Why isn't anesthesia as competitive as radiology?

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hivoltage said:
anesthesia can be done by crnas... They do it all the time. I see it. They cant medically evaluate the patient.. Thats our jobs. But in the or. Save for the hardest cases they do it all. So you will be competing with that your whole career. They view you( hospital administrators) as an escape valve. So you are just their to keep the malpractice attorneys happy. So be careful when going into this field. Do diligent research because the last thing you wanna do is have only a few choices and have to go to bfe to work and your wife/husband will not be happy and you will get divorced and have to work to pay the child support/alimony.
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WholeLottaGame7 said:
I don't think any specialty is truly immune to mid-level encroachment. If anything, I think diagnostic rads is safer than IR, where you have mid-levels doing PICCs, dialysis access, other fluoro procedures. It is what it is: there are too few providers for the amount of health care we're trying to provide as a country.
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Personally, I think Radiology has a bigger problem to deal with than mid-levels doing simple IR procedures like PICCs. Turf wars with actual Physicians of other specialties. Cards kicked Rads to the curb and do all their own imaging. Neuro/Neurosurgery/Ortho are pretty heavy in their respective imaging areas.

I would not be surprised to see both Rads and Gas becoming similarly competitive in the near future, as the Radiology job market currently sucks and DR lifestyle isn't what it use to be due to decreasing reimbursements. The thing that I always was wondering is that both Rads and Gas are pretty cyclical specialties. Both hit slumps in the mid 90's, created a shortage, then BAM, there was lots of money to be made and jobs wherever your heart desired. Even more in Radiology with the advent of PACS. Radiology went through the roof in terms of becoming highly competitive, I wonder why Anesthesiology remained just moderately competitive at best.
 
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PercAVR said:
Anesthesia is a job that can be done by a Nurse (CRNA) under supervision of a Surgeon. It does not need a doctoral degree. And that's the way it's going to be in 10-15 years.
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So as a cardiology fellow, how many perc AVRs have you done?
 
PercAVR said:
Anesthesia is a job that can be done by a Nurse (CRNA) under supervision of a Surgeon. It does not need a doctoral degree. And that's the way it's going to be in 10-15 years.
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Hey... Pssssst... YOUR IGNORANCE IS SHOWING.
 
MCAT guy said:
Won't there always be a need for MDAs? The sky is falling specialty talk is scary.
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There will indeed be a need for MDs. However, there's no such medical degree as an MDA.

Just sayin'.
 
I don't recall the numbers, but aren't there a decent number more anesthesiology spots per year compared to radiology? I know at least at the programs I interviewed at, there were several that had rather large (15-25 residents per year) anesthesiology programs, whereas most radiology programs seemed to be just 5-10 per year or thereabouts. Smaller the programs (derm, ophtho, ENT, etc.), always the more competitive.

badasshairday said:
Radiology went through the roof in terms of becoming highly competitive, I wonder why Anesthesiology remained just moderately competitive at best.
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MCAT guy said:
Won't there always be a need for MDAs? The sky is falling specialty talk is scary.
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It is scary.. but it is true. You can choose to ignore it. thats fine or you can choose to at least listen to those involved with it. We are training too many anesthesiologists. we are. There wont be need for this many. One Anesthesiologist can supervise 3-4 rooms. When most of the hospitals convert to CRNA based anesthesia there will be need for fewer and fewer MDs. In fact with the stroke of a pen, any politician can get rid of us altogether by allowing any Doctor(surgeon, dentist, gastroenterologist) supervise anesthetists. Not ideal but hey it saves money.

The reason we are training too many anesthesiologists is because the academic centers want more and more residents because they want the money for it.. and to staff their ORs. DOesnt really hurt them. but all these floods of graduates are graduating all of a sudden it becomes a problem.
 
ProRealDoc said:
So as a cardiology fellow, how many perc AVRs have you done?
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Where I am, when it's time to do the TA or TF percAVRs, the CRNAs aren't welcome in the cath lab, only Anesthesiologists do those cases. When I started (2 yrs ago), I asked the cath lab director, "Are those CRNAs or Anesthesiologists doing perc valves...?" His very quick reply was, "No no, these are serious, difficult cases, we wouldn't think of using CRNAs for these."

D712
 
hivoltage said:
It is scary.. but it is true. You can choose to ignore it. thats fine or you can choose to at least listen to those involved with it. We are training too many anesthesiologists. we are. There wont be need for this many. One Anesthesiologist can supervise 3-4 rooms. When most of the hospitals convert to CRNA based anesthesia there will be need for fewer and fewer MDs. In fact with the stroke of a pen, any politician can get rid of us altogether by allowing any Doctor(surgeon, dentist, gastroenterologist) supervise anesthetists. Not ideal but hey it saves money.

