To young attendings: Do you regret choosing anesthesiology?

[anbuitachi]

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.

Definitely but surgery has more control over how they practice than we do. So if you are ok with the field, its probably not that bad. Eg you dont have to do 12 hr flaps as a surgeon. Also you can sit, dont have to stand.

There's also a huge demand for surgeons. It takes longer to train surgeons than anesthesiologists, and with people getting older and sicker, more surgeries are needed.

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[anbuitachi]

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

Did you adjust for Number of patients you are taking care of???

 

[deleted162650]

Did you adjust for Number of patients you are taking care of???

Dude, you no read the whole thread either brah?

Blended unit value is a metric that’s independent of volume.

 

[deleted171991]

Dude, you no read the whole thread either brah?

Blended unit value is a metric that’s independent of volume.

You expect us to read the entire chart? Who do you think we are, internists?

 

[nimbus]

Dude, you no read the whole thread either brah?

Blended unit value is a metric that’s independent of volume.

“You no read”???

Are you turning Asian? You sound like my mother.

 

[nimbus]

Definitely but surgery has more control over how they practice than we do. So if you are ok with the field, its probably not that bad. Eg you dont have to do 12 hr flaps as a surgeon. Also you can sit, dont have to stand.

There's also a huge demand for surgeons. It takes longer to train surgeons than anesthesiologists, and with people getting older and sicker, more surgeries are needed.

As an example, I know a urologist who got heavily into power lifting over the past 2 years. He now trains on Tuesday, Thursday, and Saturday mornings. That is protected lifting time. No cases or office. If he has a Saturday addon, they are in the afternoon. Also know orthopedists who don’t work Fridays.

 

[nvrsumr]

Pain is a highly reimbursed procedural field with the easy ability to hang your own shingle. No nites, weekends or holidays.

Just say no to prescribing opioids and the patient population is fine. Basically nonoperative msk and spine issues.

 

[bronx43]

Pain is a highly reimbursed procedural field with the easy ability to hang your own shingle. No nites, weekends or holidays.

Just say no to prescribing opioids and the patient population is fine. Basically nonoperative msk and spine issues.

Saying no to opioids is not that viable in a competitive market. When I send a patient of mine to pain management and they dont prescribe opioids and only try to push injections despite the patient saying they don’t work that well, then I never refer there ever again. Unless you’re in BFE, there are usually many pain practices around willing to accommodate.

 

[nvrsumr]

Im in a competitive market. I am sure I lost referrals when I started but now a non issue.

Nothing in medicine is a given but Pain can have derm hours and compensation.

 

[GravelRider]

Saying no to opioids is not that viable in a competitive market. When I send a patient of mine to pain management and they dont prescribe opioids and only try to push injections despite the patient saying they don’t work that well, then I never refer there ever again. Unless you’re in BFE, there are usually many pain practices around willing to accommodate.

Be honest though, you only refer a patient to pain management for opioids because the patient is a pain in the a$$, right? I know I did and those referrals often got rejected (rightfully so). You’re telling me an internist or family doc can’t manage gabapentin or oxycodone? The reality is you either don’t want to or more likely you know the patient is drug seeking and looking for a re-up. Drug seekers were an enormous reason I left internal medicine. The opioid crisis is very real.

 

[VA Hopeful Dr]

Be honest though, you only refer a patient to pain management for opioids because the patient is a pain in the a$$, right? I know I did and those referrals often got rejected (rightfully so). You’re telling me an internist or family doc can’t manage gabapentin or oxycodone? The reality is you either don’t want to or more likely you know the patient is drug seeking and looking for a re-up. Drug seekers were an enormous reason I left internal medicine. The opioid crisis is very real.

Or in today's climate I don't want to take the risk of prescribing opioids to 99% of people who are currently on them?

Sure I can do it but a) the data doesn't really support doing so and b) I don't feel like risking legal troubles.

I'm OK if the pain management folks don't want to write for those meds (it lets me then say "well the pain expert says you don't need these, so let's get you weaned off of them and see what other options we have"). But, I do want them to offer other options to the patient (including a taper if the patient is willing) and not just refuse to see them outright because they are on opioids.

