved large increases in programs for Ortho or Cards. This is in contrast to Anesthesiology where expansion is underway. I agree EM is not faring well due to producing way too many graduates but are we far behind?

As for taxes you fail to also grasp the importance of S corp/LLC vs W-2. Those providers who are "small businesses" keep far more of their hard earned money than W-2 workers. I hate to say it but being W-2 for those earning more than $450K (Biden's tax plan) will cost that person a lot of money. The tax code is designed to favor the S corp or LCC (sole proprietor) vs W-2. The "take home" pay is far bigger than you realize if structured properly.

 

[<(^_^)>]

I think your last few sentences are good advice. I really do. But, in the USA, not the UK, which specialty is in the very front lines of medicine facing the brunt of the issues you mentioned? Ortho? IR? Cards? No. It is Anesthesiology with serious issues regarding reimbursement from CMS and over 54,000 nurse providers of anesthesia ready and willing to work for Medicare rates. Who will replace all the Cards and Ortho docs? NPs? There are maybe 100 NPs who could fill those shoes vs 54,000 CRNAs ready to go right now.

ACGME has not approved large increases in programs for Ortho or Cards. This is in contrast to Anesthesiology where expansion is underway. I agree EM is not faring well due to producing way too many graduates but are we far behind?

As for taxes you fail to also grasp the importance of S corp/LLC vs W-2. Those providers who are "small businesses" keep far more of their hard earned money than W-2 workers. I hate to say it but being W-2 for those earning more than $450K (Biden's tax plan) will cost that person a lot of money. The tax code is designed to favor the S corp or LCC (sole proprietor) vs W-2. The "take home" pay is far bigger than you realize if structured properly.

I can’t imagine any CRNA is willing to work for Medicare rates. But to your point about the number of CRNAs that’s actually a huge point in favor of anesthesiology over these other fields. 36,000 NPs graduated last year. There were 91,000 NPs in 2010 and 325,000 today. 10,000 PAs graduate a year. Both these numbers are increasing around 2,000 and 1,000 respectively every year. Within a decade they will outnumber all physicians.

NP Fact Sheet

There are more than 385,000 nurse practitioners (NPs) licensed in the U.S. 1 More than 39,000 new NPs completed their academic programs in 2021-2022. 2 88.0% of NPs are certified in an area of primary care, and 70.3% of all NPs deliver primary care. 3 83.2% of full-time NPs are seeing Medicare…

www.aanp.org

https://www.nccpa.net/wp-content/uploads/2021/07/Statistical-Profile-of-Certified-PAs-2020.pdf

Compare that to 26,600 US MD+DO, and about 35k total positions in the match.

So yes, there are plenty of NPs/PAs. The difference is they can do a 3-6 month “residency” and switch into whatever field isn’t saturated yet. A lot of procedural fields have high pay due to artificial scarcity. Sounds good until in the interests of “addressing the shortage” and “providing affordable healthcare” mid-levels are allowed to perform colonoscopies or replace knees independently. Who will train them? Who trained CRNAs?

And I’m familiar with various strategies to minimize taxation, but in a world of increasingly employed physicians (a majority now, regardless of preference) that will no longer be an option even for proceduralists moving forward.

To be clear, I don’t think the sky is falling (unless you’re expecting to make 800k as a physician), but the rest of medicine is now experiencing a surge of NPs/PAs which is unlike anything we have seen before. We have seen an incredible expansion in scope of practice over the last decade and I don’t see any slowing down. Let’s also not forget the “floor” of working for NP/PA wages is much lower than CRNA wages that’s for sure.

 

[BLADEMDA]

I can’t imagine any CRNA is willing to work for Medicare rates. But to your point about the number of CRNAs that’s actually a huge point in favor of anesthesiology over these other fields. 36,000 NPs graduated last year. There were 91,000 NPs in 2010 and 325,000 today. 10,000 PAs graduate a year. Both these numbers are increasing around 2,000 and 1,000 respectively every year. Within a decade they will outnumber all physicians.

