To young attendings: Do you regret choosing anesthesiology?

[deleted162650]

If you came out of residency a "very long time ago" and didn't make a barnfull of hay in the 2000s you were either in the military or there's something wrong with you.

Funny you say that. My group formed in the late 90’s, and the OG guys that have been here from the beginning say they’re making more now than they ever have.

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[nimbus]

Funny you say that. My group formed in the late 90’s, and the OG guys that have been here from the beginning say they’re making more now than they ever have.

The late nineties were orders of magnitude worse than now.

 

[deleted162650]

The late nineties were orders of magnitude worse than now.

Right, but they're saying 2018 was the best year we've ever had in the group's 20yr existence. (including all those years in the 2000's).

 

[seniormd]

If you came out of residency a "very long time ago" and didn't make a barnfull of hay in the 2000s you were either in the military or there's something wrong with you.

At age 57 I'm going to be at least half retired. I sure won't be taking in-house cot call 5 times per month. And I was/am in the military.

I understand that some guys have a stable full of ex-wives who need alimony and boat payments to make through their 60s, but there's no reason anesthesiologists can't quit taking brutal q6 in-house trauma/transplant/OB/etc call when they're 25 years deep in their careers. I mean, some people like it and more power to them, but if you hate it, don't do it.

Also, LOL at the way you're attempting to strong-arm your daughter's specialty choice.

The ASA is weak, I agree with you there.

All parents direct their kids either blatantly or subtly.
I have money. I just spent very long hours making it. Keep the time denominator in mind when you calculate your wages. That is $ per hour.

 

[deleted126335]

Funny you say that. My group formed in the late 90’s, and the OG guys that have been here from the beginning say they’re making more now than they ever have.

On a per hour inflation adjusted basis? Possible, but I have my doubts. Especially if MD Anesthesia. More llikely with an ACT with a higher supervision ratio.

 

[deleted162650]

On a per hour inflation adjusted basis? Possible, but I have my doubts. Especially if MD Anesthesia. More llikely with an ACT with a higher supervision ratio.

Per hour basis - Yes. Inflation adjusted - I really can't comment on that. Even in the years I've been here, reimbursement has gradually improved year over year while workload has remained unchanged.

 

[docmeow4]

What is the typical work schedule like for an attending anesthesiologist?

 

[Neopolymath]

Funny you say that. My group formed in the late 90’s, and the OG guys that have been here from the beginning say they’re making more now than they ever have.

My mentors say this too. Why do I keep hearing otherwise? Is this just another example of average physicians being awful businessmen in general?

 

[deleted162650]

My mentors say this too. Why do I keep hearing otherwise? Is this just another example of average physicians being awful businessmen in general?

The actual reimbursements for Anesthesia services are not decreasing. Even MediCare payments typically adjust upwards (ever so slightly) every few years. The issue has been the increasing prevalence of employee jobs over the last few years be it academic/"privademic", AMC's, or direct hospital employed models. Your employer is always going to try and pay you the bare minimum they can get away with and pocket the rest. They do this by either paying crappy to begin with, or paying the same but expecting/extracting more work from you. The PP groups that have weathered the storm and don't have craptastic payer mixes are doing just fine.

 

[Neopolymath]

The actual reimbursements for Anesthesia services are not decreasing. Even MediCare payments typically adjust upwards (ever so slightly) every few years. The issue has been the increasing prevalence of employee jobs over the last few years be it academic/"privademic", AMC's, or direct hospital employed models. Your employer is always going to try and pay you the bare minimum they can get away with and pocket the rest. They do this by either paying crappy to begin with, or paying the same but expecting/extracting more work from you. The PP groups that have weathered the storm and don't have craptastic payer mixes are doing just fine.

That makes sense. It appears that anesthesiology is the specialty that most requires a very strong group/partners in order to not get totally hosed. A strong group seems to go a long way compared to other specialties.

 

[deleted162650]

That makes sense. It appears that anesthesiology is the specialty that most requires a very strong group/partners in order to not get totally hosed. A strong group seems to go a long way compared to other specialties.

