What's the catch with anesthesia?

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Doctoscope

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It's no secret that anesthesia has exploded in popularity and competitiveness over the last few years. I think like every other person I've talked to in my class wants to pursue anesthesia. It seems the money is good, its got a short(ish) residency compared to other competitive fields, the job market seems to be on fire... so what's the catch? Every specialty has them, and I was just wondering what anesthesia's glaring cons are. Is it the CRNA dynamics? What are some things that should make a medical student go, "Oh, maybe I really shouldn't pursue this field"? Thanks for your advice.

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It's no secret that anesthesia has exploded in popularity and competitiveness over the last few years. I think like every other person I've talked to in my class wants to pursue anesthesia. It seems the money is good, its got a short(ish) residency compared to other competitive fields, the job market seems to be on fire... so what's the catch? Every specialty has them, and I was just wondering what anesthesia's glaring cons are. Is it the CRNA dynamics? What are some things that should make a medical student go, "Oh, maybe I really shouldn't pursue this field"? Thanks for your advice.
Don’t look at the money now. You can read countless threads. You can consider other fields that have daytime hours and not a lot of call with stress. But it’s probably better than a surgery career. Just do outpatient, neurology or rheumatology.
 
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Go into psych. Better career long term.

People will burn out in anesthesia by age 50-55. You see countless threads

Psych u can do tele psych. Pay can be 400k in psych plus side gigs. Remote working plus inpatient

Psych is better play. Always be ahead of the game. Psych is where it’s at.

Tons of people with supposed mental health problems. I’m not a firm believer in mostly made up mental health crap but it pays the bills.
 
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The catch is that you usually have to take call, you don't "own" or bring patients (which is both good and bad), the job market goes in cycles, and it can be physically taxing from a wear-and-tear standpoint. Every field has its ups and downs. Just do whatever field you're happiest in day-to-day and don't worry about the gamesmanship of optimizing this and that - everything will change.

Not that long ago rad-onc and EM were super hot and both are now in the dumps. Radiology used to be ultra saturated and now it's in high demand. Anesthesia a few years ago had a tight job market and people were fully unemployed with no hope during COVID, yet now the employers are all desperate for anyone. It all cycles.

But I agree with aneftp - psych is underrated and a very wise choice. It's interesting, the pay is great, remote work with full location independence is 100% possible, there are side-gigs galore, and it has high longevity. Psych is also one of the few specialities where you can be a true one man/woman show with cash pay patients, almost no overhead, essentially no other staff to manage, and no hassle from overlords. There's something to be said for being able to hang your shingle then do whatever you want whenever you want.
 
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Anesthesiology is not going to give you the same rewarding feeling of “healing” a patient as clinical or procedural medicine will. And in some ways it’s thankless for the amount of mental power involved. Even now with the shortage I don’t think the workplace is expressing more appreciation towards anesthetists. I think it’s more of a “holy sh$t how do we get someone to come here so we can keep operating.” So people who go into anesthesiology tend to be a little more chill or low ego and don’t need much external validation. A lot of type A overachievers who match into anesthesiology are going to have regrets later.
 
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I honestly have no idea why the new grads are going into anesthesia right now. I suppose they are thinking on a per hour basis working locums they’ll make the most money for the least amount of work. That’s very short sighted.
5 years from now they’ll find themselves running 10-1 or paid minimally more than crnas to work in a collaborative model where the drs do hard cases n crnas do asa 1s and claim crna care has better outcomes.
5 years, maybe a touch more but ultimately the field is f—-ed
 
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I honestly have no idea why the new grads are going into anesthesia right now. I suppose they are thinking on a per hour basis working locums they’ll make the most money for the least amount of work. That’s very short sighted.
5 years from now they’ll find themselves running 10-1 or paid minimally more than crnas to work in a collaborative model where the drs do hard cases n crnas do asa 1s and claim crna care has better outcomes.
5 years, maybe a touch more but ultimately the field is f—-ed
That’s why I tell med students to look into this psych.

I see things. Like I was one of the few after the bust in 1994/1995 entering med school class who said I was gonna to do rads or anesthesia and peeps thought I was crazy

Be ahead of the game not with trend.

It’s like me telling hospitals admin docs want 20 weeks off for full 1.0 fte to retain w2 docs and admin looking like me like I’m crazy. They say they don’t want to be the leaders with offering massive vacation. I tell them 20 weeks is over pay in May 2024. It may not be over pay come Jan 2025 because the market is dynamic.
 
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Just do what you're interested in and doesn't have a terrible job market. These things tend to be cyclical. There was a recent time when radiology was very unpopular and people were doing multiple fellowships just to get a job. On the other hand, EM was ridiculously popular with zero open spots in soap and now it's a disaster.
 
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Go into psych. Better career long term.

People will burn out in anesthesia by age 50-55. You see countless threads

Psych u can do tele psych. Pay can be 400k in psych plus side gigs. Remote working plus inpatient

Psych is better play. Always be ahead of the game. Psych is where it’s at.

Tons of people with supposed mental health problems. I’m not a firm believer in mostly made up mental health crap but it pays the bills.
Idk, you can work 3 days a week for 11 months or 6 months a year in anesthesia with little to no call and make that kind of money. Anyone can tolerate working 26 weeks a year with no weekends or nights, regardless of interest. If you're making 400k+ in psych you're probably taking 4 weeks off at best unless you're churning, which is its own stress.