NP Fact Sheet

There are more than 385,000 nurse practitioners (NPs) licensed in the U.S. 1 More than 39,000 new NPs completed their academic programs in 2021-2022. 2 88.0% of NPs are certified in an area of primary care, and 70.3% of all NPs deliver primary care. 3 83.2% of full-time NPs are seeing Medicare…

www.aanp.org

https://www.nccpa.net/wp-content/uploads/2021/07/Statistical-Profile-of-Certified-PAs-2020.pdf

Compare that to 26,600 US MD+DO, and about 35k total positions in the match.

So yes, there are plenty of NPs/PAs. The difference is they can do a 3-6 month “residency” and switch into whatever field isn’t saturated yet. A lot of procedural fields have high pay due to artificial scarcity. Sounds good until in the interests of “addressing the shortage” and “providing affordable healthcare” mid-levels are allowed to perform colonoscopies or replace knees independently. Who will train them? Who trained CRNAs?

And I’m familiar with various strategies to minimize taxation, but in a world of increasingly employed physicians (a majority now, regardless of preference) that will no longer be an option even for proceduralists moving forward.

Absurd to think Orthopedists will train NPs to do knee replacements solo in 6 months. Who will credential these NPs? Ditto for Cardiac catheterizations and NP placing stents. That won't happen anytime soon.

NPs/PAs are looking for the easy buck. That means Derm, FP and EM. Gi has some risks to it because the public perceives a scope up the arse as something not terribly complicated (ignorance). I can see NP/PA trying to move in on that turf.

I think it is truly disingenuous to compare the role of NPs/PAs in our healthcare system to CRNAs. CRNAS are decades ahead of other midlevels in terms of operating independently both practically and by law practicing a dangerous medical specialty under the guise of nursing. I am pretty certain patients won't be lining up to get cardiac stents by NPs anytime soon if ever. The type of IR work done at high acuity hospitals will not be performed by NPs anytime soon either as they won't be granted privileges nor should they.

So, I must disagree with your conclusion that Anesthesiology is similar to many other fields. The only other specialties truly feeling the heat from NPs are EM, Derm and FP.

• 88.9% of NPs are certified in an area of primary care, and 70.2% of all NPs deliver primary care.3

 

[BLADEMDA]

CRNA Opt Out States | Everything CRNA

According to the AANA, US Federal law requires that nurse anesthetists must be supervised by a physician when doing their job of providing anesthesia. In…

www.everythingcrna.com

20 states as of today and growing each year.

CRNA Salary | Everything CRNA

This year, over 5,000 nurse anesthetists participated in a CRNA career survey given by the American Association of Nurse Anesthetists. This is the most prestigious…

www.everythingcrna.com

 

[<(^_^)>]

CRNA Opt Out States | Everything CRNA

According to the AANA, US Federal law requires that nurse anesthetists must be supervised by a physician when doing their job of providing anesthesia. In…

www.everythingcrna.com

20 states as of today and growing each year.

CRNA Salary | Everything CRNA

This year, over 5,000 nurse anesthetists participated in a CRNA career survey given by the American Association of Nurse Anesthetists. This is the most prestigious…

www.everythingcrna.com

https://www.sacbee.com/news/politics-government/capitol-alert/article246035050.html 29 (now) and growing every year.

Absurd to think Orthopedists will train NPs to do knee replacements solo in 6 months. Who will credential these NPs? Ditto for Cardiac catheterizations and NP placing stents. That won't happen anytime soon.

NPs/PAs are looking for the easy buck. That means Derm, FP and EM. Gi has some risks to it because the public perceives a scope up the arse as something not terribly complicated (ignorance). I can see NP/PA trying to move in on that turf.

I think it is truly disingenuous to compare the role of NPs/PAs in our healthcare system to CRNAs. CRNAS are decades ahead of other midlevels in terms of operating independently both practically and by law practicing a dangerous medical specialty under the guise of nursing. I am pretty certain patients won't be lining up to get cardiac stents by NPs anytime soon if ever. The type of IR work done at high acuity hospitals will not be performed by NPs anytime soon either as they won't be granted privileges nor should they.