I would say the same is true for any of the hospital based, consultant specialties: Rads, Anes, Path, EM (as in what Hospital Admin would like to do to them if you allow it).

 

[IMGASMD]

I would say the same is true for any of the hospital based, consultant specialties: Rads, Anes, Path, EM (as in what Hospital Admin would like to do to them if you allow it).

I see the road the happiness has been changed.

 

[Planktonmd]

I am not even close to call myself a "young attending" but I have tremendously enjoyed my 30 years journey, I had some bad days but I still love this job!
This might not be the case for the young generation since the challenges are getting worse everyday... but I have to say that I still feel very happy and excited every time I have the privilege of providing excellent care to a patient, and even if no one recognizes my efforts I still go home with a pleasant sense of achievement which is all I need to keep getting up at 0500 everyday.
If I had a choice... I wouldn't have changed a thing!
I had a fulfilling career and I am at peace with my decisions.

 

[DirtDocMD]

Even if you have a “strong group”, you are literally one administrator away from having an RFP issued, and either a) getting bounced out of the hospital or b) having to work for some shady AMC, if that’s who the administration picks to be the “exclusive anesthesia provider”.

There ARE great anesthesia jobs out there, and many of them are great up until the very moment they aren’t, which often involves an AMC, more call, more hours, and more “shut up/keep your head down/do your job as OTHER PEOPLE see fit” directives.

If you’re willing to move to where the good jobs are, and willing to pack it in when a good job goes bad (and don’t have a spouse that demands you live in a “boat anchor” of a house or live within 30 miles of all their surviving family members) you can still have a good job. Unfortunately, you will have little control over what makes an anesthesia job good or bad, like you would if you had your own office/practice. It is in the hands of surgeons/GI/cardiology/administrators/AMC executives...

 

[PieOHmy]

I am concerned that folks are getting bogged down with the CRNA issue. Even without that issue, the specialty is a disaster. We work very long hours with erratic schedules to make a little bit more than other doctors.
Yes I regret it, and of course I would never have picked it had I known. My advisors weren’t honest.

The above is a very true statement. The fact that the ASA or our academic leaders cannot effectively deal with the nasty rhetoric from the CRNA or keep any of this silliness in check to me is mind boggling and should be telling of what kind of leadership we have. You should be asking yourself why you are paying dues?
The lack of control of your schedule, inability to scale up or down your schedule based on your personal needs in addition to brutal early mornings, brutal early afternoons and brutal late evenings make anesthesia ripe for burnout. Couple that with a very difficult work pressurized environment with people who think you are over paid and useless makes it particularly challenging to really succeed and be happy. You have to be on your game ALL THE TIME. Curveballs are dealt routinely. WHich if fine? but leads to burnout and emotional fatigue.
These are things that should be taken into consideration when considering anesthesia.

 

[AdmiralChz]

Very Happy:

PP
MD Only
West Coast

I am PP, east coast and ACT model. I'm quite happy with my growing family. As I often say, not every ACT practice out there is a hellscape. The secret is to employ your nurses. I grew up around here and have zero interest in the west coast.

No practice is perfect, and we had plenty of former MD-only west coasters come back to academia following horrible experiences out in practice.

 

[AdmiralChz]

Do you regret choosing Anesthesiology?
Do you see yourself having a decent job for the next 30 years?
Do you see CRNA = MD in the near future where you will be treated like "just another CRNA"? (Or, CRNAs calling themselves "I am Dr. ABC, and I will be your anesthesiologist" while practicing independently)
If you could go back to medical school, would you still choose Anesthesiology?

For completeness:

No.
Yes, but see #4 below...
Nope, and even the guys 60+ in my practice say the same old concerns about this have been around since they were in their 20s. Yawn.
Yes, but like many above I am not sure I would pick medicine again if push comes to shove. If this medicare for all thing really goes through and commercial insurance collapses, our medical system as we know it will crumble. I have no idea what the finally outcome will be, but if salaries don't straight go down I definitely see much more work to maintain it. This will be double true for our colleagues in surgery, EM and primary care.