Psychiatry is also gonna require dealing with overlords. They'll be the people paying you, demanding things from you, and getting upset if it isn't just how they want it. And they'll also be on anti-psychotics/lithium/5 SSRIs at once.

I firmly believe that you need to truly enjoy the people you're serving to get fulfillment in a field like psychiatry. It is sometimes hard listening to admins or surgeons complain, but just wait until you're the repository of misery/med management for a bunch of much more interesting folks.
 
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For it to be lucrative, recognize this is a call taking specialty. And you don’t know when you are going to go home. You work until the surgeries are done. I cope with this by living very close to the hospital, and everyone does their best to find a group that’s fair, but it’s not always easy to find a lifestyle minded group.

You can take day doc jobs that are true shifts, but that comes with a big pay cut in desirable cities. It’s easier for a crna to get high paying shift jobs, the docs usually don’t. To get relieved for the day when surgeries are still going on means that someone else is getting paid better, in order for you to go home by x time no matter what.

Academics might have better relief systems but many PP groups run lean.
 
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I honestly have no idea why the new grads are going into anesthesia right now. I suppose they are thinking on a per hour basis working locums they’ll make the most money for the least amount of work. That’s very short sighted.
5 years from now they’ll find themselves running 10-1 or paid minimally more than crnas to work in a collaborative model where the drs do hard cases n crnas do asa 1s and claim crna care has better outcomes.
5 years, maybe a touch more but ultimately the field is f—-ed

I don't know about "5 years" from now. This current problem with super high demand for anesthesia servix3s will only begin to be fixed 3-5 years from now as trainee numbers ramp up.
 
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Go into psych. Better career long term.

People will burn out in anesthesia by age 50-55. You see countless threads

Psych u can do tele psych. Pay can be 400k in psych plus side gigs. Remote working plus inpatient

Psych is better play. Always be ahead of the game. Psych is where it’s at.

Tons of people with supposed mental health problems. I’m not a firm believer in mostly made up mental health crap but it pays the bills.

The House of God. That book has always had the answers.
 
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I don't know about "5 years" from now. This current problem with super high demand for anesthesia servix3s will only begin to be fixed 3-5 years from now as trainee numbers ramp up.
That’s not the only issue. I literally asked 4 crnas if they wanted to take a pure 1099 job Monday -Thursday 7-5pm. No calls no weekends at $200/hr guaranteed long term contract. For a year or more. That’s 350k assuming no calls and no weekends and 8 weeks off

And they wanted their cake and eat it also. These next gen entitled crna want not only money. But they wanted to be prn 1099 and choose when they want to work. And what weeks or days they are available

It’s simply this mindset that leads to. Shortage.

I say have Uber surged pricing. Lock in schedules 60 days in advance. Pay more for more undesirable shifts. Very simple.
 
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What students don't realize, or fully comprehend, is that anesthesia needs to have coverage 24/7, 365. You never know when you're going to go home as surgeries often go long, there's always an add on or emergency. Someone has to cover those cases and since we don't bring cases to the hospital, a lot of groups are yes man doing whatever the surgeons/hospital want. Every day is unpredictable.
 
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Friend of mine is Uro-Gyn making >700K doing 4 days/week, no nights, no weekends, and no real call. If he gets called he just says "here's my clinic number, have the patient call on Monday morning." Just a suggestion!
 
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Things to be aware of as a student:
1. If you have an ego and enjoy people recognizing you on a regular basis as a physician, this is not for you.

2. In residency and med school, you think of an anesthesiologist being solo in a room on a good first name basis with all the surgeons who respect you or supervising by dictating a plan to the anesthetist who follows every word you say while you are there for induction, extubation, or any emergencies. The reality is, often the surgeon just sees you as the thing that delays him/her from operating with needless questions or rigmarole. Some won't bother to learn your name. The general trend is this generation of workers (not just nurses, everyone) are more entitled and overconfident than ever and will not treat you with respect by helping you with basic stuff (i.e. turn on bair hugger, start an IV, pull stylet, get a drug you need, etc.) when you are solo. "You make the big bucks and that's not my job!" When you are supervising, you are not involved in patient care as much as you would think. You are more of the H&P monkey seeing patients, doing blocks, and managing PACU issues. You are hardly in the OR and are completely at the mercy of whoever is the primary in the room that you are supervising. Some anesthetists listen, more and more don't and feel that they can do whatever they want and not tell you when things go awry (remember, you are ultimately responsible for their bad choices). I suspect that collaborative models will essentially take over everywhere with higher and higher ratios of supervision once the market cools. Look into QZ billing. I can see places have you medically direct 4 rooms while doing QZ billing for another couple of off site places like endo.

3. People do not understand anesthesia and are quick to blame you for anything. You are constantly on the defensive. It was cute at first but now is annoying. Many people promising patients "You won't remember anything!" who aren't involved in anesthesia at all for a case done mostly under local or "the patient is in pain! Do something!" when they are actually having an anxiety attack with a perfectly functioning spinal anesthetic. I have seen anesthesiologists get blamed for lumbar radiculopathy because they got a perfectly placed epidural (no, ma'am, you were pushing for delivery which caused a disc herniation), a bilateral vocal cord paresis resulting in an ICU stay after aspiration and need for long-term tube feeds (no, sir, you were intubated for 22 hours in the OR because your surgeon took 22 hours to do what a competent one can do in 4 hours. We extubated you within 5 minutes of the surgery being done), and a median nerve palsy in a 16yo undergoing shoulder surgery because of "anesthesia's interscalene block (sorry, that block can't do that, it was the surgeon's positioning of some instrument or pressure on the nerve in the surgical field that did it). It is perfectly acceptable for other services to tell patients it was "anesthesia's fault" that you had a poor outcome but if you explain what actually happened to patients, everyone is mad at you and thinks you're the bad guy or unnecessarily casting blame on others.