So, I must disagree with your conclusion that Anesthesiology is similar to many other fields. The only other specialties truly feeling the heat from NPs are EM, Derm and FP.

• 88.9% of NPs are certified in an area of primary care, and 70.2% of all NPs deliver primary care.3

Who will credential them? Why the board of nursing of course! And as mentioned earlier physician “associates” aren’t happy being assistant either. Again, a lot can happen in 10 years and 10 years ago they were 1/4 the number. IR is currently seeing some encroachment, then they’ll jump to diagnostic cath and probably stent placement eventually. Their pitch of lowering cost of care resonates across the political spectrum (as evidenced by continued expansion of full practice authority).

As for 70.8% of NPs doing primary care or used to be 77.8% just a couple years ago. Shows how fast things are shifting. https://www.healthaffairs.org/doi/10.1377/hblog20181211.872778

I am pretty certain patients won't be lining up to get cardiac stents by NPs anytime soon if ever.

You mean the doctor (of nursing practice) that saw them in clinic and was so kind? The one that’s covered by their insurance? The one that happened to be on call when they had a heart attack?

To expand on your list of EM/Derm/FP I would add pediatrics, PM&R, endocrinology, allergy, sleep medicine, neurology, hospitalists, critical care, pulmonology, nephrology, rheumatology, OB-GYN and Oncology. Oh and also surgery clinic visits are increasingly PA/NP these days. The united lobbying power of NPs/PAs/insurance companies/hospitals with the purported goal of lowering cost is formidable which is how we got here today. Anyone that goes into surgery/cardiology/GI/IR in 2021 to “avoid” mid-levels is likely in for a rude awakening in the course of their career.

Do what you like, live modestly, save aggressively and be thankful for what you have.

 

[Drwine]

I agree that the ASA won a pyrric victory in maintaining time units in the CMS Medicare formula. If government payment model ever become the norm hospitals will have to step up with a ton of subsidy to even attract CRNAs. Demand for anesthesia services keeps increasing so the demise of private insurance companies would bring things to a head if supply and demand forces rationing of anesthesia services.

 

[Aheadbyacentury]

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.

You are speaking the truth.

 

[otherstuff12321]

@BLADEMDA, what specialty would you recommend instead? Would picking another specialty be a better idea than doing a fellowship after anesthesia? My step 1 score was 245-248 and I'm looking to go into a specialty that's hands on, lifestyle-friendly, and not in a clinic. Something similar to anesthesiology.

What would you recommend for naifs like me?

 

[CopaceticOne]

I'm looking to go into a specialty that's hands on, lifestyle-friendly, and not in a clinic.

Pathology

 

[BLADEMDA]

I always tell the Med students who have a step 1 over 245 to consider all options like DR/IR, cards, urology, ENT, etc. ultimately, you need to like the job enough to do it for 30 years. If the only thing you can stand is Anesthesia then do the fellowship year.

 

[GassYous]

@BLADEMDA, what specialty would you recommend instead? Would picking another specialty be a better idea than doing a fellowship after anesthesia? My step 1 score was 245-248 and I'm looking to go into a specialty that's hands on, lifestyle-friendly, and not in a clinic. Something similar to anesthesiology.

What would you recommend for naifs like me?

Midlevel IR

 

[Drwine]

I reached out to my politically active colleagues and they mentioned that dealing with CMS one of their top priorities and their focus has been redirected in this direction.

 

[deleted126335]

Pathology

Pathologists have been fu(ked for years.

 

[Urzuz]

Pathologists have been fu(ked for years.

I don’t know, I expect the demand for pathologists to skyrocket in the next decade as cRNas and other mid levels continue to gain independence.

 

[CopaceticOne]

Pathologists have been fu(ked for years.

Don't disagree, but it meets the requirements listed.

Specialties with no clinic: pathology, EM, anesthesiology, IM Hospitalist, critical care, Nuc Med, DR
Specialties that are hands-on (from the above list): pathology, EM, anesthesiology, critical care
Lifestyle will depend on the job.

