What's the catch with anesthesia?

[MCAJrob]

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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).

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.

Basically our setup as well except we don’t supervise hearts.

We work 35-40h of in hospital time per week but pull closer to 650-675k for cardiac people doing that. 10 weeks off. Hospital just dropped OB service tbd if it ever comes back.

Major metro area (I count having 3x pro sports teams as major metro).

As they say on those bumper stickers,
“Life Is Good”

 

[MTGas2B]

Major metro area (I count having 3x pro sports teams as major metro).

Do NHL and MLS count?

 

[geauxg8rs]

Do NHL and MLS count?

NHL should count. No to soccer. This is ‘merica

 

[MTGas2B]

NHL should count. No to soccer. This is ‘merica

Ain't Canada though, eh?

 

[abolt18]

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.

He's hospital employed, paid ~$60/RVU and produces 12.5-13K RVUs/yr with that 4 days/week.

He's actually moving soon for family reasons and his new employer is paying him $2 more per RVU.

 

[Coffee PRN]

Basically our setup as well except we don’t supervise hearts.

We work 35-40h of in hospital time per week but pull closer to 650-675k for cardiac people doing that. 10 weeks off. Hospital just dropped OB service tbd if it ever comes back.

Major metro area (I count having 3x pro sports teams as major metro).

As they say on those bumper stickers,
“Life Is Good”

Your hourly is around $400/hr as a W2? Man…I’d be tempted to switch from locums for a gig like that

 

[abolt18]

You can certainly find jobs with a lot less of those downsides.

We are 80-90% solo cases (98% solo for me on CV team). ZERO crnas and a handful of AAs. Hospital employed. I take a decent amount of extra call intentionally and that has me working about 50hrs/week and on track to make about $750 this year. That's only taking 6 weeks vacation this year. Next year I should do the same or more with 8 weeks vacation.

Nurses are great (or at least good enough), surgeons are easy to work with, work satisfaction is through the roof for me. Very low stress.

Compared this to the year I worked in academics with a boatload of crnas, of which 20% were awful to work with, I got stripped of vacation days and meeting days because they were understaffed, and got paid about 50-60% of what I'm making now. I also never got to sit my own cases.

 

[anonperson]

He's hospital employed, paid ~$60/RVU and produces 12.5-13K RVUs/yr with that 4 days/week.

He's actually moving soon for family reasons and his new employer is paying him $2 more per RVU.

That's a good situation.

But he's producing 90th percentile RVUs and getting paid appropriately.

Not the norm for your typical urogynecologist. Good for him on hustling but median wRVUs is around 6500 to 7500.

 

[abolt18]

That's a good situation.

But he's producing 90th percentile RVUs and getting paid appropriately.

Not the norm for your typical urogynecologist. Good for him on hustling but median wRVUs is around 6500 to 7500.

Pretty sweet when you can achieve 90%ile production with 4 days per week. I'm putting in a lot more than him to achieve the same $$$. And he never has to spend the night away from home at the hospital.

 

[SRYSPAC]

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.

I have found the same in my limited experience of 5 years as an attending. Do you think the naysayers for medically directed jobs on this forum largely work in MD only practices but have never actually worked with solid CRNAs and AAs? It's not perfect by any means, and obviously you have to know who in the department needs a bit more of a watchful eye, and also avoid 6-10:1 supervision jobs, but I've been very happy with my choice, and I remember my psych rotations as a med student and intern (former military here so psych was required) and I couldn't imagine wanting to do that.

 

[aneftp]

Basically our setup as well except we don’t supervise hearts.

We work 35-40h of in hospital time per week but pull closer to 650-675k for cardiac people doing that. 10 weeks off. Hospital just dropped OB service tbd if it ever comes back.

Major metro area (I count having 3x pro sports teams as major metro).

As they say on those bumper stickers,
“Life Is Good”

Unfortunately partners are leaving who are making 800k in many major areas (4 major teams sports )

650-675k is standard locums pay with no calls or weekends these days in most
Most areas plus 10 weeks off.