Separate note - if the above happens, I fully expect a secondary private market to spring up with private hospitals catering to the rich who can afford non-governmental insurance and don't want to wait in months-long lines for elective surgeries. If this is the case, you'll want to be working there.

 

[Timeoutofmind]

Right, but they're saying 2018 was the best year we've ever had in the group's 20yr existence. (including all those years in the 2000's).

Over a 20 something year horizon, salaries would have to have doubled in order to have kept pace with inflation (which has averaged 3% a year)....when you compare day one with today in real dollars (rule of 72)

 

[deleted162650]

With the exception of housing in certain areas, things were not 1/2 as expensive in 2000 as they are now.

 

[Twiggidy]

The actual reimbursements for Anesthesia services are not decreasing. Even MediCare payments typically adjust upwards (ever so slightly) every few years. The issue has been the increasing prevalence of employee jobs over the last few years be it academic/"privademic", AMC's, or direct hospital employed models. Your employer is always going to try and pay you the bare minimum they can get away with and pocket the rest. They do this by either paying crappy to begin with, or paying the same but expecting/extracting more work from you. The PP groups that have weathered the storm and don't have craptastic payer mixes are doing just fine.

This right here.

 

[Twiggidy]

I see the road the happiness has been changed.

Yeah....it's pretty much Derm Ophtho these specialties if you can now.

 

[agolden1]

Yeah....it's pretty much Derm Ophtho these specialties if you can now.

For now.... Check out their boards here and you'll see several recent discussions have centered around senior partners selling out their practices to private equity groups. It's just the tip of the iceberg for them, but after seeing the debacle so many other specialties are in, you'd think they would have learned.

 

[bronx43]

Yeah....it's pretty much Derm Ophtho these specialties if you can now.

There is no road to happiness anymore. It’s all varying degrees of misery.

 

[seniormd]

The above is a very true statement. The fact that the ASA or our academic leaders cannot effectively deal with the nasty rhetoric from the CRNA or keep any of this silliness in check to me is mind boggling and should be telling of what kind of leadership we have. You should be asking yourself why you are paying dues?
The lack of control of your schedule, inability to scale up or down your schedule based on your personal needs in addition to brutal early mornings, brutal early afternoons and brutal late evenings make anesthesia ripe for burnout. Couple that with a very difficult work pressurized environment with people who think you are over paid and useless makes it particularly challenging to really succeed and be happy. You have to be on your game ALL THE TIME. Curveballs are dealt routinely. WHich if fine? but leads to burnout and emotional fatigue.
These are things that should be taken into consideration when considering anesthesia.

Very well said. We need this kind of refreshing honesty.

 

[Man o War]

Yeah....it's pretty much Derm Ophtho these specialties if you can now.

Optho job market is declining according to the residents and fellows we have here. Derm is suffering from mid level encroachment and private equity woes.
The next 10 years will be interesting for doctors.....

 

[bronx43]

Optho job market is declining according to the residents and fellows we have here. Derm is suffering from mid level encroachment and private equity woes.
The next 10 years will be interesting for doctors.....

Not to mention derm is significantly more saturated than it was just a few years ago. There is a derm office every few blocks where I work. They just keep spouting up like weeds. And half are MOHS... I guess in this country, you’re not allowed to die without having every basal cell cut off you.

 

[CyrusHabs7695]

All parents direct their kids either blatantly or subtly.
I have money. I just spent very long hours making it. Keep the time denominator in mind when you calculate your wages. That is $ per hour.

What specialty do you wish you would have picked instead of gas?

 

[VA Hopeful Dr]

Not to mention derm is significantly more saturated than it was just a few years ago. There is a derm office every few blocks where I work. They just keep spouting up like weeds. And half are MOHS... I guess in this country, you’re not allowed to die without having every basal cell cut off you.

Send them my way - soonest derm appointment with an MD my patients can get is 3-4 months out.

 

[bronx43]

Send them my way - soonest derm appointment with an MD my patients can get is 3-4 months out.