 

[bronx43]

Be honest though, you only refer a patient to pain management for opioids because the patient is a pain in the a$$, right? I know I did and those referrals often got rejected (rightfully so). You’re telling me an internist or family doc can’t manage gabapentin or oxycodone? The reality is you either don’t want to or more likely you know the patient is drug seeking and looking for a re-up. Drug seekers were an enormous reason I left internal medicine. The opioid crisis is very real.

Gabapentin is one thing but I dont prescribe any opioids. Whether the patient is a pain in the a$$ or not. I manage immunosuppressive medications. Not pain meds.

 

[GravelRider]

Or in today's climate I don't want to take the risk of prescribing opioids to 99% of people who are currently on them?

Sure I can do it but a) the data doesn't really support doing so and b) I don't feel like risking legal troubles.

I'm OK if the pain management folks don't want to write for those meds (it lets me then say "well the pain expert says you don't need these, so let's get you weaned off of them and see what other options we have"). But, I do want them to offer other options to the patient (including a taper if the patient is willing) and not just refuse to see them outright because they are on opioids.

But the previous post inferred no longer giving any referrals to a pain doc who doesn’t want to manage opioids either, which implies no longer referring patients who may actually benefit from interventional pain procedures.

We all know that the vast majority of these opioid addicted patients are a giant pain in the a$$ and any attempted referral to a pain management clinic is the definition of a dump. A referral to a known “pill mill” may actually be a disservice to the patient, but that’s another topic for another thread.

 

[bronx43]

But the previous post inferred no longer giving any referrals to a pain doc who doesn’t want to manage opioids either, which implies no longer referring patients who may actually benefit from interventional pain procedures.

We all know that the vast majority of these opioid addicted patients are a giant pain in the a$$ and any attempted referral to a pain management clinic is the definition of a dump. A referral to a known “pill mill” may actually be a disservice to the patient, but that’s another topic for another thread.

Learn to read.

I said I will stop referring if they don’t prescribe opiates and keep pushing injections despite patient saying it’s not effective.

 

[GravelRider]

Learn to read.

I said I will stop referring if they don’t prescribe opiates and keep pushing injections despite patient saying it’s not effective.

Relax. I read perfectly well. You said “saying no to opioids is not viable in a competitive market.” Isn’t that the line of thinking that caused the opioid crisis in the first place? You also went on to say or infer that a pain management doc that does not use opioids will no longer get referrals from you. Your original post definitely implied that. You ever wonder why the injections don’t work, but that medication that rhymes with schmalaudid worked great?

A referral for opioid management from any internist is a dump, plain and simple. That’s my firm opinion. If the injections don’t work then it’s on you to figure out what to do with their opioids (answer: get them off and stop contributing to their addiction).

 

[VA Hopeful Dr]

Relax. I read perfectly well. You said “saying no to opioids is not viable in a competitive market.” Isn’t that the line of thinking that caused the opioid crisis in the first place? You also went on to say or infer that a pain management doc that does not use opioids will no longer get referrals from you. Your original post definitely implied that. You ever wonder why the injections don’t work, but that medication that rhymes with schmalaudid worked great?

A referral for opioid management from any internist is a dump, plain and simple. That’s my firm opinion. If the injections don’t work then it’s on you to figure out what to do with their opioids (answer: get them off and stop contributing to their addiction).

Actually the crises was mainly caused by us PCP types in the 90s and early 2000s believing the lie that opioids were safe for chronic non-cancer pain. You can see this in the older PCP cohort still prescribing the things like candy. Earlier this year I covered for a doc in her 50s while she was getting chemo. Every other patient was on opioids. Even money says she started most of them.

That said, while lots of those types of referrals are dumps there are lots that aren't. Most PCPs don't know how to taper opioids even if they wanted to. Same thing with benzos. Does that make every referral to psych for a benzo taper a dump?

My ideal pain physician: if they don't want to take over someone's chronic opioids (that I promise I didn't start) is to offer to get them off of those drugs and offer different pain control options. If the patient refuses, that's on the patient.

 

[Neopolymath]

Relax. I read perfectly well. You said “saying no to opioids is not viable in a competitive market.” Isn’t that the line of thinking that caused the opioid crisis in the first place? You also went on to say or infer that a pain management doc that does not use opioids will no longer get referrals from you. Your original post definitely implied that. You ever wonder why the injections don’t work, but that medication that rhymes with schmalaudid worked great?