Notice u don’t even mention beeper time. I count beeper time as time on the clock.

 

[aneftp]

Yes, we have a decent amount of beeper time, Q7 first calls. However, post call days for first call are 95% even with zero call ins. Most 1st call days done by 7-8pm, 2nd call done by 3-5pm (only called in as a generalist if there is a concurrent cardiac case), non-call done by 11am-130pm.

I've talked with many jobs, this is one of the best ones I've found in a major metro personally for W-2 work, both cardiac and general. It's a great job if you want to settle down, have a wider case mix than most locums, a consistent place to work, and start or move a family, with milder weather than a lot of the midwest.

Just a weird world and anesthesia job market we live in.

Most people just want to make their own schedule. Not have to fight for Xmas or spring break or summer vacation weeks if they have kids. The best way is just to do locums or even prn w2.

Im from Midwest. The true east coast and true west coast are still brutal working conditions for most anesthesia practices.

 

[coffeebythelake]

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.

is your place boonies? Suburban? HCOL / LCOL?

 

[deleted1183938]

Unfortunately partners are leaving who are making 800k in many major areas (4 major teams sports )

650-675k is standard locums pay with no calls or weekends these days in most
Most areas plus 10 weeks off.

Notice u don’t even mention beeper time. I count beeper time as time on the clock.

Partners are leaving going where? 650-675 without call? How much is that per hour? Let’s not act like your 50l weeks are normal here.

 

[deleted1183938]

When we've got 4 cardiac and 3.5 general docs, the flexibility I've had is second to none, including locums I've done. They usually want week long blocks for the bigger money in my experience, which is limiting compared to our practice. We have the ability to take single or 2-3 day vacations if we want. Basically 50 days off to spread around as we want, with post call days to boot.

For example, I have a small vacation coming up. Take 1st call Tuesday, then post Wednesday. Take 2 days off Th/Fri, and you've gotten a 5 day vacation with 2 vacation days taken.

With post call days, it probably adds up to around 70-75 weekdays off per year. Out of 260 weekdays that's pretty good for our pay I think. Most people sell a little vacation back if they want for a little more money.

How do you have more CV docs than general docs? In any case you can’t have a weeklong vacation at a time?

 

[geauxg8rs]

Ain't Canada though, eh?

Hockey players don’t act hurt. Soccer players are part athlete/part actor

 

[Meyer-Overton]

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.

I'm honestly surprised seeing that you recommend this. Seems like you give a great sales pitch for anesthesia on other threads. I agree psych is good but idk man

 

[amyl]

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.

curious your location - yours sounds like a truly great job.
i talk to lots of my friends all over the country and i dont think they would describe the crna situation like you do. one example- i have friends in ft worth that do have higher supervision ratios... the crnas do what they want and view the anesthesiologist as mostly irrelevant - they may be nice to her face.... example 2- outskirts of dallas (one of the drs that left there is on here but may not comment) has malignant crnas that dont call the anesthesiologists even when theyre in trouble and has higher supervision ratios. note the job listed in longview tx that I asked twice about supervision ratios and relationship with crnas... not answered - twice. there are no AAs in dfw so that may make the enviorment better elsewhere.
another friend that does locums lots of places and complains about malignant or entitled crnas everywhere she goes except north dakota. two friends work in florida and say nice things about their crnas but those jobs are also 475 for full call taking positions - one envision and one that the hospital just employed napa fall apart.
personally, I cant complain.... I do mostly solo work and work with mostly good crnas when I am on care team but I think there is pressure from the hospital to increase supervision ratios. I am well paid and have 9 weeks vacation... i dont expect more money at all.... I am worried about pressure to increase ratios. lots of gi centers in town have the gi dr delegate crnas or have a placeholder firefighter anesthesiologist.... I just dont think we have the same culture that your city does.... im envious

 

[aneftp]

When we've got 4 cardiac and 3.5 general docs, the flexibility I've had is second to none, including locums I've done. They usually want week long blocks for the bigger money in my experience, which is limiting compared to our practice. We have the ability to take single or 2-3 day vacations if we want. Basically 50 days off to spread around as we want, with post call days to boot.