Code word MD. All the offices here consist of 1-2 MDs and about 7 mid levels

 

[VA Hopeful Dr]

Code word MD. All the offices here consist of 1-2 MDs and about 7 mid levels

Well yeah, we have one office here with a bunch of midlevels who can do next day appointments. They get my stubborn rash patients or general pains-in-the-ass who demand a dermatologist for their warts. Interestingly, that office's MD also have a 3-4 month wait.

The MD-only office gets my worrisome lesions or biopsy-proven cancers. They're also the ones with the long new patient wait. Almost like people want to see the MDs.

 

[OTCAwesome]

What specialty do you wish you would have picked instead of gas?

If you ever want to get a response from any of us, stop calling it gas.

The specialty is anesthesiology
We are not gas passers, we are Anesthesiologists

 

[seniormd]

What specialty do you wish you would have picked instead of gas?

Definitely would have looked at cardiology, radiology, heme onc.
Possibly rheumatology or pulmonary medicine, neurology or neuropsych.

 

[seniormd]

If you ever want to get a response from any of us, stop calling it gas.

The specialty is anesthesiology
We are not gas passers, we are Anesthesiologists

True, but this is another sign of the disrespect that our specialty has to endure. The pp probably didn’t mean any disrespect, but this kind of terminology is common. If you correct a surgeon or nurse, even politely, you get labeled as a troublemaker.

 

[Block-Buster]

Nope. It's pretty sweet. I enjoy my job. good work/life balance. Home call is KEY. I like OB but I could probably give up the in-house epidural babysitting and/or OB call in general. I'm biased, but I agree with what others have said about the virtues of being in an independent physician-owned private practice who employs midlevels (if you have them at all).

 

[CyrusHabs7695]

If you ever want to get a response from any of us, stop calling it gas.

The specialty is anesthesiology
We are not gas passers, we are Anesthesiologists

Didnt mean any disrespect, thought it was just a short hand typing name

 

[Twiggidy]

Optho job market is declining according to the residents and fellows we have here. Derm is suffering from mid level encroachment and private equity woes.
The next 10 years will be interesting for doctors.....

Yeah so basically these question isn't "Do you regret doing anesthesiology?" but rather, "Do you regret doing medicine?" Probably not. It's the most stable well paying professional career. I think much of the complaining on all of the forums is mostly #firstworldproblems I think we all need to realize we can't live the lives our predecessors lived in medicine.

 

[Twiggidy]

If you correct a surgeon or nurse, even politely, you get labeled as a troublemaker.

No you don't

 

[BLADEMDA]

So, 50 percent are happy with their choice while the other 1/2 has regrets. That seems about right.

But, going forward finding that group which allows MGMA 75th percentile or greater has never been harder. 90 percent plus of all jobs on Gaswork are pretty bad with pay well below the 50th percentile.

I remember in the mid 2000s when 1/2 the jobs posted were good ones. No longer. Now one must rely on networking and friends to land that good job. This means the majority of new graduates won’t be getting a good job. I define a good job as one which pays more than 50th percentile MGMA with reasonable hours and call schedule. The job should maximize your 401k savings each year as well. That means a very large employer contribution annually.

The facts are the field is no longer what it once was. There is a future for Anesthesiology but not among the top 5 or even 8 specialty choices imho.

Comments about the past aren’t really helpful to the MS4 or PGY1 entering the field. What matters is today and where The field is headed over the next 3-5 years. Based on that would you pick Anesthesiology today with a Step 1 of 250? No. But, what about a Step 1 of 225? Realistically, med students have limited choices today because the match is so competitive.

In the end, the decision is based on so many factors especially the Step 1 and 2 scores of the student. With options being very limited for more than 1/2 of all anesthesia residents did they make a wise choice?

 

[Twiggidy]

Nope. It's pretty sweet. I enjoy my job. good work/life balance. Home call is KEY. I like OB but I could probably give up the in-house epidural babysitting and/or OB call in general. I'm biased, but I agree with what others have said about the virtues of being in an independent physician-owned private practice who employs midlevels (if you have them at all).