4. Empty Foley catheters and push beds. Can you name any other physician who is expected to routinely do this?

5. You exist to serve the surgeons. They don't want to start cases till 2PM and their cases will go to 8PM? Guess you better cancel your dinner plans. Patient took Warfarin and the case is elective so you want to cancel? Too bad, surgeon wants you to give FFP because he is going out of town for two weeks starting tomorrow and he doesn't want to make his patients mad. You want to do a lower extremity nerve block BEFORE the case? Sorry, surgeon says it interferes with his post-op neuro exam so you have to wait till he gives the "OK" when the patient is about to leave Phase I of PACU so you do the block while he goes home (don't worry, he rounded after the case was done to kill time before getting that neuro exam!). With anesthesia heading more and more towards a hospital employed model, it is becoming harder and harder to fight these ridiculous requests. Have done at least 2-3 ELECTIVE open-heart cases on the weekend because the "surgeon doesn't have time during the week." Absolutely bonkers

6. Holidays, nights, and weekends. They become more valuable as you get older. Now, it just interferes with my life to be at the hospital during these times. Also, in-house call at some places. Very few specialties have attendings that do this.

7. SRNAs introducing themselves as anesthesia residents now. Huge slap in the face to anesthesia training.

8. I realize billing is getting cut for every specialty but in anesthesia it is quite severe. Private groups are now dependent on supplement payments from the hospitals they cover which I think is the fast road to being employed by the health system. An anesthesiologist has some of the most leverage to lose from being hospital employed compared to other physician specialties. I imagine a lot of anesthetics actually lose money or break even. I suspect this to get worse with the No Surprises Act. Someone in the c-suite is going to notice this and cut compensation eventually. Not now or soon, I think, but eventually.

These are things I wish someone mentioned to me as a med student. Overall, I am clearly on the more pessimistic side. I really love giving anesthesia, doing regional blocks, and taking care of really sick patients. I get enjoyment from a perfectly balanced anesthetic that leads to a quick wake-up and recovery. But, boy, do the politics suck!
 
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7.1: CRNAs introducing themselves as doctor or nurse anesthesiologist now that everyone has their University of Phoenix online degree
 
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7. SRNAs introducing themselves as anesthesia residents now. Huge slap in the face to anesthesia training.
Or - Hi I’m Kelly, “part of the anesthesia team” to fully obfuscate everything.
 
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Things to be aware of as a student:
1. If you have an ego and enjoy people recognizing you on a regular basis as a physician, this is not for you.

2. In residency and med school, you think of an anesthesiologist being solo in a room on a good first name basis with all the surgeons who respect you or supervising by dictating a plan to the anesthetist who follows every word you say while you are there for induction, extubation, or any emergencies. The reality is, often the surgeon just sees you as the thing that delays him/her from operating with needless questions or rigmarole. Some won't bother to learn your name. The general trend is this generation of workers (not just nurses, everyone) are more entitled and overconfident than ever and will not treat you with respect by helping you with basic stuff (i.e. turn on bair hugger, start an IV, pull stylet, get a drug you need, etc.) when you are solo. "You make the big bucks and that's not my job!" When you are supervising, you are not involved in patient care as much as you would think. You are more of the H&P monkey seeing patients, doing blocks, and managing PACU issues. You are hardly in the OR and are completely at the mercy of whoever is the primary in the room that you are supervising. Some anesthetists listen, more and more don't and feel that they can do whatever they want and not tell you when things go awry (remember, you are ultimately responsible for their bad choices). I suspect that collaborative models will essentially take over everywhere with higher and higher ratios of supervision once the market cools. Look into QZ billing. I can see places have you medically direct 4 rooms while doing QZ billing for another couple of off site places like endo.

3. People do not understand anesthesia and are quick to blame you for anything. You are constantly on the defensive. It was cute at first but now is annoying. Many people promising patients "You won't remember anything!" who aren't involved in anesthesia at all for a case done mostly under local or "the patient is in pain! Do something!" when they are actually having an anxiety attack with a perfectly functioning spinal anesthetic. I have seen anesthesiologists get blamed for lumbar radiculopathy because they got a perfectly placed epidural (no, ma'am, you were pushing for delivery which caused a disc herniation), a bilateral vocal cord paresis resulting in an ICU stay after aspiration and need for long-term tube feeds (no, sir, you were intubated for 22 hours in the OR because your surgeon took 22 hours to do what a competent one can do in 4 hours. We extubated you within 5 minutes of the surgery being done), and a median nerve palsy in a 16yo undergoing shoulder surgery because of "anesthesia's interscalene block (sorry, that block can't do that, it was the surgeon's positioning of some instrument or pressure on the nerve in the surgical field that did it). It is perfectly acceptable for other services to tell patients it was "anesthesia's fault" that you had a poor outcome but if you explain what actually happened to patients, everyone is mad at you and thinks you're the bad guy or unnecessarily casting blame on others.