A referral for opioid management from any internist is a dump, plain and simple. That’s my firm opinion. If the injections don’t work then it’s on you to figure out what to do with their opioids (answer: get them off and stop contributing to their addiction).

Every other proceduralist would laugh at the idea of managing anything but their single procedure they did for a patient at the request of the referring doc. Naturally, an anesthesiology subspecialist would take the crap and say "THANK YOU."

 

[bronx43]

Relax. I read perfectly well. You said “saying no to opioids is not viable in a competitive market.” Isn’t that the line of thinking that caused the opioid crisis in the first place? You also went on to say or infer that a pain management doc that does not use opioids will no longer get referrals from you. Your original post definitely implied that. You ever wonder why the injections don’t work, but that medication that rhymes with schmalaudid worked great?

A referral for opioid management from any internist is a dump, plain and simple. That’s my firm opinion. If the injections don’t work then it’s on you to figure out what to do with their opioids (answer: get them off and stop contributing to their addiction).

Actually, no. My contention was against the statement from the poster that said he doesn't prescribe any narcotics. This, in my opinion, is not viable depending on your location. I'm not saying that you have to prescribe opiates for EVERYTHING... but I do expect that a pain specialist should prescribe it when it is indicated.

If your argument is that narcotics are never indicated, then we may as well ban it across the country, which I would be fine with.

But last time I checked, the specialty is called pain medicine... not spine injections.

 

[GravelRider]

Actually the crises was mainly caused by us PCP types in the 90s and early 2000s believing the lie that opioids were safe for chronic non-cancer pain. You can see this in the older PCP cohort still prescribing the things like candy. Earlier this year I covered for a doc in her 50s while she was getting chemo. Every other patient was on opioids. Even money says she started most of them.

That said, while lots of those types of referrals are dumps there are lots that aren't. Most PCPs don't know how to taper opioids even if they wanted to. Same thing with benzos. Does that make every referral to psych for a benzo taper a dump?

My ideal pain physician: if they don't want to take over someone's chronic opioids (that I promise I didn't start) is to offer to get them off of those drugs and offer different pain control options. If the patient refuses, that's on the patient.

I agree with all of that. That’s a different type of referral than “this patient needs drugs.” The patient needs to be aware that the goal is to get off opioids.

 

[nvrsumr]

I have been practicing this way for a decade. There are multiple threads in these forums regarding the competitiveness of the CO market. The opinion of a PCP on what does or does not make a viable pain practice is of limited utility.

Again for the OP and younger members on the forum pain can be a nice option for anesthesiologists concerned about mid levels and who want to be independent.

 

[VA Hopeful Dr]

I agree with all of that. That’s a different type of referral than “this patient needs drugs.” The patient needs to be aware that the goal is to get off opioids.

Agreed. Now in my opinion (which is not likely to be popular), that's a great conversation for the pain physician to have with the patient. I'd be happy to do it if I had time between their hypertension, diabetes, and anxiety.

 

[VA Hopeful Dr]

Every other proceduralist would laugh at the idea of managing anything but their single procedure they did for a patient at the request of the referring doc. Naturally, an anesthesiology subspecialist would take the crap and say "THANK YOU."

Except outside of IR I don't refer patients for procedures. I refer for problems that may or may not require a procedure. If I send a patient with arthritis to ortho saying "please replace this guy's knee", they're going to smile, nod, and call me an dingus behind my back and do whatever they want with the patient. Same with cardiology and chest pain, I can't refer specifically for a cath.

 

[bronx43]

I have been practicing this way for a decade. There are multiple threads in these forums regarding the competitiveness of the CO market. The opinion of a PCP on what does or does not make a viable pain practice is of limited utility.

Again for the OP and younger members on the forum pain can be a nice option for anesthesiologists concerned about mid levels and who want to be independent.

I'm not a PCP but I do refer to pain. But explain to me why would I refer to a pain clinic that doesn't prescribe any narcotics regardless if it's indicated over a pain clinic that does? I guess it's a viable model if you're taking the overflow from the other clinics...