Granted, the hands on nature of pathology is MUCH different.

 

[Airway]

Midlevel IR

The federal system has mid-levels radiology doing procedures (Chest tube, CVC, paracentesis I know for sure). They are in everything.

 

[abolt18]

I don’t know, I expect the demand for pathologists to skyrocket in the next decade as cRNas and other mid levels continue to gain independence.

Pathologists have their own midlevels. Never heard of a pathologists' assistant? (Yes, called a "PA" in those circles)

https://www.pathassist.org/page/What_is_a_PA

Except their national organization on its own website makes their role very clear.

"Pathologists’ Assistants play a critical role in the delivery of healthcare services in both surgical pathology and autopsy pathology. They are key partners in assisting the Pathologist to arrive at a pathologic diagnosis, but it is the sole responsibility of the Pathologist to render a diagnosis."

 

[Neopolymath]

Pathologists have their own midlevels. Never heard of a pathologists' assistant? (Yes, called a "PA" in those circles)

https://www.pathassist.org/page/What_is_a_PA

Except their national organization on its own website makes their role very clear.

"Pathologists’ Assistants play a critical role in the delivery of healthcare services in both surgical pathology and autopsy pathology. They are key partners in assisting the Pathologist to arrive at a pathologic diagnosis, but it is the sole responsibility of the Pathologist to render a diagnosis."

It's a pretty gross job. I mean their first job responsibility is grossing after all.

/I'll see myself out

 

[Blockit]

@BLADEMDA, what specialty would you recommend instead? Would picking another specialty be a better idea than doing a fellowship after anesthesia? My step 1 score was 245-248 and I'm looking to go into a specialty that's hands on, lifestyle-friendly, and not in a clinic. Something similar to anesthesiology.

What would you recommend for naifs like me?

You asked blade but I will give you the correct answer 😂
If you decide to remain within anesthesiology you should do a fellowship, preferably in pain medicine. Lots of income potential there, and usually four days a week. Work in a situation where you are procedure heavy and can get a nurse practitioner to see the whiny med refill patients. Cardiac fellowship would also be excellent for your income but not nearly as family-friendly unless you manage to find a smaller community hospital with a couple of good cardiac surgeons who only like to work during the day.

Options outside of anesthesiology would be to do ortho, particularly sports medicine or one of those specialties where you could do most of your work in an ambulatory surgery center. If you were to join a big ortho group as a right of passage they would make you take a **** ton of hospital call, which sucks. I tend to think that pain docs, plastic surgeons, and ortho surgeons who work predominantly out of an ambulatory surgery center with the potential of ownership stake have the best chance at being satisfied intellectually as well as with income for 30 years.
You are treated differently as a proceduralist. Work on building a reputation for high-quality care and attentiveness among your patients and everyone will be fighting to see you forever.

 

[BLADEMDA]

You asked blade but I will give you the correct answer 😂
If you decide to remain within anesthesiology you should do a fellowship, preferably in pain medicine. Lots of income potential there, and usually four days a week. Work in a situation where you are procedure heavy and can get a nurse practitioner to see the whiny med refill patients. Cardiac fellowship would also be excellent for your income but not nearly as family-friendly unless you manage to find a smaller community hospital with a couple of good cardiac surgeons who only like to work during the day.

Options outside of anesthesiology would be to do ortho, particularly sports medicine or one of those specialties where you could do most of your work in an ambulatory surgery center. If you were to join a big ortho group as a right of passage they would make you take a **** ton of hospital call, which sucks. I tend to think that pain docs, plastic surgeons, and ortho surgeons who work predominantly out of an ambulatory surgery center with the potential of ownership stake have the best chance at being satisfied intellectually as well as with income for 30 years.
You are treated differently as a proceduralist. Work on building a reputation for high-quality care and attentiveness among your patients and everyone will be fighting to see you forever.

The most competitive specialties typically require Step 1 scores closer to 250 not 245 and that includes Ortho. I would be very cautious with borderline Step scores trying to Match these days. If the Med student crushes Step 2 then that changes things quite a bit.