4. Empty Foley catheters and push beds. Can you name any other physician who is expected to routinely do this?

5. You exist to serve the surgeons. They don't want to start cases till 2PM and their cases will go to 8PM? Guess you better cancel your dinner plans. Patient took Warfarin and the case is elective so you want to cancel? Too bad, surgeon wants you to give FFP because he is going out of town for two weeks starting tomorrow and he doesn't want to make his patients mad. You want to do a lower extremity nerve block BEFORE the case? Sorry, surgeon says it interferes with his post-op neuro exam so you have to wait till he gives the "OK" when the patient is about to leave Phase I of PACU so you do the block while he goes home (don't worry, he rounded after the case was done to kill time before getting that neuro exam!). With anesthesia heading more and more towards a hospital employed model, it is becoming harder and harder to fight these ridiculous requests. Have done at least 2-3 ELECTIVE open-heart cases on the weekend because the "surgeon doesn't have time during the week." Absolutely bonkers

6. Holidays, nights, and weekends. They become more valuable as you get older. Now, it just interferes with my life to be at the hospital during these times. Also, in-house call at some places. Very few specialties have attendings that do this.

7. SRNAs introducing themselves as anesthesia residents now. Huge slap in the face to anesthesia training.

8. I realize billing is getting cut for every specialty but in anesthesia it is quite severe. Private groups are now dependent on supplement payments from the hospitals they cover which I think is the fast road to being employed by the health system. An anesthesiologist has some of the most leverage to lose from being hospital employed compared to other physician specialties. I imagine a lot of anesthetics actually lose money or break even. I suspect this to get worse with the No Surprises Act. Someone in the c-suite is going to notice this and cut compensation eventually. Not now or soon, I think, but eventually.

These are things I wish someone mentioned to me as a med student. Overall, I am clearly on the more pessimistic side. I really love giving anesthesia, doing regional blocks, and taking care of really sick patients. I get enjoyment from a perfectly balanced anesthetic that leads to a quick wake-up and recovery. But, boy, do the politics suck!

In private practice 2 and 4 is much better. Nurses are much more helpful such as helping you with intubation like pulling stylet and giving laryngeal manipulation. They also bring the patient to the or and empty the foley. This is not the case in academics where the nurses just chart and don’t feel obligated to help you. They often don’t treat you like a doctor. I also work solo so have a much better relationship with surgeons and don’t have to deal with Crnas. Not sure how much longer solo practice will be feasible in the future. Solo is much more rewarding and less stressful.
 
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Things to be aware of as a student:
1. If you have an ego and enjoy people recognizing you on a regular basis as a physician, this is not for you.

2. In residency and med school, you think of an anesthesiologist being solo in a room on a good first name basis with all the surgeons who respect you or supervising by dictating a plan to the anesthetist who follows every word you say while you are there for induction, extubation, or any emergencies. The reality is, often the surgeon just sees you as the thing that delays him/her from operating with needless questions or rigmarole. Some won't bother to learn your name. The general trend is this generation of workers (not just nurses, everyone) are more entitled and overconfident than ever and will not treat you with respect by helping you with basic stuff (i.e. turn on bair hugger, start an IV, pull stylet, get a drug you need, etc.) when you are solo. "You make the big bucks and that's not my job!" When you are supervising, you are not involved in patient care as much as you would think. You are more of the H&P monkey seeing patients, doing blocks, and managing PACU issues. You are hardly in the OR and are completely at the mercy of whoever is the primary in the room that you are supervising. Some anesthetists listen, more and more don't and feel that they can do whatever they want and not tell you when things go awry (remember, you are ultimately responsible for their bad choices). I suspect that collaborative models will essentially take over everywhere with higher and higher ratios of supervision once the market cools. Look into QZ billing. I can see places have you medically direct 4 rooms while doing QZ billing for another couple of off site places like endo.

3. People do not understand anesthesia and are quick to blame you for anything. You are constantly on the defensive. It was cute at first but now is annoying. Many people promising patients "You won't remember anything!" who aren't involved in anesthesia at all for a case done mostly under local or "the patient is in pain! Do something!" when they are actually having an anxiety attack with a perfectly functioning spinal anesthetic. I have seen anesthesiologists get blamed for lumbar radiculopathy because they got a perfectly placed epidural (no, ma'am, you were pushing for delivery which caused a disc herniation), a bilateral vocal cord paresis resulting in an ICU stay after aspiration and need for long-term tube feeds (no, sir, you were intubated for 22 hours in the OR because your surgeon took 22 hours to do what a competent one can do in 4 hours. We extubated you within 5 minutes of the surgery being done), and a median nerve palsy in a 16yo undergoing shoulder surgery because of "anesthesia's interscalene block (sorry, that block can't do that, it was the surgeon's positioning of some instrument or pressure on the nerve in the surgical field that did it). It is perfectly acceptable for other services to tell patients it was "anesthesia's fault" that you had a poor outcome but if you explain what actually happened to patients, everyone is mad at you and thinks you're the bad guy or unnecessarily casting blame on others.