 

[Southpaw]

I'm not a PCP but I do refer to pain. But explain to me why would I refer to a pain clinic that doesn't prescribe any narcotics regardless if it's indicated over a pain clinic that does? I guess it's a viable model if you're taking the overflow from the other clinics...

Probably because it’s highly likely your patient won’t benefit from opioids and everyone but the patient knows it.

 

[bronx43]

Probably because it’s highly likely your patient won’t benefit from opioids and everyone but the patient knows it.

So there's no indication for opioids in the treatment of pain?

 

[Neopolymath]

Except outside of IR I don't refer patients for procedures. I refer for problems that may or may not require a procedure. If I send a patient with arthritis to ortho saying "please replace this guy's knee", they're going to smile, nod, and call me an dingus behind my back and do whatever they want with the patient. Same with cardiology and chest pain, I can't refer specifically for a cath.

I understand the subtle difference you are highlighting about language. It's a good point and I appreciate you sharing it.

That said, the ONLY reason an ortho doc does that is because it takes a 1 minute exam and 1 minute to tell the patient to take some nsaids/see PT. If it took longer they would be whining like they do inpatient with medicine. Personally, I think referring to an interventional pain doc implies that they are assessing the patient for injections. Same for GI, cardiology etc. That may not be what we say or teach, but that absolutely looks like what is going on in my inexperienced mind. Their procedure is the tool you don't offer. You don't consult surgeons for things you don't think are surgery so why is this any different?

I have sympathy for the PC folks. This seems like one of the few opportunities for PC docs to get to dump a patient lol. I just think it's kind of humorous that its on another specialty that gets a lot of **** from all angles too.

 

[nvrsumr]

I'm not a PCP but I do refer to pain. But explain to me why would I refer to a pain clinic that doesn't prescribe any narcotics regardless if it's indicated over a pain clinic that does? I guess it's a viable model if you're taking the overflow from the other clinics...

This is your perogative. I offer certain services within the purview of my specialty and choose not to provide others. I focus on msk/spine.

There are no overflow patients in my area and I think you have the hierarchy flipped. The bottom feeders have to prescribe opioids because that’s the only way they can get patients.

 

[bronx43]

This is your prerogative. I offer certain services within the purview of my specialty and choose not to provide others. I focus on msk/spine.

There are no overflow patients in my area and I think you have the hierarchy flipped. The bottom feeders have to prescribe opioids because that’s the only way they can get patients.

10 years of no nites, no weekends, no holidays. Own my building with a procedure suite and 270 degree floor to 20 foot ceiling views of the Rockies. My dog greets the patients in the waiting room. Something seems to be working ....

I mean, good for you. I am glad your practice is going well. I am saying if a pain doc opened up in my area and doesn't prescribe any narcotics, he/she wouldn't get much business from anyone here. Maybe my area is just an anomaly and no one else expects pain clinics to write for pain medications anymore...?
I'm not a pcp so I don't really care, honestly. Worst comes to worst, I direct patients to their PCP.

 

[IMGASMD]

There are plenty of “models” for pain. Came across few interventional pain doctors, who will NOT give a script until the patient got intervention.

You interpret that however you want.

 

[deleted162650]

“You no read”???

Are you turning Asian? You sound like my mother.

Nah, just workin’ on my pidgin before my trip to HI in a couple months.

‘Dis haole gotta go find some da kine grinds eh braddah? (Shaka)

 

[Neopolymath]

I mean, good for you. I am glad your practice is going well. I am saying if a pain doc opened up in my area and doesn't prescribe any narcotics, he/she wouldn't get much business from anyone here. Maybe my area is just an anomaly and no one else expects pain clinics to write for pain medications anymore...?
I'm not a pcp so I don't really care, honestly. Worst comes to worst, I direct patients to their PCP.

Is he advertising as a pain clinic or as someone who does injections and whatever? In my town there are both and it's pretty obvious which is which. I don't think I would get mad at a guy for not writing pain meds who says his practice is not for pain meds.

 

[GravelRider]

Agreed. Now in my opinion (which is not likely to be popular), that's a great conversation for the pain physician to have with the patient. I'd be happy to do it if I had time between their hypertension, diabetes, and anxiety.

Isn’t that the definition of a “dump,” though? You can do something (and probably should), but you just don’t want to or can’t find the time to?