Agree with all of this

 

[Twiggidy]

So, 50 percent are happy with their choice while the other 1/2 has regrets. That seems about right.

But, going forward finding that group which allows MGMA 75th percentile or greater has never been harder. 90 percent plus of all jobs on Gaswork are pretty bad with pay well below the 50th percentile.

I remember in the mid 2000s when 1/2 the jobs posted were good ones. No longer. Now one must rely on networking and friends to land that good job. This means the majority of new graduates won’t be getting a good job. I define a good job as one which pays more than 50th percentile MGMA with reasonable hours and call schedule. The job should maximize your 401k savings each year as well. That means a very large employer contribution annually.

The facts are the field is no longer what it once was. There is a future for Anesthesiology but not among the top 5 or even 8 specialty choices imho.

Comments about the past aren’t really helpful to the MS4 or PGY1 entering the field. What matters is today and where The field is headed over the next 3-5 years. Based on that would you pick Anesthesiology today with a Step 1 of 250? No. But, what about a Step 1 of 225? Realistically, med students have limited choices today because the match is so competitive.

In the end, the decision is based on so many factors especially the Step 1 and 2 scores of the student. With options being very limited for more than 1/2 of all anesthesia residents did they make a wise choice?

If I had my Step score today, which was above 240, I would probably scratch and claw my way into surgery, a surgical subspecialty, or a procedure based medical specialty. Most of us did anesthesiology because we like to "do things" and not have clinic. With the 3 situations I listed you can still "do things" and possibly minimize the clinic part, or a least suffer through it. Especially since the world is heading towards PSH (perioperative surgical home), surgery is going to become a prime field because it's going to allow surgeons to focus on OPERATING. That will increase surgeon satisfaction and make it an attractive field.

If you do chose anesthesiology, you need to have an open mind. Don't think you're going to make 700k living in NYC or LA with good work life balance. If you want big money be prepared to work very hard and take a fair amount of call. Also be open to small markets, small towns, and country towns. If the job is in a decent place, has a decent case mix, and is only home OR call, really evaluate you priorities, spending, hobbies, etc and just take the job otherwise you'll find yourself somewhere desirable hustling for cases or frequently in house babysitting epidurals or just not making enough money.

In all of medicine nowadays, there's more to a job than just a paycheck.

 

[nimbus]

For a little perspective, here’s a thread that’s full of regret.

If not rad onc, where else would you suggest med students look?

I'm facing the unfortunate reality of not really enjoying any of my core rotations or electives outside of radiation oncology, and I'm getting to a point where I need to start making decisions. I entered medical school intent on becoming an oncologist, but I have come to find that I really do...

forums.studentdoctor.net

 

[pgg]

But, going forward finding that group which allows MGMA 75th percentile or greater has never been harder.

Haven't 25% of all jobs always been MGMA 75th percentile or better?

I suspect what you're predicting is that 2020s era 90th %ile jobs are going to pay what 2000s and 2010s era 75th %ile jobs paid. I believe that but I hope you're wrong.

 

[pgg]

For a little perspective, here’s a thread that’s full of regret.

If not rad onc, where else would you suggest med students look?

I'm facing the unfortunate reality of not really enjoying any of my core rotations or electives outside of radiation oncology, and I'm getting to a point where I need to start making decisions. I entered medical school intent on becoming an oncologist, but I have come to find that I really do...

forums.studentdoctor.net

Rad onc has always struck me as a specialty that was perpetually on the edge of becoming irrelevant. So one dimensional, and uniquely vulnerable to ever-improving cancer treatments that don't involve nuclear cannons and plutonium (or whatever) seeds. Very cool specialty though.

 

[deleted50478]

Haven't 25% of all jobs always been MGMA 75th percentile or better?

I suspect what you're predicting is that 2020s era 90th %ile jobs are going to pay what 2000s and 2010s era 75th %ile jobs paid. I believe that but I hope you're wrong.

I think he’s saying there used to be good jobs advertised and there aren’t many advertised anymore. The top 25% jobs still make up 25% of jobs obviously, but those are never advertised unless they are in hard-to-recruit locations.