4. Empty Foley catheters and push beds. Can you name any other physician who is expected to routinely do this?

5. You exist to serve the surgeons. They don't want to start cases till 2PM and their cases will go to 8PM? Guess you better cancel your dinner plans. Patient took Warfarin and the case is elective so you want to cancel? Too bad, surgeon wants you to give FFP because he is going out of town for two weeks starting tomorrow and he doesn't want to make his patients mad. You want to do a lower extremity nerve block BEFORE the case? Sorry, surgeon says it interferes with his post-op neuro exam so you have to wait till he gives the "OK" when the patient is about to leave Phase I of PACU so you do the block while he goes home (don't worry, he rounded after the case was done to kill time before getting that neuro exam!). With anesthesia heading more and more towards a hospital employed model, it is becoming harder and harder to fight these ridiculous requests. Have done at least 2-3 ELECTIVE open-heart cases on the weekend because the "surgeon doesn't have time during the week." Absolutely bonkers

6. Holidays, nights, and weekends. They become more valuable as you get older. Now, it just interferes with my life to be at the hospital during these times. Also, in-house call at some places. Very few specialties have attendings that do this.

7. SRNAs introducing themselves as anesthesia residents now. Huge slap in the face to anesthesia training.

8. I realize billing is getting cut for every specialty but in anesthesia it is quite severe. Private groups are now dependent on supplement payments from the hospitals they cover which I think is the fast road to being employed by the health system. An anesthesiologist has some of the most leverage to lose from being hospital employed compared to other physician specialties. I imagine a lot of anesthetics actually lose money or break even. I suspect this to get worse with the No Surprises Act. Someone in the c-suite is going to notice this and cut compensation eventually. Not now or soon, I think, but eventually.

These are things I wish someone mentioned to me as a med student. Overall, I am clearly on the more pessimistic side. I really love giving anesthesia, doing regional blocks, and taking care of really sick patients. I get enjoyment from a perfectly balanced anesthetic that leads to a quick wake-up and recovery. But, boy, do the politics suck!

A lot of what you’re saying is dependent on where and how you practice. Solo MD in private practice won’t have to deal with 2, 4 and 7. Even 3 is rare in a collegial work environment.

But your number 5 is the big one. You don’t really understand just how much your work and lifestyle are dictated by the whims of the surgeons until you’re in it. It’s even worse when you have children.

Did the surgeon change their plans last minute and want to move their 9am start up to 7am? Too bad, tell your spouse they have to take the kids to school today, sorry for promising to help.

Is the surgeon taking 8+ hours to finish that add on case they said would be only 2 hours? Too bad, call your spouse and tell them you won’t be able to make your kid’s football game.

Does the surgeon on call hate seeing his family and would rather line up entirely elective add on procedures past 10pm? Too bad, maybe you can sneak out of the OR to FaceTime your kid goodnight. That’s assuming your spouse even picks up the phone if they’re not too annoyed with your job.
 
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The catch is that anesthesiology is the only specialty where you're not treated with respect. This translates to having to do pretty much everything yourself without any help (as others mentioned, emptying foley, pushing beds, etc.) If you ask for help, you will often get attitude.

Even IM, FM, and psych docs (less competitive specialties) have nurses and support staff that view them and respect them as physicians. Heck, someone with just an intern year could open up a DPC or ketamine clinic and they would be treated with more respect!

Essentially, in anesthesiology you trade in your the respect and prestige garnered from a doctorate of medicine in exchange for money.

A lot of anesthesiologists will cope by saying that it doesn't bother them. But there's a lot of very lengthy posts in here from people who don't sound unbothered. I think that's telling :rofl:
 
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The catch is that anesthesiology is the only specialty where you're not treated with respect. This translates to having to do pretty much everything yourself without any help (as others mentioned, emptying foley, pushing beds, etc.) If you ask for help, you will often get attitude.

Even IM, FM, and psych docs (less competitive specialties) have nurses and support staff that view them and respect them as physicians. Heck, someone with just an intern year could open up a DPC or ketamine clinic and they would be treated with more respect!

Essentially, in anesthesiology you trade in your the respect and prestige garnered from a doctorate of medicine in exchange for money.

A lot of anesthesiologists will cope by saying that it doesn't bother them. But there's a lot of very lengthy posts in here from people who don't sound unbothered. I think that's telling :rofl:
At my job (100% peds) I get very high respect from the rest of the hospital - and I respect all of them back. In the adult world there was much less respect going in all directions. So perhaps this is an ad to be a pediatric anesthesiologist.
 
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It's no secret that anesthesia has exploded in popularity and competitiveness over the last few years. I think like every other person I've talked to in my class wants to pursue anesthesia. It seems the money is good, its got a short(ish) residency compared to other competitive fields, the job market seems to be on fire... so what's the catch? Every specialty has them, and I was just wondering what anesthesia's glaring cons are. Is it the CRNA dynamics? What are some things that should make a medical student go, "Oh, maybe I really shouldn't pursue this field"? Thanks for your advice.
IMO the catch is its hard work and serious work day in and day out..

You are not in an office writing scripts in a suit and a white coat.

There will inevitably bad outcomes and complications from what you do.

You are not in the position to have the OR wait for you until the timing works for you to do your case or come in an see a patient at your discretion.

When you are on call you are IN HOUSE and not at home answering the call and then g doing the case of making rounds whenever is convenient for you - the case is coming now so get up we need you in the OR.

You are a hospital monkey. Working in the depths of the OR, accommodating surgeons and a messed up system to try and make things work for the patient.

At the end of the shift you are exhausted, dirty from the hospital/patients, frustrated by working with mid levels who overstep their bounds with little experience, annoyed by surgeons who did routine cases all night because its convenient for them..