For example, I have a small vacation coming up. Take 1st call Tuesday, then post Wednesday. Take 2 days off Th/Fri, and you've gotten a 5 day vacation with 2 vacation days taken.

With post call days, it probably adds up to around 70-75 weekdays off per year. Out of 260 weekdays that's pretty good for our pay I think. Most people sell a little vacation back if they want for a little more money.

Good for u. It really boils down to location, payor mix and hospital competition

Partners are leaving going where? 650-675 without call? How much is that per hour? Let’s not act like your 50l weeks are normal here.

Partners just doing locums. U can easily do 20k per week 3 weeks a month supervising 1:2 (1:3) 3 weeks out of a month. That’s 60k no calls x 12 months. 720k. Easy. I just got locums contract like that.

Don’t focus on the hourly pay. It’s all $350/400/hr at thus point.

It’s the work load that’s important to me especially for calls (money ball)

I can’t work post call if I’m up doing 2-3 c/s solo plus putting 5-6 epidural nightly. That’s too much work even at $450-hr to work 140 hrs for the week.

Pace of work matters.

These partners getting burned out too much work even for 800k a year.

Workload matters more than hourly rate for locums

Now if the hourly rate were $250/hr vs $425/hr. Than that’s a huge gap and gotta use ur common sense what matters more.

 

[2Fast2Des]

You can certainly find jobs with a lot less of those downsides.

We are 80-90% solo cases (98% solo for me on CV team). ZERO crnas and a handful of AAs. Hospital employed. I take a decent amount of extra call intentionally and that has me working about 50hrs/week and on track to make about $750 this year. That's only taking 6 weeks vacation this year. Next year I should do the same or more with 8 weeks vacation.

Nurses are great (or at least good enough), surgeons are easy to work with, work satisfaction is through the roof for me. Very low stress.

Compared this to the year I worked in academics with a boatload of crnas, of which 20% were awful to work with, I got stripped of vacation days and meeting days because they were understaffed, and got paid about 50-60% of what I'm making now. I also never got to sit my own cases.

Um, can I apply? What state is this mystical job in?

 

[ERRES2288]

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

Agree long term I see serious concerns but this has been the narrative for over 30 years. I have a family member who was anesthesiologist told me the exact same thing in 2005.

 

[NicholasPavona]

Market tightening, less jobs, lower pay...caveat emptor.

 

[teacher2md]

I don’t think med students (and even residents, to an extent) realize how stressful anesthesia can be, until it’s YOUR patient who is bronchospasming and sats are 50%; or it’s YOUR patient in who is hemorrhaging with MAP 40s while you’re scrambling to start the Belmont.

Yes, we’re trained to deal with these situations, but it’s still a big cortisol dump. I do cardiac and had a dicey situation the other day; it was handled fine my HR didn’t even go above 80 according to my watch; but I still get home and feel completely drained.

Maybe other specialties deal with this; but I suspect we have a proportionally higher percentage of stress than most.

 

[abolt18]

I don’t think med students (and even residents, to an extent) realize how stressful anesthesia can be, until it’s YOUR patient who is bronchospasming and sats are 50%; or it’s YOUR patient in who is hemorrhaging with MAP 40s while you’re scrambling to start the Belmont.

Yes, we’re trained to deal with these situations, but it’s still a big cortisol dump. I do cardiac and had a dicey situation the other day; it was handled fine my HR didn’t even go above 80 according to my watch; but I still get home and feel completely drained.

Maybe other specialties deal with this; but I suspect we have a proportionally higher percentage of stress than most.

This got me curious to look back at my watch data from yesterday. Horrible type A dissection. My HR didn't go above 90 but my overall "stress" level measured on my watch was a fair amount higher than normal yesterday. Completely wiped when I got home. I think you described it perfectly.