The reason we are training too many anesthesiologists is because the academic centers want more and more residents because they want the money for it.. and to staff their ORs. DOesnt really hurt them. but all these floods of graduates are graduating all of a sudden it becomes a problem.
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wow.

Anesthesia sounds like one of the better specialties, with pharmacology + physiology + procedures.

If it were for all this political crap, I think it would be close to tops on my list. Thanks for everyone's insight.
 
1300 new residents each year + AA + CRNAs = a lot of anesthesia
 
I think Anesthesia is going to 'tank' any day now. As a resident nearing the end of Ca1 year, I now only have 6 job offers. If Anesthesia jobs were still booming, I'd probably have at least 7 offers.

Those darn CRNA's have got us again...

As soon as ObamaBoy gets rids of trial lawyers (which will be never), I'll get worried.

CJ
 
CrazyJake said:
I think Anesthesia is going to 'tank' any day now. As a resident nearing the end of Ca1 year, I now only have 6 job offers. If Anesthesia jobs were still booming, I'd probably have at least 7 offers.
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Hilarious.

At least the SDN Anesthesia forum is booming - it seems like we usually have the most members viewing vs the other specs - clearly our witty repartee has been noticed.
 
PMPMD said:
Hilarious.

At least the SDN Anesthesia forum is booming - it seems like we usually have the most members viewing vs the other specs - clearly our witty repartee has been noticed.
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I freaking love this forum.

Anyways, Radiology and Anesthesiology are the best specialties in medicine. Can't go wrong with either one. 👍
 
hivoltage said:
It is scary.. but it is true. You can choose to ignore it. thats fine or you can choose to at least listen to those involved with it. We are training too many anesthesiologists. we are. There wont be need for this many. One Anesthesiologist can supervise 3-4 rooms. When most of the hospitals convert to CRNA based anesthesia there will be need for fewer and fewer MDs. In fact with the stroke of a pen, any politician can get rid of us altogether by allowing any Doctor(surgeon, dentist, gastroenterologist) supervise anesthetists. Not ideal but hey it saves money.

The reason we are training too many anesthesiologists is because the academic centers want more and more residents because they want the money for it.. and to staff their ORs. DOesnt really hurt them. but all these floods of graduates are graduating all of a sudden it becomes a problem.
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So, despite the fact that the number of anesthesia residents is relatively constant from year to year (slowly trending upward), and there are new CRNA schools opening on what seems like a yearly basis, it's the MDs that we're producing too many of? I'd be more concerned if I were a CRNA that the talent pool is being diluted. All you have to do is a quick perusal of the CRNA forums to see that there are plenty of CRNAs that are equally concerned.

The take-home point is that every field has it's problems. Not that we as a specialty can afford to rest on our laurels, but at the end of the day I feel pretty comfortable with an MD behind my name that my skills will be in demand.
 
MCAT guy said:
1300 new residents each year + AA + CRNAs = a lot of anesthesia
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Good thing America is aging by the day and there are lots of sick patients. And growing.
 
doctor712 said:
Good thing America is aging by the day and there are lots of sick patients. And growing.
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america is aging that is true.. but the amount of surgeries are down across the nation
 
hivoltage said:
america is aging that is true.. but the amount of surgeries are down across the nation
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That's incorrect. I'm writing a paper on geriatric anesthesia and have the figures in front of me. Over 3 years, 10 years, since 1996, surgeries are up. And, arguably, as the aged age even more, and sicker patients can get their perc avrs etc etc, this trend will continue.

D712
 
doctor712 said:
That's incorrect. I'm writing a paper on geriatric anesthesia and have the figures in front of me. Over 3 years, 10 years, since 1996, surgeries are up. And, arguably, as the aged age even more, and sicker patients can get their perc avrs etc etc, this trend will continue.

D712
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I'd have to agree here. As the baby boomers start aging, there will be more and more surgeries. Even the current elderly population are having plenty of surgeries.
 
Doctor4Life1769 said:
I'd have to agree here. As the baby boomers start aging, there will be more and more surgeries. Even the current elderly population are having plenty of surgeries.
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And thus 1/2 the topic of the paper. 🙂 I've spoken to enough anesthesiologists with the "I'm worried about work when I get to be an MD..."
and i'm told,

a) there are a lot of sick people
b) this won't change
c) there will always be a lot of sick people that need excellent doctors
d) strive to be one of these excellent doctors
e) all else, the political, the encroachment, play your role and do what you can do, but don't avoid anesthesia if you love it. that would be a shame.

D712
 
WholeLottaGame7 said:
So, despite the fact that the number of anesthesia residents is relatively constant from year to year (slowly trending upward), and there are new CRNA schools opening on what seems like a yearly basis, it's the MDs that we're producing too many of? I'd be more concerned if I were a CRNA that the talent pool is being diluted. All you have to do is a quick perusal of the CRNA forums to see that there are plenty of CRNAs that are equally concerned.