We would get some people in my residency who would think its a lifestyle field like radiology, and it can be if you go to work in an ASC or something, but a full time call taker in a big academic hospital its not an easy gig, i would argue one of the toughest gigs in medicine from a work standpoint
 
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The catch is that anesthesiology is the only specialty where you're not treated with respect. This translates to having to do pretty much everything yourself without any help (as others mentioned, emptying foley, pushing beds, etc.) If you ask for help, you will often get attitude.

Even IM, FM, and psych docs (less competitive specialties) have nurses and support staff that view them and respect them as physicians. Heck, someone with just an intern year could open up a DPC or ketamine clinic and they would be treated with more respect!

Essentially, in anesthesiology you trade in your the respect and prestige garnered from a doctorate of medicine in exchange for money.

A lot of anesthesiologists will cope by saying that it doesn't bother them. But there's a lot of very lengthy posts in here from people who don't sound unbothered. I think that's telling :rofl:
If you are in a good community hospital. Nursing staff can be great. They push the patients in the room for you. They set place monitors on the patients for you. Even setup a line and central line kits. It varies so much from facility to facility. Some places they don’t care about anesthesia. That’s true

Treat nursing staff at small places with some good will. I spent $600 Thursday buying everyone lunch for nursing week (fully (not 50%) but fully deductible obviously ) at small hospital I go to. It’s drop in the bucket with the amount of money I’m getting.
 
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over the years you will have hundreds of little moments of terror causing adrenaline/cortisol bursts in the background of being slowly boiled in an ever increasing pot of administrative, compliance, and regulatory pressure.

But I like it.
 
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You should absolutely go into anesthesia. Very good money for 45-48 hrs/wk, 1:13 overnight call, usually 1:3 supervision (10% sitting, 1:2 with a heart, occasional 1:4 later in the day to get colleagues out).

The reality of our jobs is that to the surgeons and OR staff we are like offensive lineman - the better you are at your job and the more smoothly things go... the less you get noticed. Exceptions are ICU, cardiac, (outpatient) pain. This bothers some personality types that should never have gone into anesthesia.

People since the 1980's have continuously warned about 1:6, 1:8, 1:10. Hasn't happened. Not on the horizon at any reasonably sized center.

95% of CRNA's are kind, easy to work with, happy to have you there. If your practice isn't filtering out the other 5% then you're doing it wrong. I also work with CAA's so this is significantly less of an issue. Malignant CRNA's are <5% and naturally filter out in 1-2 years.

The supply/demand shortage is making it so that anesthesia groups are getting large stipends (or employed by hospitals) to supplement anesthesia billing. These should all come with contracts for rooms down at 1p/3p/5p/7p/9p, etc. You should know how many staff you have and when you're getting off ahead of time. This staying 5 hrs over is only at night when your on overnight call anyway. It otherwise never happens.

This garbage about taking s**t from surgeons and OR staff sounds terrible. You (and your leadership) need to grow a backbone.

Could you make >1M doing cards, cardiac surgery, neurosurg, ortho? Sure. But if 750k and 10 wks off (being in the top 1%) isn't good enough because you need to be in the top 0.5% then you have a personality disorder or spending problem.
 
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In private practice 2 and 4 is much better. Nurses are much more helpful such as helping you with intubation like pulling stylet and giving laryngeal manipulation. They also bring the patient to the or and empty the foley. This is not the case in academics where the nurses just chart and don’t feel obligated to help you. They often don’t treat you like a doctor. I also work solo so have a much better relationship with surgeons and don’t have to deal with Crnas. Not sure how much longer solo practice will be feasible in the future. Solo is much more rewarding and less stressful.
This. Hence I hate, loathe, despise academic medicine.
 
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At my job (100% peds) I get very high respect from the rest of the hospital - and I respect all of them back. In the adult world there was much less respect going in all directions. So perhaps this is an ad to be a pediatric anesthesiologist.
You couldn’t pay me enough to deal with screaming babies all day long.
 
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I still enjoy the day to day practice of anesthesia. I don't enjoy call but it pays well. I don't like supervision and I worry that I'll have to do more and more of it over time.

Anesthesia remains uniquely suited to late career winding down to part time and no call work.

I would HATE psychiatry or any other specialty that forced me to speak to other humans for extended periods, or get on the q20min treadmill of a clinic.

I probably could've tolerated and even enjoyed the surgery bits of a surgical specialty, but not the rest of it.


Almost everything is cyclic. Right now the anesthesia job market is good. It probably won't always be so.

Surgery isn't cyclic, that **** is miserable through all cycles. But they do get to tell everyone they're the captain of the ship.


The bottom line is that all medical specialties are being squeezed and marginalized by administrators. Do something that interests you and has income and lifestyle you can tolerate. It's a job, it'll always be a job, but there are moments of deep satisfaction to enjoy. Enjoy them and don't dwell on the other crap.

Don't let your feelings get hurt by market forces that pay equal or sometimes even better money to people who do some of the things you do, but in a generally worse way.


Live beneath your means. Be nice to people. Marry well or not at all. The rest of it will sort itself out.
 
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The catch is that anesthesiology is the only specialty where you're not treated with respect. This translates to having to do pretty much everything yourself without any help (as others mentioned, emptying foley, pushing beds, etc.) If you ask for help, you will often get attitude.

Even IM, FM, and psych docs (less competitive specialties) have nurses and support staff that view them and respect them as physicians. Heck, someone with just an intern year could open up a DPC or ketamine clinic and they would be treated with more respect!