Shouldn’t it be on the trusted primary care physician who knows the patient well to have difficult conversations like goals of care or getting a patient on board with treating an opioid addiction? I think it should (and I think you should be compensated highly for it).

 

[VA Hopeful Dr]

Isn’t that the definition of a “dump,” though? You can do something (and probably should), but you just don’t want to or can’t find the time to?

Shouldn’t it be on the trusted primary care physician who knows the patient well to have difficult conversations like goals of care or getting a patient on board with treating an opioid addiction? I think it should (and I think you should be compensated highly for it).

No. I can manage CHF pretty well. Cards can do it better because they can use the whole visit to focus on just that.

When I did DPC that was actually a selling point - that given enough time us PCPs can do a lot more than most people realize.

 

[VA Hopeful Dr]

I understand the subtle difference you are highlighting about language. It's a good point and I appreciate you sharing it.

That said, the ONLY reason an ortho doc does that is because it takes a 1 minute exam and 1 minute to tell the patient to take some nsaids/see PT. If it took longer they would be whining like they do inpatient with medicine. Personally, I think referring to an interventional pain doc implies that they are assessing the patient for injections. Same for GI, cardiology etc. That may not be what we say or teach, but that absolutely looks like what is going on in my inexperienced mind. Their procedure is the tool you don't offer. You don't consult surgeons for things you don't think are surgery so why is this any different?

I have sympathy for the PC folks. This seems like one of the few opportunities for PC docs to get to dump a patient lol. I just think it's kind of humorous that its on another specialty that gets a lot of **** from all angles too.

I mean, maybe?

I send lots of peds joint stuff to Ortho if I'm unsure what's going on. That likely takes them some time, and if they get mad about it I never see it.

 

[GravelRider]

There are plenty of “models” for pain. Came across few interventional pain doctors, who will NOT give a script until the patient got intervention.

You interpret that however you want.

You could argue that this is a good reason for a pain doc not to prescribe opioids. I’m sure there are plenty of patients that keep going back for their injections that don’t work in order to walk out with that fresh re-up script for oxys. The pain doc gets paid and the patient gets their goodies. Everybody wins!

 

[IMGASMD]

You could argue that this is a good reason for a pain doc not to prescribe opioids. I’m sure there are plenty of patients that keep going back for their injections that don’t work in order to walk out with that fresh re-up script for oxys. The pain doc gets paid and the patient gets their goodies. Everybody wins!

You interpret however you want is the name of the game......

 

[Southpaw]

So there's no indication for opioids in the treatment of pain?

I don’t do pain now. My recollection from residency is that I didn’t see much coming out of a rheum office except the desire for opioid management. My opinion is that it’s a difficult patient population to help/treat.

 

[bronx43]

I don’t do pain now. My recollection from residency is that I didn’t see much coming out of a rheum office except the desire for opioid management. My opinion is that it’s a difficult patient population to help/treat.

This doesn't answer the question. Do opioids have a role in controlling pain, yes or no.

Whether rheumatology patients are difficult to treat isn't the issue.

 

[Southpaw]

This doesn't answer the question. Does opioids have a role in controlling pain, yes or no.

Whether rheumatology patients are difficult to treat isn't the issue.

I don’t care for internet argument winning. And I know what you’re doing. You want to play the literal word tit-for-tat game. Go for it.

I don’t believe opioids have a role in chronic pain. I do believe they have a role in end of life pain. But I imagine you’re not interested in that.

 

[bronx43]

I don’t care for internet argument winning. And I know what you’re doing. You want to play the literal word tit-for-tat game. Go for it.

I don’t believe opioids have a role in chronic pain. I do believe they have a role in end of life pain. But I imagine you’re not interested in that.

that’s fine. That’s at least an answer. I would agree with you. But then they need to just ban opioids nationally for non end of life pain.

Then at least referring physicians would know that when you refer to “pain medicine” you’re basically just getting a yes or no for injection.

 

[Southpaw]

that’s fine. That’s at least an answer. I would agree with you. But then they need to just ban opioids nationally for non end of life pain.