The take-home point is that every field has it's problems. Not that we as a specialty can afford to rest on our laurels, but at the end of the day I feel pretty comfortable with an MD behind my name that my skills will be in demand.
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Nicely said, Dude.
 
"shards of mayhem"

You ARE becoming a writer!
 
to you guys think for future anesthesiologists its very important to do a fellowship?
 
WholeLottaGame7 said:
I don't think any specialty is truly immune to mid-level encroachment.
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Have to disagree with this. The more complex the specialty the less likely it is to be encroached on. Think of something uber-specialized like pediatric cardiac surgery. Those cases are so technically challenging that not even seasoned adult cardiac surgeons will perform them. They can only be done by those who have gained the technical prowess that comes through super-specialized training. No nurse/mid-level has the technical ability or operative knowledge to independently fix a tetralogy of fallot or hypoplastic left heart skin-to-skin.
 
NewIntern said:
Have to disagree with this. The more complex the specialty the less likely it is to be encroached on. Think of something uber-specialized like pediatric cardiac surgery. Those cases are so technically challenging that not even seasoned adult cardiac surgeons will perform them. They can only be done by those who have gained the technical prowess that comes through super-specialized training. No nurse/mid-level has the technical ability or operative knowledge to independently fix a tetralogy of fallot or hypoplastic left heart skin-to-skin.
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There are only a handful of pediatric cardiac surgeons or other docs so specialized that they are relatively immune. Adult cardiac guys may do fistulas or pleurodesis. Peds ENT could lose the majority of their practice of T&A and BMTs and not that many of them could get enough ent malignancies, etc. to fill their days. Even peds cardiac guys may do broviacs and cannulations that would be subject to encroachment.

Even specialized docs can lose a portion of their practice/billing whuich could be enough to sink them.
 
GypsySongman said:
There are only a handful of pediatric cardiac surgeons or other docs so specialized that they are relatively immune. Adult cardiac guys may do fistulas or pleurodesis. Peds ENT could lose the majority of their practice of T&A and BMTs and not that many of them could get enough ent malignancies, etc. to fill their days. Even peds cardiac guys may do broviacs and cannulations that would be subject to encroachment.

Even specialized docs can lose a portion of their practice/billing whuich could be enough to sink them.
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This.

It's not about mid-levels taking over the super-complicated, extremely technical procedures; there's no money in doing those a couple of times a month. Even highly specialized physicians need to bang out the simple and easy cases, because that's where the money is. And if it's simple and easy, there's going to be somebody with less education trying to angle for a slice of the pie.

FWIW, though, I agree that the surgical subspecialties are the most insulated.
 
GypsySongman said:
Even specialized docs can lose a portion of their practice/billing whuich could be enough to sink them.
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It's not just that.

Giving up the low hanging fruit to midlevels just sucks in principle. Lots of those 'low hanging fruit' cases are enjoyable, lower stress, or otherwise personally satisfying.

I like doing epidurals in healthy laboring women. I like doing tonsils in healthy kids. I like doing routine, 'easy' anesthetics in ASA 1 & 2 patients because I get a lot of satisfaction from doing them efficiently and well.

If there's any CRNA threat on the horizon that I worry about, it's that they'll spend every day doing the hernias and labor epidurals, while I'm doing 400 pound OSA'er TKA redos followed by back-to-back add-on ICU dead gut cases followed by the abrupted meth-&-cocaine-using teenage c-section. Don't get me wrong, that's a fun day, but it's not fun EVERY day.
 
WholeLottaGame7 said:
It's not about mid-levels taking over the super-complicated, extremely technical procedures; there's no money in doing those a couple of times a month. Even highly specialized physicians need to bang out the simple and easy cases, because that's where the money is. And if it's simple and easy, there's going to be somebody with less education trying to angle for a slice of the pie.
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The more specialized your specialty is the less "simple and easy cases" there are that can be done independently by anybody except by those who have trained as much as you. I'm just using pediatric cardiac surgery as an example, but there aren't really any simple bread and butter pediatric cardiac surgery cases that can be done independently skin-to-skin by anybody other than a pediatric cardiac surgery attending or advanced fellow. Nurses/mid-levels may assist them but that's as far as it will go (assisting). But the less specialized the field is the more nurses/mid-levels will be able to encroach on it. The more you specialize yourself the more you separate yourself from those wanting to encroach.
 