Essentially, in anesthesiology you trade in your the respect and prestige garnered from a doctorate of medicine in exchange for money.

A lot of anesthesiologists will cope by saying that it doesn't bother them. But there's a lot of very lengthy posts in here from people who don't sound unbothered. I think that's telling :rofl:
I disagree that we are the least respected. Have you ever seen a pathologist called in at night to look at some slides bc the surgeon is slow and couldn’t get to the case until after hours? Or have the surgeon argue with them about their diagnosis? Maybe not the norm elsewhere but I’ve seen both.

What about ER docs? They get cursed out by patients daily and specialists roll their eyes at their admission requests and management.

As far as medicine jobs go this is a very good one. No paperwork, decent pay, no one bothering you at home (depending on the job). For the time being hospitals have been willing to subsidize our services while many specialties are just having to swallow reimbursement cuts. That will probably change and if the money was average this will be a pretty bad job, especially if inflation continues and other white collar jobs continue to outpace us. But this will be a medicine-wide problem.

Regarding supervision, I prefer working solo but it doesn’t have to be a bad job if you have a good relationship with the CRNAs. I’ve seen both and it only takes in bad egg to poison the whole system but it can be done wells Also in my experience employed jobs have malpractice covered and the institution is the one taking the hit when there’s a bad outcome (this is one reason hospitals preferred not to employ anesthesiologists for many years).

All that to say, I’ve had a good run in this field despite graduating at an awful time (mid 2010s). I’m pessimistic on the future but I never would have imagined the past 4 years would go as well as they have and yet here we are.
 
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The lack of having to respond to direct patient inquiries through the EMR is a huge benefit that those of us who’ve been doing this a while take for granted. Primary care specialties are getting completely hammered with this relatively new dynamic that patients love.
 
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The lack of having to respond to direct patient inquiries through the EMR is a huge benefit that those of us who’ve been doing this a while take for granted. Primary care specialties are getting completely hammered with this relatively new dynamic that patients love.
That and they’re all stuck in pre-authorization phone tag hell. Plus they have to take a lot of their note-work home. I love that when we’re done we’re done.
 
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You should absolutely go into anesthesia. Very good money for 45-48 hrs/wk, 1:13 overnight call, usually 1:3 supervision (10% sitting, 1:2 with a heart, occasional 1:4 later in the day to get colleagues out).

The reality of our jobs is that to the surgeons and OR staff we are like offensive lineman - the better you are at your job and the more smoothly things go... the less you get noticed. Exceptions are ICU, cardiac, (outpatient) pain. This bothers some personality types that should never have gone into anesthesia.

People since the 1980's have continuously warned about 1:6, 1:8, 1:10. Hasn't happened. Not on the horizon at any reasonably sized center.

95% of CRNA's are kind, easy to work with, happy to have you there. If your practice isn't filtering out the other 5% then you're doing it wrong. I also work with CAA's so this is significantly less of an issue. Malignant CRNA's are <5% and naturally filter out in 1-2 years.

The supply/demand shortage is making it so that anesthesia groups are getting large stipends (or employed by hospitals) to supplement anesthesia billing. These should all come with contracts for rooms down at 1p/3p/5p/7p/9p, etc. You should know how many staff you have and when you're getting off ahead of time. This staying 5 hrs over is only at night when your on overnight call anyway. It otherwise never happens.

This garbage about taking s**t from surgeons and OR staff sounds terrible. You (and your leadership) need to grow a backbone.

Could you make >1M doing cards, cardiac surgery, neurosurg, ortho? Sure. But if 750k and 10 wks off (being in the top 1%) isn't good enough because you need to be in the top 0.5% then you have a personality disorder or spending problem.
You’re making 750k for <50 hours a week, 10 weeks off? 👀
 
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Private groups are now dependent on supplement payments from the hospitals they cover which I think is the fast road to being employed by the health system. An anesthesiologist has some of the most leverage to lose from being hospital employed compared to other physician specialties. I imagine a lot of anesthetics actually lose money or break even. I suspect this to get worse with the No Surprises Act. Someone in the c-suite is going to notice this and cut compensation eventually. Not now or soon, I think, but eventually.
The supply/demand shortage is making it so that anesthesia groups are getting large stipends (or employed by hospitals) to supplement anesthesia billing.
So which is it? Is employment good or bad for anesthesia?
 
Employment is the future at least in Midwest. Once everyone is employed and 1099 dries up, then the salaries will fall.

So save as much as you can now. Try to retire earlier. Or get lucky with a side gig or something. 1099 currently pays well but still sucks to travel everywhere and live out of a hotel.
 
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Then you shouldn't be in anesthesia because we deal with this from crybaby surgeons frequently.
Never had to wipe tears and snot from a grown as person working literally in the OR. While listening to earpiercing screaming.
Let them bitch all day long. My life keeps going.
 
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So which is it? Is employment good or bad for anesthesia?
Depends on your perspective. It is good to be employed because someone else consumes/pays for all the brunt work that makes it very unprofitable to do anesthesia: negotiating with insurances for payments, submitting billing to insurance, hiring anesthesia techs, hiring mid-levels to sit cases, purchasing anesthesia machine equipment and airway supplies, renting anesthesia machines, purchasing anesthesia drugs, covering benefits for employees (401k, health insurance, dental, vision, vacation), etc. Anesthesia units do not cut the mustard to pay for all this stuff and still pay anesthesiologists/CRNAs the salaries they have gotten used to in the last 10 years. Unless the American public decides that they only want spinals and regional for all their anesthetics without any sedation (then we would have a profitable business). When you are employed, they pay your salary/benefits with the facility fees generated from the surgeries that you allow to happen by giving anesthesia. Being employed means you don't care that you used an anesthesia circuit, disposable GlideScope, sterile gloves, and Precedex that combined cost more that what you billed for the case in anesthesia units. The big PE anesthesia groups have been getting away with it because they have been able to negotiate higher anesthesia unit rates simply due to their large footprint (that is going away with the No Surprises Act and these cases ending up in court).