Then at least referring physicians would know that when you refer to “pain medicine” you’re basically just getting a yes or no for injection.

well I imagine opioids, if aiming for FDA approval today as a new drug, would certainly be declined. And I agree that they should be banned. Pain physicians do a ton of non-opioid medication management that most PCPs, rheumatologists, etc. probably don't have time for or interest in. At least we did a lot of that in residency. I don't know where the money is in pain as I don't currently do it, but if it's like any other field of medicine it's in the procedures.

 

[VA Hopeful Dr]

well I imagine opioids, if aiming for FDA approval today as a new drug, would certainly be declined.

Don't be so sure.

Despite Warnings, FDA Approves Potent New Opioid Painkiller

Critics, including some leading anesthesiologists, say the drug is unnecessary, and they worry it will be diverted and abused. The Food And Drug Administration says it is addressing safety concerns.

www.npr.org

 

[Southpaw]

Don't be so sure.

Despite Warnings, FDA Approves Potent New Opioid Painkiller

Critics, including some leading anesthesiologists, say the drug is unnecessary, and they worry it will be diverted and abused. The Food And Drug Administration says it is addressing safety concerns.

www.npr.org

$1.1 billion projected in annual sales. nice. I like the example they give for its limited utility - the morbidly obese patient in extreme pain in the ED in whom no one can get an IV. shot of IM morphine would do just fine. shame on us....

 

[BLADEMDA]

This doesn't answer the question. Do opioids have a role in controlling pain, yes or no.

Whether rheumatology patients are difficult to treat isn't the issue.

Yes. I think opioids do have a role in the management of pain along with nerve blocks, nsaids, and other medications like TCAs, Gabapentin, etc.
Opioids by themselves should not be the main route of controlling non end of life chronic pain. But, can it be part of a multi-modal strategy to control chronic pain? Yes. But, the dosage needs to be carefully monitored and the risks/benefits discussed with the patient. 10 years ago the thought was we needed more opioids and now the thinking is opioid free. While I agree the use of opioids can foster a very slippery slope towards addiction I would hate for the government to decide for Physicians and patients how best to manage their pain.

What role does medical marijuana play in this situation? What are the long term side-effects? I really prefer the government stay out of the way as much as possible when it comes to pain management.

CBD and CBD Oil: What Is It and Does It Really Work?

CBD products have become remarkably popular. Here's what you need to know about about CBD oil.

www.livescience.com

FDA Advisors Weigh COX-2 Inhibitor Safety

Celecoxib, day 1: little objection to label updates, but plenty of open questions

www.medpagetoday.com

Our findings do not support the premise that selective COX-2 inhibitors as a class increase cardiovascular risk compared with nonselective COX-1 and COX-2 inhibitors (27). On the contrary, in the primary results from the PRECISION trial, selective COX-2 inhibition with celecoxib was noninferior for cardiovascular safety to nonselective COX-2 > COX-1 inhibition with ibuprofen or COX-1 > COX-2 inhibition with naproxen in the intention-to-treat population.

 

[OTCAwesome]

Listen, we do a great job of derailing these threads. to the OP original question:

Do you regret choosing Anesthesiology -

Good God no!

Do you see yourself having a decent job for the next 30 years

Meh.... probably, I'm boarded in crit care as well. I moreso worry for the solely cerebral specialties with AI coming online.

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)

Meh, possibly, in the midwest, youre still going to be pulling >500K

If you could go back to medical school, would you still choose Anesthesiology?

OMG yes!

 

[BLADEMDA]

Listen, we do a great job of derailing these threads. to the OP original question:

Do you regret choosing Anesthesiology -

Good God no!

Do you see yourself having a decent job for the next 30 years

Meh.... probably, I'm boarded in crit care as well. I moreso worry for the solely cerebral specialties with AI coming online.

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)

Meh, possibly, in the midwest, youre still going to be pulling >500K

If you could go back to medical school, would you still choose Anesthesiology?

OMG yes!

Just the other day I overheard the following: "I am a nurse anesthetist. I have a doctorate in anesthesia. There are 2 pathways to practicing anesthesia in the USA: Medical School or Nursing School. But, the end result is the same."

I'm sure 50% of practicing Anesthesiologist would choose the specialty again. But, what about the other half? Which half will you be in? Do you have any other options realistically?