Derm ,Ortho, Neurosurgery, Direct IR, typically require very high step 1 and 2 scores. ENT, Urology, DR, IM are more in the range of 245. A little bit of realism is very important as the last Match was extremely competitive.

 

[BLADEMDA]

This is 2020 data. 2021 was very competitive. I would be very wary of trying to Match without the appropriate Step 1 and 2 scores in place. At the very least a back-up specialty is required for applicants "stretching" to Match a competitive specialty without the stats.

 

[BLADEMDA]

The most competitive specialties typically require Step 1 scores closer to 250 not 245 and that includes Ortho. I would be very cautious with borderline Step scores trying to Match these days. If the Med student crushes Step 2 then that changes things quite a bit.

Derm ,Ortho, Neurosurgery, Direct IR, typically require very high step 1 and 2 scores. ENT, Urology, DR, IM are more in the range of 245. A little bit of realism is very important as the last Match was extremely competitive.

Please don't misunderstand my post. Of course, a student can Match into almost any specialty with a 245 but I like to advise Students to be realistic and achieve the mean Step 1 score for their specialty of choice; there are no guarantees period but the MATCH is so competitive these days that those students below the mean really should have a backup plan in place.

 

[Aheadbyacentury]

Please don't misunderstand my post. Of course, a student can Match into almost any specialty with a 245 but I like to advise Students to be realistic and achieve the mean Step 1 score for their specialty of choice; there are no guarantees period but the MATCH is so competitive these days that those students below the mean really should have a backup plan in place.

Blade they dont give scores for step 1 anymore.. Its pass or fail.. You should have a pass to match into ANY specialty.

 

[Blockit]

Blade, the most shocking bit of data on that graphic you put up is how many individuals actually applied to be vascular surgeons. What a depressing specialty.

 

[ambiturner]

@BLADEMDA, what specialty would you recommend instead? Would picking another specialty be a better idea than doing a fellowship after anesthesia? My step 1 score was 245-248 and I'm looking to go into a specialty that's hands on, lifestyle-friendly, and not in a clinic. Something similar to anesthesiology.

What would you recommend for naifs like me?

You got some good answers here. If job security is your objective, in the absence of unforeseen political moves, the best path is to do something prohibively difficult to learn. No mid level army is going to start doing spinal fusions, free flaps, tendon transfers, etc. bc it takes years to learn those things. However, the government could unilaterally decide to start paying less for any of those procedures at any point as they have with CABG, MRIs, cataracts, etc in the past.

Doing something difficult won’t guarantee you a good lifestyle, but the reality in medicine is a lot of people have crappy lifestyles bc they refuse to work less and make less. There is more control in surgery than you think.

Or you could just do anesthesia since you like it and it’s still a decent job. And don’t forget, if it gets really bad here you can go to pretty much any other decent medical system in the English speaking world and do your own cases, with more respect.

 

[otherstuff12321]

You got some good answers here. If job security is your objective, in the absence of unforeseen political moves, the best path is to do something prohibively difficult to learn. No mid level army is going to start doing spinal fusions, free flaps, tendon transfers, etc. bc it takes years to learn those things. However, the government could unilaterally decide to start paying less for any of those procedures at any point as they have with CABG, MRIs, cataracts, etc in the past.

Doing something difficult won’t guarantee you a good lifestyle, but the reality in medicine is a lot of people have crappy lifestyles bc they refuse to work less and make less. There is more control in surgery than you think.

Or you could just do anesthesia since you like it and it’s still a decent job. And don’t forget, if it gets really bad here you can go to pretty much any other decent medical system in the English speaking world and do your own cases, with more respect.

But these difficult specialties often have high ratings of "regret" among physicians, and specialty satisfaction and regret don't necessarily correlate with how hard-working the doctors in them are. Some specialties are just not as conducive to nice lifestyles as others. At this point, I'm considering going into anesthesia and accepting that whatever happens, happens.

Damned if you do, damned if you don't.