Being employed is bad for anesthesia because now you have less of a say in what happens. If there is a problematic CRNA who doesn't listen and puts patients in danger, you don't have the ability to just fire them because they don't work for you. You have to go through the employers who hired that troublemaker and go through some admin BS to get rid of them which may or may not happen. You are also not involved in the hiring process; you don't get to pick who is apart of your team and sits in your cases or who gets to be an anesthesia tech for you. You can't say, we only have staff to run 1 room after 5pm because you are employed and likely salaried so you will stay late until the rooms come down to 1 so the call person can be the only one there. Once the surgeons realize that they can work late and they'll have anesthesia coverage, they WILL take advantage of this and admin WILL allow it to collect those juicy facility fees (which are paying you, once again). In a PP model, they are more likely to listen because they don't want the anesthesia group to leave and have NO anesthesia for who knows how long and lose tons of money. An employed model also means that the admin can decide arbitrary things that don't make sense i.e. we are switching to all QZ billing so we don't have to have as many anesthesiologists on staff, we are getting rid of the IV team in the hospital and expect the anesthesia service to do all the difficult IV's and lab draws, the anesthesia service is now responsible for running all the codes and airways on the floors since they just sit in the lounge and drink coffee while the nurse is in the room, or taking away academic days at an academic center because they are short on staff for anesthesiologists. Much less of a say in how things are run because you are viewed as a necessary evil that costs money as opposed to a physician who brings in patients and generates money.

Generally speaking, you have a choice to make: do I want to worry about finances of the practice constantly (means running a lean service and asking for hand-outs) or am I okay with putting up with someone telling me how to do things all the time? Which one is good or bad is entirely subjective and up to you.
 
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Sounds great indeed. Haven’t seen anything close to that near a major metro. 600k max with ton of calls
One of my colleagues posted a couple years back. Hired 2 docs off SDN while 20 strangers told me how I was lying and how bad the job was because it was AMC.
 
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One of my colleagues posted a couple years back. Hired 2 docs off SDN while 20 strangers told me how I was lying and how bad the job was because it was AMC.
Good for you. How much call? Supervising CRNAs or doing own cases? How much OB?
 
Good for you. How much call? Supervising CRNAs or doing own cases? How much OB?
2 hospitals, 26 full time call taking docs (2 more in August) so 1:13 overnight about to be 1:14. Half of the call from home. Pre/post off. 90% supervision. CRNA's cover OB and call us for sections or when needed. 10 weekends a year.
 
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Friend of mine is Uro-Gyn making >700K doing 4 days/week, no nights, no weekends, and no real call. If he gets called he just says "here's my clinic number, have the patient call on Monday morning." Just a suggestion!

That income is not the norm for urogynecology.

The work hours I believe (lack of call, emergencies etc) but our procedures do not reimburse that much to make $700k on a regular basis.
 
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Being employed is bad for anesthesia because now you have less of a say in what happens. Once the surgeons realize that they can work late and they'll have anesthesia coverage, they WILL take advantage of this and admin WILL allow it to collect those juicy facility fees (which are paying you, once again).
Thanks for the response. If the surgeon is also employed and a w2, what is usually their incentive to work late? Do they still get an additional salary bump from facility fees? And if they do get a bump from facility fees I'm assuming it's way more than anesthesia gets as part of their "stipend?"
 
Thanks for the response. If the surgeon is also employed and a w2, what is usually their incentive to work late? Do they still get an additional salary bump from facility fees? And if they do get a bump from facility fees I'm assuming it's way more than anesthesia gets as part of their "stipend?"

Most employed surgeons are paid a low base salary with RVU and call incentives built into their contract. This is what motivates them to actually work.
 
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Thanks for the response. If the surgeon is also employed and a w2, what is usually their incentive to work late? Do they still get an additional salary bump from facility fees? And if they do get a bump from facility fees I'm assuming it's way more than anesthesia gets as part of their "stipend?"
Most common employed surgeon models pay by the RVU or are salaried with a production incentive after a minimum is met. Respectable systems want their OR days 7-5 versus the ‘doing my hip fracture at 5 after clinic’ model since they know they have to pay overtime for the OR staff and those cases barely bring anything in at that point. Where you get into trouble is places with some employed/some private surgeons since you get the worst of both worlds.
 
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2 hospitals, 26 full time call taking docs (2 more in August) so 1:13 overnight about to be 1:14. Half of the call from home. Pre/post off. 90% supervision. CRNA's cover OB and call us for sections or when needed. 10 weekends a year.
Lovely. How easy are the CRNAs? I am curious. I literally am in a practice that although toxic in many ways has some of the easiest and most competent CRNAs I have ever worked with.
 
What's the catch? There are three.

1) Supervising.
2) Working with surgeons.
3) Taking call.

Only two of these things can be avoided if you find the right job.
 
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