Whether today’s average job is as good as the average job 10 years ago (it isn’t) is a different issue.

 

[bronx43]

Rad onc has always struck me as a specialty that was perpetually on the edge of becoming irrelevant. So one dimensional, and uniquely vulnerable to ever-improving cancer treatments that don't involve nuclear cannons and plutonium (or whatever) seeds. Very cool specialty though.

Agreed. It always surprised me that so many people thought it was some perpetual golden goose when it really is just a very specific treatment modality without a specific disease or organ system.

 

[seniormd]

So, 50 percent are happy with their choice while the other 1/2 has regrets. That seems about right.

But, going forward finding that group which allows MGMA 75th percentile or greater has never been harder. 90 percent plus of all jobs on Gaswork are pretty bad with pay well below the 50th percentile.

I remember in the mid 2000s when 1/2 the jobs posted were good ones. No longer. Now one must rely on networking and friends to land that good job. This means the majority of new graduates won’t be getting a good job. I define a good job as one which pays more than 50th percentile MGMA with reasonable hours and call schedule. The job should maximize your 401k savings each year as well. That means a very large employer contribution annually.

The facts are the field is no longer what it once was. There is a future for Anesthesiology but not among the top 5 or even 8 specialty choices imho.

Comments about the past aren’t really helpful to the MS4 or PGY1 entering the field. What matters is today and where The field is headed over the next 3-5 years. Based on that would you pick Anesthesiology today with a Step 1 of 250? No. But, what about a Step 1 of 225? Realistically, med students have limited choices today because the match is so competitive.

In the end, the decision is based on so many factors especially the Step 1 and 2 scores of the student. With options being very limited for more than 1/2 of all anesthesia residents did they make a wise choice?

But the only way to make a wise choice is with good information. Your points are well taken. I figure around 1/2 of my colleagues would have chosen another specialty if they had to do it all over again. Another 1/4 would without doubt have chosen something else if their grades and scores in med school were better.

 

[anbuitachi]

If you made teh mistake of going into medicine, but still want a field with career protection, respect, power, and money, then you have to pick a surgical field. All the other medical fields including derm, are subject to mid level encroachment, and corporate takeover. The vast vast majority of doctors making 7 figures per year at my institution are surgeons, or proceduralists (IR, IC). Sometimes as an anesthesiologist it sucks knowing you work more hours and more irregular hours with less control, respect, power, job stability than the people on the other side of the drape, but it's just how it is.

 

[deleted171991]

Right, but they're saying 2018 was the best year we've ever had in the group's 20yr existence. (including all those years in the 2000's).

Inflation-adjusted and on an hourly basis?

 

[deleted162650]

Inflation-adjusted and on an hourly basis?

That’s already been addressed. You really have to read the whole thread. Our blended has improved over the time I’ve been here.

 

[bronx43]

If you made teh mistake of going into medicine, but still want a field with career protection, respect, power, and money, then you have to pick a surgical field. All the other medical fields including derm, are subject to mid level encroachment, and corporate takeover. The vast vast majority of doctors making 7 figures per year at my institution are surgeons, or proceduralists (IR, IC). Sometimes as an anesthesiologist it sucks knowing you work more hours and more irregular hours with less control, respect, power, job stability than the people on the other side of the drape, but it's just how it is.

Agree that surgery is the easiest way into guaranteed money and control over one's career. However, not everyone would enjoy or even would tolerate the proceduralist lifestyle/job. I know a lot of people, including myself, who would rather quit medicine than stand there for 10-12 hours a day doing a neck dissection.

But that doesn't mean that one cannot make large sums of money even in this environment outside of surgery. Physician owned medical groups are still out there, and unless there is massive overhaul to the medical system, most will be viable in the foreseeable future. If you're partner in one of these groups, then your income potential is rather high. The high earners in these MD owned (non-surgical) groups make bank.

Most important thing for med students picking a field outside of surgery is knowing the supply and demand. If you're considering a patient facing specialty and your supply is low, then you'll be safe and will have huge opportunity to be prosperous. For now.