NewIntern said:
The more specialized your specialty is the less "simple and easy cases" there are that can be done independently by anybody except by those who have trained as much as you. I'm just using pediatric cardiac surgery as an example, but there aren't really any simple bread and butter pediatric cardiac surgery cases that can be done independently skin-to-skin by anybody other than a pediatric cardiac surgery attending or advanced fellow. Nurses/mid-levels may assist them but that's as far as it will go (assisting). But the less specialized the field is the more nurses/mid-levels will be able to encroach on it. The more you specialize yourself the more you separate yourself from those wanting to encroach.
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Again, not disagreeing with you entirely, which is why I think it's important to pursue fellowship opportunities. My point, is, upon further reflection, twofold:

1) The number of positions that are immune to mid-level encroachment is far fewer than the number of MDs, so it's going to be an issue for the majority of physicians entering the workforce in some capacity or another.

2) There's kind of a Catch-22 when it comes to fighting off mid-levels. From an evidence perspective, the best way to prove that we're superior is to make both sides even and compare outcomes, but we're already defending our turf by claiming that we're superior and that it would be unethical to perform those studies. And I haven't seen a lot of studies performed by mid-level societies that can be claimed as concrete science (as unbiased as I can possibly be given my background), sometimes for the same aforementioned reason.

So what can be done? I think at this stage all you can reasonably do is specialize as much as your field allows, be the best clinician you can be, and support your physicians' organization.

Obviously there are far more qualified people on this board to speak on the topic, but this is my personal impression.
 
Peds anesthesia fellow close to graduating here.

From a peds anesthesia perspective jobs are pretty good in large cities. Obviously you get paid a lot less in bigger cities vs smaller ones, but its still not too shabby, with an average salary of >250k/year. Go out to the midwest/south and you'll see some places are paying ~350-400k. I don't recall many practices I looked at incorporating large amounts of crnas, and many places had attendings doing their own rooms several days out of the week.

Peds cardiac seems to mostly attg only but there are a few places that have a small amount of CRNAs that help out.

It doesn't seem like CRNA infiltration in pedi anesthesia is as bad as it is with adult outpt centers at all.

If you are willing to take a pay cut in the long run (peds anesthesia guys usually make the same or slightly less that general anesthesia guys), and can afford to lose a year of attending salary I would highly recommend it. The skill set you learn and comfort level you gain with the <1 yo group seems to be in high demand. For single people with no children (like myself), and a moderately high debt load (~$110,000 from med school) it wasn't that much of a sacrifice.

I love anesthesiology, and I feel if I had to do it again I would. For newbies considering the field I probably would consider doing a fellowship however.
 
invitro said:
Peds anesthesia fellow close to graduating here.

From a peds anesthesia perspective jobs are pretty good in large cities. Obviously you get paid a lot less in bigger cities vs smaller ones, but its still not too shabby, with an average salary of >250k/year. Go out to the midwest/south and you'll see some places are paying ~350-400k. I don't recall many practices I looked at incorporating large amounts of crnas, and many places had attendings doing their own rooms several days out of the week.

Peds cardiac seems to mostly attg only but there are a few places that have a small amount of CRNAs that help out.

It doesn't seem like CRNA infiltration in pedi anesthesia is as bad as it is with adult outpt centers at all.

If you are willing to take a pay cut in the long run (peds anesthesia guys usually make the same or slightly less that general anesthesia guys), and can afford to lose a year of attending salary I would highly recommend it. The skill set you learn and comfort level you gain with the <1 yo group seems to be in high demand. For single people with no children (like myself), and a moderately high debt load (~$110,000 from med school) it wasn't that much of a sacrifice.

I love anesthesiology, and I feel if I had to do it again I would. For newbies considering the field I probably would consider doing a fellowship however.
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How much longer would the fellowship be if you were to do peds cardiac? Is it all combined into 1 year, or does this turn into 2 years?
 
Could this doomsday nonsense lead to more newly minted anesthesiologists doing fellowships, allowing the market to swing wide-open for CRNAs to do all the general cases?
 
GypsySongman said:
No. Fellowship is mostly a way for them to get another year of slave labor out of you.
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100% agree. Unless you are not strong and you suck, it may help. Or if you wanna go into academics. Otherwise its a waste of time ( unless u wanna do pain or ICU). Just be able to do it all, and do it well, and you shall be alright my young ones
 
Doctor4Life1769 said:
How much longer would the fellowship be if you were to do peds cardiac? Is it all combined into 1 year, or does this turn into 2 years?
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Why is it that doing a peds fellowship causes you to take a cut in pay? I love working with kids and am strongly considering pursuing a pediatric fellowship...but I also want to maximize my financial earning potential (to pay off loans, start a family, etc). Is it worth taking the paycut for a year only to make less in the longrun vs. looking for a general job right out of the gate?
 
TobyTheDog said:
Why is it that doing a peds fellowship causes you to take a cut in pay? I love working with kids and am strongly considering pursuing a pediatric fellowship...but I also want to maximize my financial earning potential (to pay off loans, start a family, etc). Is it worth taking the paycut for a year only to make less in the longrun vs. looking for a general job right out of the gate?
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Because peds jobs that 'require' fellowship are mostly academic and academics pays less.
 
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