 

[anbuitachi]

wait until medicare for all shows up and lets see how it goes. perhaps it wont be 50 50 anymore.

 

[TheLoneWolf]

Dont mean to derail any threads

Pain fellow

Not superglam

Declining reimbursement over years continued, average difference in pay between pain and anesthesia is much smaller then you can guess. Anesthesia can pay more if thats someones primary concern.

Risk of litigation and DEA monitoring can be stressful

Lots of paperwork that is outside of the clinic hours. It is very busy during clinic, little time to do any paperwork or you will be wayy behind.

Dealing with insurance and prior authorizations.

After hours phone calls that take a lot of time and documentation

Some meds you cant start due to high cost and copays. Unfortunately patients may have to fail the cheaper medications to qualify for better.

20 or more procedures a day expected at many places I interviewed PP. Academics protected but have to teach, lectures, supervise, meetings.

Wearing heavy lead all day will place a lot of strain on your back, hips, knees over the years. Attending I know has to retire in his 50s due to bad back. Did case on an interventional radiologist and his spine barely resembles what you would expect, around same age as the other attending. Little data on long term low dose radiation exposure but is something to consider.

Patient population is not easy and can be demanding or threatening. One of the few fields where you can actually get killed by your patients. Multiple cases you can search. Outburts not uncommon for not starting, continuing, or decreasing meds.

Less vacation time then anaesthesia- across all jobs I looked at

Med management in a good location is expected by most referrers and if you work for someone you might not have a choice. Not everyone prescribes high dose opioids but it is not unusual to see lots on low dose managed by pain management. Cofellows took jobs where they are expected to prescribe.

Lots of shady stuff with medical marijuana, prp, stem cell not supported by much data

Before I went in, someone told me that 1/3 will do great, 1/3 will get some temporary improvement, 1/3 will get no benefits despite everything. Mostly true

Lots of chemical coping, anxiety, depression who either don't want psychiatry, or cant afford

Some neurosurgery and less common ortho referrals may be dumps for meds or after failed procedures.

The number of people on disability and haven't worked in years within the pain clinic was surprising. Some want to get back to work and are motivated but this may not be as common as you would think.

Procedures may help in the short term but patients expect more permanent options. What do you when a person had 10 or more procedures over 2 years and pain scores are not or minimally improved? Some just place a stim then will proceed with pills.

Where I did residency,I know 3-4 who went back to the OR after a few years

on SDN, another 3-4 big names on the threads went back to the OR and say they work less, have more off time and are happier

With all the stuff I mentioned, it can be an excellent option if you work for yourself and have freedom to do what you want in terms of meds and procedures without worrying about your partners expectations of procedure volume or opioid management. Downside is hours and lots of paperwork but may be worth it for select individuals.

Its not all procedures and derm hours.

 

[spicy water]

I've been out in practice for about 4 years now.

Do you regret choosing Anesthesiology?
No, it's a great specialty. It has its downsides, as do all specialties.

Do you see yourself having a decent job for the next 30 years?
Yes, and good job security. It's certainly hard to forecast what will happen to pay, but we will still likely be paid well by many standards (maybe just not compared to current levels of compensation).

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)
I don't think there will be a time when "CRNA = MD", but I think there will always be a misguided campaign from CRNAs to claim equality.

If you could go back to medical school, would you still choose Anesthesiology?
Yes, almost certainly. I chose this field because it was and is a good fit for my interest and abilities. It allows us to practice medicine in a very unique fashion, in a context that I find palatable (hospital setting without clinic and minimal rounds) and make a significant impact in patient's lives (whether or not we get credit for that).There are many other facets that I appreciate about it and could go on, but I think it's a gem of a specialty.

 

[chocomorsel]

Saying no to opioids is not that viable in a competitive market. When I send a patient of mine to pain management and they dont prescribe opioids and only try to push injections despite the patient saying they don’t work that well, then I never refer there ever again. Unless you’re in BFE, there are usually many pain practices around willing to accommodate.

You are part of the problem. Why are you pushing for opioids? Just because the patients want them?
Is there more pain in America than the rest of the world? I mean I guess with our super obese patients whose joints hurt maybe. Lol.
But come on, seriously? “In a competitive market”. Is this about what’s best for patients or what’s good for our pocketbooks?