 

[cchoukal]

This got me curious to look back at my watch data from yesterday. Horrible type A dissection. My HR didn't go above 90 but my overall "stress" level measured on my watch was a fair amount higher than normal yesterday. Completely wiped when I got home. I think you described it perfectly.

Never for one second have I wanted a smart watch, but this would be a very interesting reason to have one.

 

[PainInTheAnes]

This got me curious to look back at my watch data from yesterday. Horrible type A dissection. My HR didn't go above 90 but my overall "stress" level measured on my watch was a fair amount higher than normal yesterday. Completely wiped when I got home. I think you described it perfectly.

Is this a bad thing though? Occasionally stressful days with normally fairly low stress, albeit busy days?

Seems like a decent way to make a living. I know most doctors clinic days just suck every day and they’re wiped after every one of them.

 

[abolt18]

Is this a bad thing though? Occasionally stressful days with normally fairly low stress, albeit busy days?

Seems like a decent way to make a living. I know most doctors clinic days just suck every day and they’re wiped after every one of them.

Not a bad thing at all. I LOVE my job!

 

[T-burglar]

the stress from high acuity cases is very bad for you. If you feel a wave of exhaustion when you get home then you had a physiologic stress response.

This is one of the reasons I think anesthesia should be very highly paid and the 10 weeks off standard is justified. Even then I’m still considering going more and more part time.

I work in a tertiary referral cardiac center

 

[pgg]

Never for one second have I wanted a smart watch, but this would be a very interesting reason to have one.

Same - I think it'd be interesting to track physiologic data for a week or two, but I don't want a watch.

 

[aneftp]

the stress from high acuity cases is very bad for you. If you feel a wave of exhaustion when you get home then you had a physiologic stress response.

This is one of the reasons I think anesthesia should be very highly paid and the 10 weeks off standard is justified. Even then I’m still considering going more and more part time.

I work in a tertiary referral cardiac center

Yes. That crap gets old. The referral hospitals day in and day out. U need like 13 weeks off at a min (1 week off every 4 weeks)

I like variety though. The past year I think I worked 10% level 1
40% level 2
40% community hospital
10% standalone outpatient.

I actually hate stand a lone outpatient because most of them are so busy plus I could get more stressed at routine peds spams at outpatient standalone than a big gsw who’s gonna to die. Because u got more explaining to do for elective outpatient complications.

 

[pgg]

the stress from high acuity cases is very bad for you. If you feel a wave of exhaustion when you get home then you had a physiologic stress response.

This is one of the reasons I think anesthesia should be very highly paid and the 10 weeks off standard is justified. Even then I’m still considering going more and more part time.

I work in a tertiary referral cardiac center

I think busy medical direction is far more painful and exhausting than any kind of solo work, however high the acuity.

I'd rather greet a type A dissection in the ER than run 4 rooms and have to cater to some whiny orthopod demanding soft-indication blocks and some slow OB/GYN where I'm afraid to leave the CRNA alone between spinal and delivery. Or GI. GI is just soul crushing. I can feel my life force oozing away with every poor prep that gets sucked into that canister on the wall.

I guess it's all relative. Gimme a heart, any heart, and leave me alone. 🙂

 

[PainInTheAnes]

the stress from high acuity cases is very bad for you. If you feel a wave of exhaustion when you get home then you had a physiologic stress response.

This is one of the reasons I think anesthesia should be very highly paid and the 10 weeks off standard is justified. Even then I’m still considering going more and more part time.

I work in a tertiary referral cardiac center

Where are you getting that this is bad for you? Just because you’re under stress occasionally doesn’t mean it’s detrimental to health necessarily.

Like is exercising hard bad for you? I’m pretty exhausted after a day of skiing and sometimes it’s stressful and intense.

Maybe if it’s every single day and affects you every day but occasional high acuity shouldn’t be bad for anything health related